Bob Kafka

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Bob Kafka leads ADAPT activists in a demonstration for home and community based services in Georgia

Bob Kafka is a disability activist with quadriplegia and leader of ADAPT.[1]


In 2012, Bob Kafka was profiled for an article at the American Society on Aging.[2] Here are some highlights:


"ADAPT is the largest all-volunteer, activist, national, grassroots, direct-action, disability rights organization in the country. We organize people with disabilities of all ages, their family members, attendants, and advocates to effect social change. Currently, our main issue is to reverse the institutional bias in the long-term-care (LTC) system."

Medicaid Activism

"ADAPT began its advocacy to reverse Medicaid institutional bias right after the Americans with Disabilities Act was passed in 1990. We never imagined that this would be such a long struggle. Though we have not attained the ultimate goal of people having an equal chance to choose Home and community-based services (HCBS), we’ve had significant wins. Most importantly, the debate is no longer [about] if there is an institutional bias, but how to reverse it—a major political shift.

"Our first win was the funding of the Real Choice System Change (RCSC) Grants allowing states to apply for funding to reform their LTC systems. The idea for these grants came from a section in the Medicaid Community Attendant Services and Support Act, a bill originally drafted by ADAPT (now called the Community Choice Act). The initial funding began with a $75 million annual appropriation, but by 2012, RCSC had spent over $300 million for state systems reform.

"The next major victory was the inclusion of $1.75 billion dollars for the Money Follows the Person (MFP) Demonstration in the Bush budget. This money (delivered through an enhanced federal Medicaid match to states) has helped thousands of residents of nursing homes and other institutions move into community settings. The healthcare reform bill of 2010 added more than $2 billion to the MFP program, and included two other significant components: the Community First Choice Option, which allows people eligible for nursing home or other institutional services to choose HCBS, with states receiving 6 percent enhanced Medicaid match; and a Home- and Community-Based Services Incentive Option, which also offers an enhanced Medicaid match as a carrot for states to select it.

"The forecast for Medicaid-funded services in 2012 is gloomy, but if we are strategic and work together as aging and disability advocates, we can make reforms in the Medicaid program to improve service delivery. One area for reform is the disparity in HCBS waiver use between the aging–physical disability community and the developmental disability community. Seventy-five percent of all waiver dollars are for people with developmental disabilities. Recent rule changes allowing states to develop waivers for all populations, regardless of label, may bring more equity and functionality to the long-term services and supports (LTSS) system.