Same Mandate, Changing Concepts of Community: An Analysis of Bills to Mandate Medicaid Coverage of Community-Based Attendant Services and Supports (1997–2010)

Abstract

Purpose – Medicaid funding for long-term services and supports (LTSS) is a key avenue for community access for people with disabilities and others. Between 1997 and 2009, the boundaries of community access were redrawn and redefined with the introduction of a series of 13 bills to change how Medicaid requires states to fund LTSS. Although they did not successfully pass into law, their presence is felt in the language of the Community First Choice (CFC) Option, part of the Patient Protection and Affordable Care Act (PPACA) of 2010. This chapter documents and analyzes the changes in the concept of community access as reflected across these bills and the CFC.

Methodology – The text of these 13 bills and the CFC were compared with attention to structure, order, and meaning. Documents were hand coded and electronically searched. Codes were entered into atlas.ti for comparison and analysis.

Findings – Four significant changes in the conceptualization of community access emerged: (1) who deserves access to community, (2) what community access entails, (3) why people deserve access to community, and (4) how community access should be organized. With the exception of the reasons why people deserve access to community, the expanded concept of community access illustrated across these bills is reflected in the text of CFC.

Originality/value of the chapter – This chapter contributes to the limited literature that documents and analyzes the historical development of community access across policy documents. In addition, it highlights the relevance of incremental analysis to understanding social change through the legislative process.

Citation

Grossman, B.R. (2011), "Same Mandate, Changing Concepts of Community: An Analysis of Bills to Mandate Medicaid Coverage of Community-Based Attendant Services and Supports (1997–2010)", Carey, A.C. and Scotch, R.K. (Ed.) Disability and Community (Research in Social Science and Disability, Vol. 6), Emerald Group Publishing Limited, Leeds, pp. 215-240. https://doi.org/10.1108/S1479-3547(2011)0000006012