workers and others. It is that debate which brings us to today's hearing.

I'm concerned that this debate, which has been focused on the Florio bill, is divisive and I believe that all the parties to this debate share a common interest in improving the way that Medicaid works for the disabled.

I've introduced H.R. 5233, which takes a much different approach to this problem than does the Florio bill in an effort to redirect the debate toward finding that common interest. H.R. 5233 has two basic purposes: to increase the availability of high-quality, community-based services under Medicaid and to improve the quality of institutional services paid for by the Medicaid Program.

It proposes a limited, incremental reform, the next logical expansion of coverage beyond the current waiver program. It has a price tag that I believe is reasonable in today's budget climate and it is neutral on the question of large versus small facilities.

The purpose of today's hearing is to see whether by comparing the Florio and Waxman bills, we can identify a middle ground on the question of Medicaid reform for the disabled. I'm hopeful that out of this hearing will develop discussions that lead to a consensus on Medicaid reform that clients, parents, advocates, workers, and State officials can support.

I would then hope that the subcommittee would consider legislation on this issue early in the next Congress. We will start off this hearing with statements from Senator Chafee and Representative Bartlett, both of whom I'm happy to welcome here today. We will then be hearing from a Medicaid consumer and from parents who have children living both in institutions and at home or in the community. The Congressional Budget Office will present cost estimates on both pieces of legislation and finally, we will hear about the impacts of both bills from the perspectives of the providers, the States and the employees who work in institutions.

I would also like to note that Representative Florio, the lead sponsor of one of the bills before us today, was called out of town at the last minute and will not be able to join us today. I want to acknowledge his leadership and commitment to improving the way the Medicaid program works for the disabled and I look forward to working with him closely in the next Congress on moving legislation.

I would also like to recognize my colleague from Utah, Mr. Nielson, who will be joining the subcommittee today at this hearing. The Congressional Research Service has prepared a side-by-side analysis of the two bills before us today and without objection, I'd like to insert it in the record.

[Testimony resumes on p. 50.]

[The Congressional Research Service side-by-side analysis and Mr. Florio's prepared statement with attachment follow:]

As you requested, we have prepared a side-by-side comparison of H.R. 5233 and H.R. 3454, bills to expand Medicaid services to community-based persons with mental retardation or related conditions. This document was prepared by the Congressional Research Service in collaboration with your office. Current law is compared with the major provisions of H.R. 5233, introduced by Representative Waxman on August 11, 1988, and H.R. 3454, introduced by Representative Florio on October 8, 1987.

Current Law

H.R. 5233 (Waxman)

H.R. 3454 (Florio)

CRS-2

of

to

exceptions. Under the case
management option, States may
target case management services
on particular groups in
designated areas within the
State. Under the "2176"
waiver, the Secretary of Health
and Human Services (HHS) may
authorize the payment
Federal Medicaid funds
States to provide habilitation
and other community-based
services to mentally retarded
and persons with related
conditions on a budget-neutral
basis. To qualify for waivered
services, individuals must show
that, but for the waivered
services, they would need the
level of care provided in an
intermediate care facility for
the mentally retarded (ICF/MR).

munity-Based Services

Would give States the option
of providing "community

habilitation services to
persons with mental
retardation and related
conditions on a statewide
basis. States would receive
Federal Medicaid matching
funds at their regular rates.
This optional benefit would
include self-help,
socialization, and adaptive
skills needed for community
living; and prevocational,
education, and supported
employment services not
available through other
Federal programs. The cost of
room and board would be
excluded. Services delivered
in a supervised residential
setting would be required to
meet Federal standards, and
States would be required to
assure that specified
protections were in place for
employees affected by coverage
of this service. (Section
101(a)).

munity-Based Services

to

Would require States
provide "an array of community
and family support services"
to any eligible individual
with a severe disability,
including case management,
individual and family support
services, specialized
vocational services (including
supported employment), and
protective intervention.
Would authorize States to
cover, at their option, any of
21 additional categories of
community and family support
services, including services
provided by family members.
With respect to both mandatory
and optional services,
Federal Medicaid matching
funds would be available at
regular rates. The cost of
room and board provided for
more than 12 weeks in any one
year would be excluded.
States could provide these new
mandatory or optional services
on less than a statewide
basis for one 3-year period.
(Sections 3 and 11).

Current Law

H.R. 5233 (Waxman)

H.R. 3454 (Florio)

CRS-4

Eligibility for

munity-Based Services

To qualify for Medicaid, an
individual must be disabled, as
determined under the
Supplemental Security Income
(SSI) program (except in
certain States using more
restrictive standards) and must
meet State income and resource
standards. Persons with mental
retardation or a related
condition may qualify for
services in an ICF/MR.
Generally, for individuals who
reside at home, the income and
resources of parents are
"deemed" available to them for
purposes of determining
eligibility for Medicaid. The
income and resources of parents
are not deemed available to
individuals in institutions
such as ICFS/MR. However,
States may, at their option,
cover individuals in the
community who would be eligible
if they were in an institution
and who are receiving services
under a "2176" waiver.
ection

1902(a)(10)(A)(ii)(IV)).

Eligibility for

munity-Based Services

States would be required to
offer "community and family
support services" to
"individuals with a severe
disability" eligible for
Medicaid who live in a family
home, foster family home, or
community living facility.
"Individuals with a severe
disability" are defined as
meeting the disability
definition under the SSI
program, subject to specific
age limits for the onset of
the disability. The age of
onset limitation would begin
at age 22 and increase by one
year each year to age 50.
(Section 2). States would be
required to continue Medicaid
coverage for such individuals
as long as they receive SSI
benefits or are deemed to
receive such benefit
(Section 10).