We the undersigned call for a fundamental restructuring of the long term care system in the United States. The Federal/State Medicaid financed program is institutionally biased, excessively complex, overly expensive, professionally-driven and unfair. This system of funding reflects the paternalistic, maintenance- oriented biases towards disabilities from the era during which it was constructed. This system of funding perpetuates second-class citizenship and community exclusion. Its costs are unsustainable. The last 40 years have seen a paradigm shift from condemning persons with disabilities to institutions to inspired life of full participation in their community. These new cultures known as the recovery, self-determination and independent living movements have brought hope and dreams to millions of Americans. However, the Medicaid system needs to be transformed to align with this new culture and values.
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