Long Term Care in New Health Law

Part One:  Restructuring Medicare & Medicaid to Provide Long Term "At Home" Care

The Patient Protection and Affordable Care Act is projected to generate $500-billion in Medicare savings by ending overpayment to Medicare Advantage plans and some reduction in provider payments. The provider payments are to be reduced by increased efficiency in the Medicare program and reducing the inflationary payments to providers.

Skilled nursing facilities, home health agencies, inpatient hospitals, hospices and other Medicare providers will see a 1-percent reduction in their annual Market Basket (inflationary) updates in 2011 through 2104.  At the same time, rural home health care providers will see higher payments.  Home health agencies, nursing homes, and ambulatory surgical centers will be required to implement Medicare value-purchasing programs, which will act to further reduce costs for the Medicare program.

The aim of these new provisions, in addition to streamlining provider payments, is to address the long-term care needs of all Americans and to shift or rebalance Medicaid payments from institutions to home and community-based care.

The new health care law establishes the Community First Choice Option, which creates a new state plan option under Medicaid to provide community based attendant supports and services to individuals with disabilities who are Medicaid eligible and who require an institutional level of care.  Services would be provided based on a functional needs assessment.  States are freed from expenditure caps currently applicable in Home and Community based waiver programs.  States that choose the Community First Option will be eligible for an enhanced Medicaid match rate of plus six percentage points  for reimbursable expenses in the program. States will have the option of providing coverage for attendant services necessary to assist eligible individuals with activities of daily living and other related tasks.

States will also be able to use the funds to transition individuals from nursing homes in a number of ways, including; first month's rent and utilities, rent and utility deposits, basic kitchen supplies and other necessities that would facilitate the individual's transition from institutional to "at home" care.

These provisions goes into effect a little over a one year from now, October 11, 2011.  For more information CLICK HERE.

Tomorrow: Part Two...Class Act & Money Follows the Person Rebalancing Demonstration

Grassroots Action Needed Right Now

Saturday night, the Senate is expected to vote on whether to allow debate on health care reform.

It’s only because of concerenced citizens, activists and people willing to be heard that we’ve gotten this close to fixing America’s broken health care system. Now you need to keep the heat on.

No matter how your senators feel about the Senate health care bill itself, tell them they must vote to allow the debate to begin.

Call your senators toll free today and tell them to let the debate begin:
1-877-702-0976

The process can seem glacial, but every day we get closer to real reform—and this is another critical vote. Senate Majority Leader Harry Reid needs 60 senators to support the process for moving forward. To be clear, this isn’t a vote for or against the bill—it’s merely a vote about whether to allow debate of the bill on the Senate floor.

Call your senators toll free today and tell them to let the debate begin:
1-877-702-0976

We are further along in the process for real health care reform than we have ever been. The House has already passed a historic bill that will end insurance company abuses, require employers to pay a fair share and establish a strong public option to lower costs and make insurance companies compete. And it won’t tax the benefits of hard-working middle class families.

The bill put forward by the Senate leadership moves us closer to the historic goal of real health care reform in America, but it's not perfect and some of it needs to be fixed. To keep the reform process moving and to fix the bill, it's critical that the Senate start to publicly debate its health care reform bill.

Call your senators toll free right now and tell them to let the debate begin: 1-877-702-0976

Long Term Care - Time For change

The Senate Select Committee on Aging held its second hearing this year on the key topic of long-term care on Wednesday, June 3. The first was back in March and following it, Committee Chairman, Herb Kohl (Dem-WI) urged the Senate to include changes in the coverage, financing, and governing standards of long-term care services and supports as part of comprehensive health reform.

Now, after last week's hearing, Senator Kohl called for stronger consumer protections and greater transparency within the long-term care insurance industry as more and more states are joining with the industry in calling for consumers to purchase LTCI.

Many seniors are confronted with devastating premium increase while many others do without due to prohibitively high premiums with great state-by-state variation in premiums and consumer safeguards for comparable plans, according to the committee's report. It cites one company which raised its rates by 40%.

"Until we can guarantee that consumers have adequate protections, and that premiums don't skyrocket down the road, long-term care insurance is not ready to be part of the health care reform solution", said Kohl.

The Kaiser Family Foundation put forth a study in conjunction with the hearing which reported, "American families today are struggling to pay for long-term are, caught in the cross hairs of an economic meltdown dramatically reducing the personal resources that have fueled over 25 percent of the nation's long-term care spending until now. The sources of out-of-pocket financing, which include home equity, personal savings, and income from adult children have provided critical private funding for a long-term care system in which insurance has played a very small role, covering only about 10 percent of all seniors."

The Kaiser analysis went on to cite High Cost, Health-Risk Deniability, Complexity of the Various Plans, and the Time Lag between purchase and use as the current primary impediments to consumers desire to buy into LTCI plans.

The report provides in-depth analysis and comparison of two suggested alternatives to the current situation: Employer Based Plans and Medicare Partnership Programs. Each provides some answers, but each also, raises many questions.

Older Americans need to keep themselves informed and involved on this critical health care issue, or they will find that once again the lobbyists of the insurance oligarchs will have their way and LTCI will remain out of reach for most of working America.