December 20, 2016

Community First Choice: Social Engineering Under the Affordable Care Act

Karren Jo Pope-Onwukwe

Social engineering is defined as "management of human beings in accordance with their place and function in society." This term causes different reactions depending on what one believes is the role of government.

When the Supreme Court issued its 1999 opinion in Olmstead v. L. C. (Olmstead) social engineers believed that there was now a mandate to fundamentally change housing policy and healthcare delivery for people with disabilities and older adults. Using the anti-discrimination language found in Title II of the Americans with Disabilities Act (ADA), this has meant an ongoing fight against the default position of placing individuals in psychiatric hospitals and nursing homes instead of creating less restrictive housing and healthcare delivery programs in the community. As an elder law and disability rights attorney, I know that the issue of housing and healthcare treatment for adults confronts families across the nation and is compounded when financial resources are limited or non-existent.

This effort to do social engineering manifested itself within the language found in the Patient Protection and Affordable Care Act of 2010 (PPACA), which added section 1915(k) to the Social Security Act, allowing states the option of providing home and community-based services (HCBS) through their State Plans, Section 1915(k), it is also known as the Community First Choice (CFC). This new benefit provides long-term care services and supports (LTSS) to people in their homes and or communities rather than living in an institution.

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