I 
111TH CONGRESS 
1ST SESSION H. R. 1670 
To amend title XIX of the Social Security Act to provide individuals with 
disabilities and older Americans with equal access to community-based 
attendant services and supports, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 23, 2009 
Mr. DAVIS of Illinois (for himself, Mr. PAYNE, Mrs. CHRISTENSEN, Mr. 
BRADY of Pennsylvania, Ms. LEE of California, Mr. MEEKS of New York, 
Mr. CARNEY, Mr. DOYLE, Mr. LARSON of Connecticut, Mr. MOORE of 
Kansas, Mr. HINCHEY, Mr. KUCINICH, Mr. LEWIS of Georgia, Ms. BALD-
WIN, Mr. COHEN, Mr. FATTAH, Ms. DELAURO, Mr. ISRAEL, Ms. KAP-
TUR, Mr. KIND, Mr. LANGEVIN, Mr. OLVER, Ms. LORETTA SANCHEZ of 
California, Ms. SCHWARTZ, Mr. SESTAK, and Ms. VELA´ZQUEZ) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
individuals with disabilities and older Americans with 
equal access to community-based attendant services and 
supports, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Community Choice Act of 2009’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings and purposes. 
TITLE I—ESTABLISHMENT OF MEDICAID PLAN BENEFIT 
Sec. 101. Coverage of community-based attendant services and supports under 
the Medicaid program. 
Sec. 102. Enhanced FMAP for ongoing activities of early coverage States that 
enhance and promote the use of community-based attendant 
services and supports. 
Sec. 103. Increased Federal financial participation for certain expenditures. 
TITLE II—PROMOTION OF SYSTEMS CHANGE AND CAPACITY 
BUILDING 
Sec. 201. Grants to promote systems change and capacity building. 
Sec. 202. Demonstration project to enhance coordination of care under the 
Medicare and Medicaid programs for dual eligible individuals. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Long-term services and supports provided 
under the Medicaid program established under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) must meet the abilities and life choices of indi-
viduals with disabilities and older Americans, includ-
ing the choice to live in one’s own home or with 
one’s own family and to become a productive mem-
ber of the community. 
(2) Similarly, under the United States Supreme 
Court’s decision in Olmstead v. L.C., 527 U.S. 581 
(1999), individuals with disabilities have the right to 
choose to receive their long-term services and sup-
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ports in the community, rather than in an institu-
tional setting. 
(3) Nevertheless, research on the provision of 
long-term services and supports under the Medicaid 
program (conducted by and on behalf of the Depart-
ment of Health and Human Services) continues to 
show a significant funding and programmatic bias 
toward institutional care. In 2007, only 42 percent 
of long-term care funds expended under the Med-
icaid program, and only about 13.6 percent of all 
funds expended under that program, pay for services 
and supports in home and community-based set-
tings. 
(4) While much effort has been dedicated to 
‘‘rebalancing’’ the current system, overall about 60 
percent of Medicaid long-term care dollars are still 
spent on institutional services, with about 40 percent 
going to home and community-based services. In 
2007, only 11 States spent 50 percent or more of 
their Medicaid long-term care funds on home and 
community-based care. 
(5) The statistics are even more dispropor-
tionate for adults with physical disabilities. In 2007, 
69 percent of Medicaid long-term care spending for 
older people and adults with physical disabilities 
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paid for institutional services. Only 6 States spent 
50 percent or more of their Medicaid long-term care 
dollars on home and community-based services for 
older people and adults with physical disabilities 
while 1⁄2 of the States spent less than 25 percent. 
This disparity continues even though, on average, it 
is estimated that Medicaid dollars can support near-
ly 3 older people and adults with physical disabilities 
in home and community-based services for every per-
son in a nursing home. 
(6) For Medicaid beneficiaries who need long- 
term care, services provided in an institutional set-
ting represent the only guaranteed benefit. Only 30 
States have adopted the benefit option of providing 
personal care, or attendant, services under their 
Medicaid programs. 
(7) Although every State has chosen to provide 
certain services under home and community-based 
waivers, these services are unevenly available within 
and across States, and reach a small percentage of 
eligible individuals. Individuals with the most signifi-
cant disabilities are usually afforded the least 
amount of choice, despite advances in medical and 
assistive technologies and related areas. 
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(8) Despite the more limited funding for home 
and community-based services, the majority of indi-
viduals who use Medicaid long-term services and 
supports prefer to live in the community, rather 
than in institutional settings. 
(9) The goals of the Nation properly include 
providing families of children with disabilities, work-
ing-age adults with disabilities, and older Americans 
with— 
(A) a meaningful choice of receiving long- 
term services and supports in the most inte-
grated setting appropriate to the individual’s 
needs; 
(B) the greatest possible control over the 
services received and, therefore, their own lives 
and futures; and 
(C) quality services that maximize inde-
pendence in the home and community. 
(b) PURPOSES.—The purposes of this Act are the fol-
lowing: 
(1) To reform the Medicaid program estab-
lished under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) to provide services in the most 
integrated setting appropriate to the individual’s 
needs, and to provide equal access to community- 
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