[Congressional Record (Bound Edition), Volume 157 (2011), Part 9]
[Senate]
[Pages 12005-12006]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. KOHL. Mr. President, in an era when Congress is actively debating 
health care programs that are of enormous consequence to our economy 
and our collective future, it is important to acknowledge that today, 
Medicare and Medicaid play an essential role in ensuring access to 
health and long-term care services for nearly 100 million Americans. In 
fact, these programs are embedded in the daily lives of nearly one of 
every three Americans.
  Medicaid is the program that currently pays for about half of all 
long-term care services in our country. Jointly financed and 
administered by states and the Federal Government, it is a program that 
all of us--taxpayers and beneficiaries and health care providers 
alike--have a major stake in seeing continue and succeed.
  As chairman of the Senate Special Committee on Aging, I know that for 
millions of older and disabled Americans who are confronting the need 
for long-term care services, anxieties are often high. The costs 
associated with long-term care can be catastrophic, and many families 
turn to Medicaid for assistance.
  In many parts of the country, Medicaid offers only limited choices of 
where and how to receive services. However, I am pleased and proud that 
a few States, Wisconsin among them, have developed Medicaid programs 
that are designed to offer beneficiaries real choices in where they 
will receive long-term care. The choices usually include nursing homes, 
assisted living residences, adult daycare, and personal care services 
delivered at home. Wisconsin and some other states are also 
increasingly offering beneficiaries the option to self-direct their 
care through programs that allow them to directly hire an aide--perhaps 
a family member or a friend--who can provide personal care within the 
confines of an approved individual budget.
  Wisconsin's Medicaid managed care program that covers long-term 
services and supports is known as Family Care, and it is one that the 
state has worked to develop for many years under several 
administrations, starting with former Governor Tommy Thompson. Family 
Care is well ahead of where many States are in terms of offering older 
adults and those with disabilities a real choice of how and where they 
can receive long-term care services.
  Today, one in five Wisconsin seniors and individuals with 
disabilities are enrolled in Medicaid. A similar proportion in six 
other States--California, Mississippi, Vermont, Louisiana, New York and 
Maine, as well as the District of Columbia, rely on the program. In 
every State, the number of older adults and individuals with 
disabilities who are enrolled in the program numbers is in the tens of 
thousands, hundreds of thousands, or millions. Last year,

[[Page 12006]]

321,700 seniors and individuals with disabilities in Wisconsin received 
coverage through Medicaid.
  During the last several weeks, I have heard a great deal from 
constituents--beneficiaries, aging and disability organizations, and 
officials--who have expressed concern about recent developments in 
Family Care. It is my understanding that the state budget that was 
recently signed into law includes a provision to cap, or freeze, the 
number of individuals in the program, and thereby remove the ability of 
those who become eligible in the future to choose whether they wish to 
receive services in a nursing home, at home, or in a community-based 
setting such as an assisted living residence.
  The State anticipates that the cap could save $265 million in the 
2011-2013 budget. Yet predictions also abound that waiting lists for 
home and community-based services for newly eligible beneficiaries will 
begin to rapidly grow again, after a period of years in which the 
Family Care Program worked to eliminate delays in receiving services. 
Such delays could prove costly, because when appropriate and cost-
effective interventions cannot be accessed by frail elders and 
individuals with disabilities, more medically intensive services are 
likely to be required later. Moreover, individuals who wish to receive 
lower cost in-home services--but who may find that institutionally 
based care is their only option--are predicted to wind up costing some 
counties significantly more.
  This year, with the first cohort of boomers turning 65, we are 
launching our Nation's ``age wave.'' It is an exciting era for older 
adults, and it will be accompanied by new possibilities and challenges 
for our country. Wisconsin, which is aging more rapidly than many 
States, has a clear responsibility to continue to provide the best 
possible long-term care services to each and every one of its older and 
disabled citizens. In the coming weeks and months, I urge State and 
local officials to work closely and cooperatively with the Federal 
Government to keep Family Care strong. Over the last 12 years, Family 
Care has proven itself to be a valuable, popular, and cost-effective 
program--one that can be improved, yes, but one that also has a proven 
track record. It is my hope, and the hope of tens of thousands of 
beneficiaries of the program, that it will be preserved and carefully 
protected.

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