Medicaid - States Considering Opting Out

In several states, officials have floated the idea of opting out of the federal Medicaid program. These states include Washington, Texas and South Carolina, Wyoming and Nevada. Medicaid is a jointly funded federal and state program (the federal government matching rates vary from50-60%). Those who qualify can get health insurance, nursing home or other institutional services. States must keep Medicaid open to all who qualify. Most individuals with Down syndrome qualify for Medicaid funding.


Medicaid is the only public funding program currently available for long-term support services for adults with disabilities to live in the community. While Individuals may qualify for these community services, the services are only provided under a Medicaid waiver or “optional services” program. Many individuals with Down syndrome and other disabilities are served under this program, however the state is not required to provide these services and long waiting lists exist.


The types of support services provided under optional services or the Medicaid waiver can help one manage in his or her own home or a living situation with one or two roommates. They include assistance with all the activities of daily living such as shopping, paying bills, decision making assistance, transportation, support to go to work, setting up medical appointments, etc.


The states mentioned above are floating the idea of giving up the federal funding and replacing Medicaid with a narrower program of their own. Gov. Rick Perry (R-TX) has proposed that his state get out of Medicaid in favor of a state-run system. However, it is not clear how a state would provide the community based services needed by adults with disabilities with no federal government assistance. . ."

India and America

. . .On the whole my memories of America are happy ones. I enjoy them in retrospect. If I were to maintain a single outstanding experience, it would be my visit to the Grand Canyon. To call it a visit is not right; a better word is "pilgrimage" - I understood why certain areas of the canyon's outcrops have been named after the temples of Brahma, Shiva and Zoroaster. I spent a day at the canyon. At dawn or a little before, I left my room at El Tovaro before other guests woke up, then took myself to a seat on the brink of the canyon. It was still dark under a starry sky. At that hour the whole scene acquired a different dimension and a strange, indescribable quality. Far down below, the Colorado River wound its course, muffled and softened. The wind roared in the valley; as the stars gradually vanished a faint light appeared on the horizon. At first there was absolute, enveloping darkness. But if you kept looking on, contours gently emerged, little by little, as if at the beginning of creation itself. The Grand Canyon seemed to me not a geological object, but some cosmic creature spanning the horizons. I felt a thrill more mystic than physical, and that sensation has unfadingly remained with me all through the years. At any moment I can relive that ecstasy. For me the word "immortal" has a meaning now. . .

. . .I confess that I view with some uneasiness the attempt to draw up detailed schemes for a "new society"; I am afraid we may fall back into the delusion that so long as we make the schemes the society will make itself. I am particularly distrustful of slogans about "peace, prosperity, and security," because I fear we may again forget the paradoxical nature of these things. . .society is not a kind of detective problem, for which a single, final and complete solution can be found. It is a work, like a work of art, which has to be imagined with vision, and made with intelligence and unremitting labor. This book does not pretend to offer any formula for constructing an Earthly Paradise: no such formula is possible. . .