CMS' failure to cover housing for lTC & the IMD rule: What they have in common is discrimination 

 CMS State Medicaid Director Nov. 13, 2018:  Letter:  SMD # 18--011

RE: Opportunities to Design Innovative Service Delivery Systems for Adults with a Serious Mental Illness or Children with a
Serious Emotional Disturbance

CMS May 17, 2019

Serious Mental Illness (SMI) and Serious Emotional Disturbance (SED) Demonstration Opportunity Technical Assistance Questions and Answers 
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"Fair Housing for People with Mental Health Disabilities" -- Fair Housing Laws & Litigation Conference (2014)
           So people, States, the Feds discriminate against people with cognitive disabilities every day quite unconsciously.
            The Cruelty & Difficulty of addressing this is that:
  • the Discrimination while unconscious to the person [human being] engaging in it --
  • IS QUITE CONSCIOUS TO THE RECIPIENT

          So Medicaid's Institute of Mental Disease Exclusion Rule is DISCRIMINATORY.   The well -intentioned Rule prohibits  Medicaid payment for "Institutes of Mental Disease."

​              Addressing this has become an important goal of the conservative and moderate Mental Health Advocacy Movements.  AND IT IS VITAL TO ADDRESS THAT.

                It is also VITAL to address the DISCRIMINATION in failure to provide HOUSING for people with with disabilities who need LONG TERM CARE.

                  Folks --we are 20 years out from Olmstead and the vast majority of States are not in compliance.   Further, they are not in compliance with Medicaid Network Adequacy or Parity either.

                      So  currently HOUSING really implicates OLMSTEAD.  Despite the fact that Olmstead is NOT limited to what Medicaid covers STATES have NOT risen to the challenge of HOUSING for PEOPLE with LTC needs although many STATES have done something.

                    HISTORICALLY,  NEITHER THE FEDS NOR STATES HAVE HAD SUFFICIENT SKIN IN THE GAME TO SOLVE THIS -- insufficient housing for people with long term care needs, especially cognitive disabilities is a HUMAN RIGHTS NIGHTMARE.

                       Why is it worse for people with cognitive disabilities?  Their alternative is often NOT the nursing home, it is:
  • Homelessness,
  • Jail, 
  • Prison, and often 
  • A CYCLE OF HOMELESSNESS & INCARCERATION

                 Further, while some areas of State & Federal Government may be promoting FAIR HOUSING, others such as CMS and STATE MEDICAID AGENCIES may have barely heard of it.

                   So what does that mean?  People with cognitive disabilities and long term care needs face even more DISCRIMINATION.

                     CMS NEEDS TO STEP UP & COVER HOUSING FOR PEOPLE NEEDING LONG TERM CARE.