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"The President's New Freedom Initiative builds on our partnership to assure Medicaid eligible individuals with disabilities are served in the most appropriate setting according to their own needs and preferences," said Secretary Thompson in a letter to the governors. "We believe there is a tremendous opportunity to serve people who meet nursing facility levels of care in their own homes or other community residential settings without increasing costs."

A number of states have already developed and implemented programs that serve individuals in community settings rather than institutions including:

• diversion programs to keep people in the community,
• transition programs to move individuals from institutional settings to community placements, and
• program models in which the "money follows the person" to assure stability for beneficiaries living in the community.

HHS has recently announced a new waiver template, "Independence Plus," designed to help states develop consumer directed services. The Center for Medicare & Medicaid Services (CMS) has also established a Web Site to help states share "promising practices" of innovative programs that states have adopted to strengthen their community long-term support systems. These promising practices are targeted towards diverse populations and usually supported by a combination of funding mechanisms, such as the Medicaid Home and Community Based Services (HCBS) waiver program, regular Medicaid state plan options, programs funded by other federal agencies, and state and local resources. The Web site is www.cms.gov/promisingpractices.

"Many states have developed innovative programs that meet the goals of President Bush's New Freedom Initiative and we are excited to be able to share their promising practices," said Secretary Thompson. "These practices should be a starting point for fostering a dynamic examination of ways to improve community support systems for persons of all ages with disabilities."

Under the President's New Freedom Initiative, many other steps have also been taken including $120 million in Systems Change Grants to support state efforts to institute community-based approaches; the Ticket to Work program, which provides for continued health insurance coverage for persons with disabilities; and the National Caregiver Support Programs aimed at helping families care for a loved one at home or in the community.

The text of Secretary Thompson's letter to governors today follows:

Dear Governor:

As partners in the Medicaid program, 7 million Americans with disabilities depend on us to provide quality health insurance and long-term care services. The President's New Freedom Initiative builds on our partnership to assure Medicaid eligible individuals with disabilities are served in the most appropriate setting according to their needs and preferences.

Nearly 20 percent of nursing home expenditures are made on behalf of individuals who have a disability and are under 65 years of age. We believe there is a tremendous opportunity to serve people who meet nursing facility levels of care in their own homes or other community residential settings without increasing costs.

Many states have engaged in activities and developed programs that serve individuals in the most appropriate community setting rather than in an institution. These programs and activities, developed under existing authority, have included diversion programs to maintain people in the community, transition programs to actively move individuals from institutional settings to community placements, and program models in which the "money follows the person" to assure stability of community living.

States continue to prove themselves to be the leaders in service delivery innovation and I am proud of our record in supporting your efforts. We recently announced a new waiver template, "IndependencePlus," which is designed to assist states in the development of consumer directed services. I have directed the Center for Medicare & Medicaid Services (CMS) to expand our efforts to share "promising practices" as examples that states have adopted to support the "money follows the person" model. A copy of the CMS letter in support of these efforts is enclosed for your information.

We hope that you will find this information to be helpful and I look forward to working with you on new ways to serve Americans with disabilities.

Sincerely,

Tommy G. Thompson
Secretary of Health and Human Services

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