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Independence and Choice
October 22, 2009 • Volume 9, Issue 42
Over ten million individuals in the United States receive long-term services and supports such as assistance with bathing and eating. Only 14 percent of these individuals receive this care in nursing homes; the remaining 86 percent are community residents, active members of society.
Most people access long-term care through Medicaid, but they must first pay out of pocket for the services until they are poor enough to be eligible for Medicaid. And while it is clear that the majority of Americans would prefer to stay in their homes while receiving assistance with their activities of daily living, Medicaid’s financing system for long-term services and supports often forces individuals into nursing homes. Over half of the people who have long-term care through Medicaid receive this care in an institution, while only about 20 percent receive their care in their homes through a Medicaid Home and Community-Based Services (HCBS) waiver.
One common sense solution included in the Senate Health, Education, Labor and Pensions (HELP) Committee’s health reform legislation (S. 1679, Affordable Health Choices Act), and added as an amendment to the House health reform bill (H.R. 3200, America’s Affordable Health Choices Act of 2009), that would keep individuals in their homes and increase their independence and choice is the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act would create a new national insurance fund for long-term care services by enrolling eligible workers into the program, and they would have access to long-term care if they ever need it. For people who pay into the insurance fund and are diagnosed as needing long-term care, the program would provide a lifetime cash benefit. That benefit would provide the recipient a great deal of independence and control over the care they receive and allow them to remain at home and active in their communities.
Additionally, the Senate Finance Committee health bill (S. 1796, America’s Healthy Future Act) expands access to community-based care under Medicaid. The bill extends the spousal protections that are currently in place for nursing home care to individuals who receive long-term care services through home- and community-based (HCBS) care. These protections allow individuals to receive long-term care services through Medicaid without bankrupting their spouse or filing for divorce to split up assets. America’s Healthy Future Act will broaden these protections to include those whose spouses are receiving vital care through an HCBS program.
Improving access to long-term services and supports is an essential part of health care reform. Congress must take action to improve access to community-based care and include the CLASS Act in the final health reform legislation so that older adults and people with disabilities can gain access to long-term supports and services—and remain active in their communities.
“The Congressional Budget Office estimates that the CLASS Act’s net effect on the federal budget would be to reduce the budget deficit by about $74 billion during the 2010–2019 period. These estimates are based on an average monthly premium of $123 and a cash daily benefit of $75 for life, with no underwriting, that preserves the program’s solvency for 75 years. It also assumes the premium amount would not change once an individual enrolls, however the benefit payment would rise each year with inflation. The CBO also estimates a reduction in Medicaid spending over 10 years because some individuals who would receive CLASS benefits would otherwise have had Medicaid pay for those long-term services and supports. The estimated reduction in the federal budget deficit over the 10 year period is the result of the five-year vesting requirement; the payout of benefits would not begin until 2016, five years after the initial enrollment in 2011.” (Community Living Assistance Services and Supports (CLASS) Act Issue Brief, Kaiser Family Foundation, October 2009.)
“Even though most older Americans would prefer to receive care at home rather than in nursing homes, many states have been slow to reform their Medicaid programs to make that choice widely available. Instead, most states have done a much better job of using Medicaid dollars to help people with developmental disabilities remain in their homes and communities than to help older people and adults with physical disabilities.” (Too Few Seniors Get Home Care, AARP, July 2008.)
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