Long Term Services and Supports in Health Care Reform

1
Long Term Services and Supports in Health Care
Reform

• Marty Ford
• The Arc and United Cerebral Palsy Disability
  Policy Collaboration
• September 14, 2009
• American Network of Community Options and
  Resources

2
Long term Services and Supports

• Medicaid as the default system but people must
  become impoverished
• Failure to address chronic conditions is a major
  weakness of the health care system
• Need for long term services/supports is an
  insurable event

3
Promising Proposals

• Community Living Assistance Services and Supports
  (CLASS) Act
• Community Choice Act of 2009 ? Community First
  Choice Medicaid Option
• Empowered at Home Act of 2009

4
Community Living Assistance Services and Supports
(CLASS Act)

• Senator Kennedy (D-MA) and Rep. Pallone (D-NJ)
  introduced the CLASS Act (S. 697, H.R. 1721)
• National long term care insurance program
• Premiums through voluntary payroll tax
• Beneficiaries must pay premiums at least 5 years
  to qualify/vest and meet test of functional need
• Cash benefits for maximum flexibility and
  consumer control
• NOT means-tested people do not have to become
  poor and remain poor to receive benefits can
  continue to work
• CLASS Act can take pressure off Medicaid
• Cost effective pays for itself
• Included in Senate HELP bill (unanimous) and
  House Energy and Commerce (directs the Secretary)

5
Community Choice Act of 2009

• Senator Tom Harkin (D-IA) and Rep. Danny Davis
  (D-IL) introduced bills (S. 683, H.R.1670)
• Would mandate Medicaid community-based attendant
  services and supports for people eligible for
  institutional services
• Covers supervision, cueing, or hands-on
  assistance for daily activities, including
• Eating, dressing, meal planning, managing
  finances, and traveling around and participating
  in the community ADLs, IADLs, health-related
  tasks, and training

6
Community First Choice Medicaid Option

• Core elements of CCA as an option for states
  same definitions - no caps or waiting lists
• Enhanced federal match 2, 4, or 6 percent
• Seen as first step, laying the groundwork for CCA
• Strong data collection
• Working with wide coalition of disability
  community
• Meeting with White House and House / Senate
  leadership and key Committee leadership

7
Medicaid Home and Community-Based Services (HCBS)
Option (Section 1915(i))

• New Medicaid option created by Deficit Reduction
  Act (2006)
• Allows HCBS services without a waiver
• State must serve people who are not eligible for
  institutional services (level of care criteria)
• Some limits
• Allows state to cap services and keep waiting
  lists
• Only covers people up to 150 percent of poverty
• Does not cover all services allowed in HCBS
  waiver
• Allows states to restrict services to some parts
  of state
• Few states have decided to use it to provide
  services

8
Empowered at Home Act of 2009

• Senators John Kerry (D-MA) and Charles Grassley
  (R-IA) and Representative Frank Pallone (D-NJ)
  introduced bills (S. 434, H.R. 2688)
• Designed to fix the problems with the HCBS
  option, the bill would
• Allow full range of waiver services
• Allow same income eligibility as
  institution/waiver
• Not allow states to cap service/run waiting lists
• Not allow services to be limited geographically
• Other provisions, including tax provisions and
  spousal impoverishment provisions

9
What are the chances of including long term
services in health care reform?

• Cost is key
• CLASS Act pays for itself
• Community First Choice Option waiting for
  Congressional Budget Office (CBO) cost estimate
  (score)
• Empowered at Home and other LTSS pieces have
  fallen out of Finance Committee proposal due to
  costs

10
What should you do?

• Senators and Representatives must hear from
  constituents that they want health care reform to
  include long term services and supports,
  specifically
• CLASS Act
• Community First Choice Medicaid Option
• Empowered at Home
• Need visits, phone calls, Faxes
• Keep up the pressure when you get home

11
Aging and Disability Communities Working Together

• Consortium for Citizens with Disabilities (CCD)
  and Leadership Council of Aging Organizations
  (LCAO)
• Principles for Financing Long Term Services and
  Supports
• Ads in Roll Call
• Letter to President Obama re inclusion of LTSS
  in health reform 96 national aging and
  disability organizations
• CCD Principles for Health Care Reform from a
  Disability Perspective
• Disability as litmus test

12
Resources

• www.passtheclassact.org
• www.passthecommunitychoiceact.org
• www.c-c-d.org