Underground Railroad 2001

People with disabilities leave the state of Tennessee to avoid nursing home incarceration.

EDITORS NOTE: This article was written 20 years ago this month. It was a very different world for people with disabilities in Tennessee. MCIL has been a significant force in making these changes. 

By Tim Wheat of MCIL
Willie Robinson has lived in Tennessee all his life. Today he is leaving because the unfair Medicaid policy will only provide him with services in the least desirable and most expensive place – an institution. Willie Robinson is moving from a Tennessee nursing home to his own apartment in Denver Colorado. Mr. Robinson is not only capable of living independently; he will be starting over in Denver Colorado where he already has his own place with attendant services. Willie is optimistic about job opportunities in Denver that are non-existent for Tennessee nursing-home residents.

"Because Tennessee has no attendant services, I have lost my job, my home, and my car," said Willie Robinson to Tennessee Senator Bill Frist at the Memphis Center for Independent Living. "I live in a nursing home now and I have no choice about what time I get up in the morning, what I have for meals and what time I go to bed at night."

The small programs that Tennessee has adopted to expand home and community-based services in our state may be effective in preventing or delaying some individual’s entry into a nursing home, however; Tennessee remains 50th in the nation at providing options to institutions. Every other U.S. state offers more cost-saving home and community-based services to provide citizens choices other than an institution.

Missouri, for example, with a larger total population than Tennessee, spends nearly $100 million less of state money on nursing facilities and over $200 million less in federal funds [Medicaid Financial Management Report FY 2000]. Tennessee is the most chronic example of the need for national Medicaid reform. Ninety five percent of the public funding for long-term care is funneled into the nursing home industry.

The for-profit nursing home industry gets more than half of its revenues from Medicaid, yet they are the fourth-largest lobby generously giving money to state lawmakers [Tennessee Registry of Election Finance]. The nursing home lobby has been involved in the guidance of the new programs for home and community based living and made sure that they did not cut into the nursing home industry's profits.

Willie has been working to change the system in Tennessee that concentrates almost all the Medicaid long-term care funding to the nursing home industry. Senators Harkin (D-Iowa) and Specter (R- Pennsylvania) will introduce bipartisan legislation this session to reform Medicaid and give people with disabilities choices in long-term care. Willie will see the MEDICAID COMMUNITY ATTENDANT SERVICES and SUPPORTS ACT (MiCASSA) become law from his own home - his new home in Colorado.