A historic long term care
victory for Hoosiers
Citizens Action Coalition of Indiana newsletter
The 2003 General Assembly has set the stage for dramatic change in
Indiana's long term care system with the
passage of Senate Enrolled Act 493. The enactment of this new law is a historic
long term care victory that will benefit all Hoosiers. The immediate
beneficiaries of the changes will be persons with disabilities of all
ages (children, adults, and senior citizens) and their families because
the legislation will eventually put in place a truly comprehensive system
of home and community based long term care services. The new act will
also benefit taxpayers and all citizens by lowering the public cost of
long term care and by improving the economy and the quality of life in
Here are highlights of the new law:
▪ The law establishes a full array of
home and community based services that includes the CHOICE program, adult
foster care, adult day care, assisted living, personal care services, and
other services necessary to keep persons out of institutions.
▪ The law sets income
eligibility for all home and community based Medicaid waivers at 300
percent of the federal Supplemental Security Income level. The current
Medicaid waiver for aged and disabled services is only 100 percent of
SSI, or about 75 percent of the federal poverty level.
▪ The rights of persons
receiving home and community based services through Medicaid waivers are
expanded by the new act.
▪ Under the new law persons
who are receiving Medicaid funded nursing home care, and who are suitable
for home care services, can choose to move back home, or into a home like
setting. Their new services will be paid for by the same Medicaid dollars
that were being used to cover their nursing home care.
▪ The law allows Medicaid
dollars saved by moving people out of nursing homes back into home and
community based care to be used to purchase home and community based
services for other persons who need those services.
▪ The law establishes
spousal impoverishment protections for home and community based care for
persons using Medicaid waiver services.
▪ The law establishes a
process to encourage best practices by nursing home providers and a
bonding process to finance nursing home conversions to other purposes.
The Public's Role in Passing SEA
Senate Enrolled Act 493 represents a major victory for CAC members
and for the seventy organizations that are members of the Indiana Home
Care Task Force. Passing the new law, and protecting the state's existing
and nationally recognized CHOICE home care program, were the primary
objectives of the Task Force and CAC heading into the 2003 legislative
session. Both objectives were achieved because the Task Force
organizations were able to mobilize their members throughout Indiana to call, write,
email, and meet with their legislators. Groups like AARP, United Senior
Action, the Indiana State Council of Senior Citizens, CICOA The Access
Network and other area agencies on aging, the Alzheimer's Association,
the Indiana Minority Health Coalition, and many others found their
members willing and wanting to engage their state senators and
representatives to vote for Senate Bill 493. The result was the
legislation's unanimous passage into law.
The public's response to the legislation was especially evident to
CAC canvassers throughout the state. Bev Myers,
a long time CAC telephone canvasser in Indianapolis, commented during the
course of the legislative session: "Talking about home care reform,
and Senate Bill 493, is good stuff. It is something our members want and
believe in." Mike Comini, the CAC staff
director in South Bend, found an equally
enthusiastic response from CAC members in northern Indiana: "Yes, they very
much like CHOICE, and they like our work on this issue." Responses
of this type were typical throughout the state and were reflected in the
strong rank and file support the legislation had among members of the
Credit for the public's strong response
to SB 493 should also be given to The Generations Project. The
project is a collaborative of ten organizations, including CAC, and is
managed by the Citizens Action Coalition Education Fund. Since the fall
of 2001 the project has conducted public education activities regarding
the merits of re-balancing Indiana's system of long term
care. In November 2002 the project hosted a statewide summit at which
national long term care policy experts discussed reform models with 120
community leaders and 11 policy makers from across the state. Many of the
ideas reviewed at the summit later became points of discussion throughout
Indiana and were reflected in SB 493. In
January 2003, the project conducted a series of media events with the
Indiana Home Care Task Force on re-balancing issues. Other activities and
publications by The Generations Project have also heightened the public's
understanding of long term care issues. CAC members interested in the
project and in obtaining literature from it should contact Will Phillips,
the associate director, at 317.423.7102 or at email@example.com.
What Happened at the State House
The legislation was developed over a period of several months
through the collective efforts of the Task Force and was drafted by its
chairperson and CAC legislative director, John Cardwell. He also
coordinated the multifaceted, inter-organizational lobbying campaign at
the State House that contributed to the bill's passage. State Senator
Greg Server, R-Evansville, was the enthusiastic author of the legislation
and its wise and skillful shepherd through the state Senate. He was
mightily assisted in the House by State Representative Charlie Brown,
D-Gary. Together, Server and Brown managed to keep SB 493 out of the many
traps that usually snare major new policy initiatives at the State House.
From their perspective the challenge facing SB 493 was two fold: avoiding
the cross hairs of the state's fiscal crisis, and keeping legislative
leaders as upbeat about the proposed new law as their colleagues and the
public. In an absolutely adroit display of legislative statesmanship and
charm, Server and Brown worked with their colleagues and the Task Force
to get the bill through the legislature without a single dissenting vote.
Truly an amazing achievement given the significance of SB 493 and its
alleged long shot chance for passage coming into the 2003 session.
The full cast of people responsible for the passage of SB 493
through the General Assembly included many people. The critical players
included State Senators Vi Simpson (D-Bloomington), the gubernatorial
candidate who helped garner bipartisan support for the bill, and Pat
Miller (R-Indianapolis), who established the parameters for passing the
bill through the Senate Health and Provider Services Committee that she
chairs. Other key Senators were John Broden
(D-South Bend), the bill's original co-sponsor, and Connie Lawson
(R-Danville), who helped build consensus support for the legislation. In
the House, Charlie Brown was joined by Representatives Vaneta Becker (R-Evansville), Andy Thomas (R-Brazil),
and John Day (D-Indianapolis) as sponsors of the bill.
These dedicated legislators were joined by House Speaker Pat Bauer
(D-South Bend), Ways and Means Chair William "Bill" Crawford
(D-Indianapolis), and other legislators in building consensus support for
the bill. Among the many advocates that supported SB 493, June Lyle and
Charlie Fields of AARP put in long State House hours skillfully assisting
the bill through the process.
It should also be noted that throughout the legislative process no
outward opposition to the legislation emerged from any advocacy group or
trade association. In fact, all three trade associations for the nursing
home industry testified for the legislation at State House hearings, including
the Indiana Health Care Association. Sadly, the only publicly stated
opposition against the legislation came from the Indiana Family and
Social Services Administration, in testimony presented to the House
Public Health Committee. The FSSA testimony was not well received by
legislators nor the public.
Privately, SB 493 had to undergo grueling negotiations to survive
the legislative process. In the Senate numerous hard nose negotiations
took place after hours, and legislators and advocates did some very serious
head knocking with the State Budget Agency once the bill was in the House
of Representatives. Because of the state's deficit spending crisis in all
these closed door negotiations the primary challenge facing the bill was
its potential impact on the state budget.
Legislative leaders in both parties, and O'Bannon
administration officials, insisted that any provisions that might add any
costs to the state budget in the upcoming two years had to be removed if
advocates wanted the bill to move through the General Assembly.
Therefore, the outcome of these meetings was the removal
from the bill of the following: deadlines for providing home care
services for persons who are on waiting lists, a temporary transition
fund for moving people on waiting lists into services, the mandatory use
of all savings generated by the bill to purchase additional home care for
persons on waiting lists, and de facto entitlement status for home care
to offset the budget and service distortions caused by the entitlement
status of nursing home care.
According to CAC's
John Cardwell, a participant in the negotiations, the most critical
aspects of the legislation were saved in the process: "The items
dropped from the bill did not change its fundamental structure nor was
its intent altered. The legislation still fundamentally changes the legal
parameters and mission of Indiana's long term care
system. In other states laws of lesser scope have been used to establish
comprehensive, accessible and affordable home and community based systems
while dramatically reducing the over utilization of nursing home care.
The SB 493 that passed the General Assembly can still meet that test. The
public will be closely scrutinizing the O'Bannon
administration's implementation of the law to insure that is the
The Real Test
For citizens needing home and community based services in Indiana the real test of
Senate Enrolled Act 493 will not be skillful legislative maneuvers, nor the outcomes of State House negotiations. The real
test will be whether or not the legislation leads to home and community
based care being available to all Hoosiers who need that care, when they
need it, as they need it, and at a price that is affordable to consumers
and taxpayers alike.
In other words, will the state administration act quickly so the
new law can begin to really transform the parameters of long term care in
Indiana by the summer of 2004, when the
changes it mandates in Medicaid waivers should be fully on line? Nancy
Griffin, AARP's Indiana director and another
veteran of the SB 493 State House negotiations, puts it this way:
"SB 493 is a great piece of legislation. But for the new law to work
the current state administration will have to demonstrate its willingness
to enforce and implement its provisions and programs.
"We know Governor O'Bannon believes
in home health care and its benefits for citizens and taxpayers, but
heretofore his administration has been terribly slow to act. With the
passage of SEA 493 such caution will no longer be acceptable. The General
Assembly has now set clear legal and policy parameters. Governor O'Bannon now has a green light to implement
comprehensive long term care reform. It is time for him to meet this test
and to finally fulfill the promise of freedom and dignity that home care
embodies for persons with disabilities," concluded Griffin.
Meeting that freedom and dignity test will be the challenge of
Senate Enrolled Act 493 going forward. That is a challenge the
organizations of the Indiana Home Care Task Force and the Citizens Action
Coalition of Indiana will address in partnership with their members and
all Hoosiers in the days ahead.