There are a multitude of dilemmas faced today by over 3 million significantly disabled Americans, many of whom depend on Medicaid for Long-Term Services and Supports (LTSS) in obtaining the services they need to simply live. While the landmark 1990 Americans with Disabilities Act (ADA) has done a lot to improve the lives of people with disabilities, the reality is that using Medicaid as the vehicle for funding LTSS places unreasonable restrictions on disabled people who want to live independent lives and be as successful as possible.

The Federal Government must change funding for LTSS in order to provide disabled Americans with real choices regarding living arrangements and maximize their earning potential without fear of being deprived of support they cannot live without. Part II of this note provides background information on LTSS (what they are, who uses them, what they cost, and how they are currently funded). Part III examines the Medicaid Program and specifically Medicaid HCBS17 Waiver Programs, which provide the bulk of LTSS funding today. A brief history of the federal laws, amendments, and policies that have impacted Medicaid LTSS are provided. Part IV analyzes an alternative to Medicaid for LTSS funding for those working-age disabled individuals who would not otherwise be Medicaid eligible. This section specifically focuses on recommendations from the congressionally established Commission on Long-Term Care and a pilot program proposed by the American Association for People with Disabilities (AAPD). Finally, Part V concludes that the Federal government must take action to establish a stand-alone, non-Medicaid Program to provide LTSS for working-age disabled Americans who are capable of working and living independently.