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Resolutions & Amendments

29th International Convention - Miami, FL (1990)

Medicaid ICF/MR Reform

Resolution No. 19
29th International Convention
June 25-29, 1990
Miami, FL


AFSCME is the leading union representing employees working in institutional and community-based facilities servicing developmentally disabled individuals. Over 100,000 members, roughly 88,000 in institutions and 12,000 in community settings, provide quality care for our nation's most vulnerable population; and


Through national conferences, local meetings and seminars, and publications, AFSCME has aggressively advocated the development of "active-treatment" in facilities across this country. Where states have relinquished their mandate to provide quality institutions, AFSCME has fought for both capital improvements and staffing increases; and


Spurred by rising costs and by the rising number of deficiencies, the federal Health Care Financing Administration (HCFA) has increased its oversight of public and private ICF/MR facilities. All large public ICF/MR facilities have undergone federal "look-behind" surveys in the past four years. Often definitions of "active-treatment" have varied from survey team to survey team and survey deficiency reports have deviated significantly from federal regulations. The deviation has produced a national HCFA Active Treatment workgroup on which AFSCME is represented; and


For over seven years, Senator Chafee and supporters have sought to enact an alleged Medicaid reform measure which, in essence, is a massive contracting-out scheme. The proposed legislation would cap Medicaid funding to ICF/MRs, arbitrarily limit facility size, allow states to develop their own rules and regulations for community care to replace current ICF/MR regulations, and completely disregard the skills and experience of existing workforces by failing to adopt meaningful worker protections; and


Continuing cost pressures in the ICF/MR program have generated additional legislative interest in improving Medicaid services to the developmentally disabled. Congressman Waxman, long-standing proponent of Medicaid reform, has recently circulated a draft Medicaid ICF/MR reform bill; and


There is considerable support among advocates and experts in the field of mental retardation and developmental disabilities for an institutional care System as part of a continuum of residential and treatment services.


That AFSCME continue to adamantly oppose any Medicaid ICF/MR legislation, like the Chafee-style measure, which fails to address the needs of residents and workers and ultimately would only lead to large-scale privatization; and


That AFSCME scrutinize any Medicaid ICF/MR reform legislation to insure that funding for existing institutional facilities and future improvements is preserved, that any funding shifts to the community are accompanied by satisfactory worker protections, and that any reform includes improvements in the quality of services in ICF/MRs of any size; and programs such as Medicare and Medicaid, and toward the improvement of staffing ratios, career ladders, training programs and worker protection at the state and local levels.


Howard, N. Jorgenson, President
Helen Sampson, Secretary
AFSCME Council 28
Olympia, WA