LTC Bullet: PPACA'd with Unfunded LTC Benefits

Wednesday, April 14, 2010


LTC Comment: If you think the CLASS Act is a financial leap in the dark, wait until you see what the rest of PPACA adds to government-financed long-term care, after the ***news.***

*** TURNABOUT IS FAIR PLAY, but this is one glitch in PPACA we bet will get fixed quick: "Baffled by Health Plan? So Are Some Lawmakers" by Robert Pear, New York Times, April 12, 2010. In a strange twist, the Congressional Research Service has reported that under the newly-signed health care reform legislation, senators, representatives and their staff members could have their health coverage removed. . . . In an 8,100 word memorandum, the CRS stated, "It is unclear whether members of Congress and Congressional staff who are currently participating in F.E.H.B.P. [Federal Employees Health Benefits Plan] may be able to retain this coverage," and the date of the enactment of this part of the bill is undefined. Much of what is specified in the health care bill does not have to be in effect until 2014, but because the date was left out of this component, it could be interpreted that it went into effect when the bill was signed. Source: AHCA/NCAL Gazette - Tuesday, April 13, 2010. ***

*** AALTCI STUDY: Los Angeles, CA - April 12, 2010 - Purchasers of true group long-term care insurance tended to be slightly older in 2009 and an increasing number selected less costly policy features according to the American Association for Long-Term Care Insurance (AALTCI) annual study of group (employer sponsored) long-term care insurance. The organization's research was based on an analysis of nearly 66,000 new purchasers. Details here. ***

*** MEDICARE GOOSE that lays golden eggs for nursing homes may be cooked. McKnight's LTC News reports "An Independent Payment Advisory Board (IPAB) established under the healthcare reform act will . . . be empowered to make Medicare payment decisions beginning in 2014. Unlike the current Medicare Payment Advisory Commission (MedPAC), the IPAB recommendations will automatically go into effect unless Congress blocks them." This is a nightmare for nursing homes, because they depend on generous reimbursements from Medicare to make up for dismal Medicaid reimbursements that don't even cover their costs. MedPAC recommends cutting Medicare nursing home reimbursements every year, but Congress ignores them. Blocking the new IPAB will be much harder. If Medicare reimbursements decline, more LTC costs will fall on states, taxpayers, and Medicaid recipients. ***

*** IS MEDICAID HOME CARE THE ANSWER? Better read this before you tackle today's LTC Bullet: WA: DSHS seeks crackdown on adult family homes. The state Department of Social and Health Services has recommended nearly a dozen new laws and launched reforms to rein in the growing adult-family home industry. By Michael J. Berens, Seattle Times. March 9, 2010. Source: AHCA / NCAL Gazette Friday, April 9, 2010 ***


LTC Comment: Medicaid is bankrupting state budgets. The federal debt plus unfunded entitlement liabilities are huge and sky-rocketing. We can't begin to afford the government-financed LTC benefits we have now. They're already so generous they choke off a private market for home care and crowd out private long-term care insurance.

So what's the obvious next step? Of course. Double down. Congress and the President larded the Patient Protection and Affordable Care Act (PPACA) with dozens of new programs and demonstrations with the expressed purpose to make Medicaid LTC benefits more attractive and easier to get than ever. Message to the public? "Don't worry about long-term care. Uncle Sugar has you covered."

But, don't take my word for it. Get all the details in a new "Briefing," published by the National Academy for State Health Policy, titled grandiloquently "Long Term Services and Supports and Chronic Care Coordination: Policy Advances Enacted by the Patient Protection and Affordable Care Act," and written by Diane Justice. Read it here.

Excerpts follow, except from the sections on CLASS which we've covered extensively elsewhere. Rejoin me afterwards for analysis and the only good news for responsible LTC planning I can squeeze out of this.


Excerpts from the NASHP "Briefing"

This report focuses on policy changes related to the continuum of care for older people- specifically long term services and supports (LTSS) and chronic care coordination. For this analysis, the Act's major provisions in these areas are organized into five categories: 1) national insurance for long term services and supports [CLASS]; 2) Medicaid options and incentives to expand LTSS; 3) other LTSS provisions; 4) chronic care coordination; and 5) nursing home reforms. (p. 1)

Medicaid Options and Incentives to Expand Long Term Services and Supports

The PPACA contains several provisions that could potentially expand the availability of Medicaid community based long term services and supports by establishing new optional benefits states can choose to add to their Medicaid state plans and /or by providing states with financial incentives to increase Medicaid funding for existing programs through targeted enhanced matching rates. (p. 3)

State Balancing Incentive Payments Program (p. 3)

Community First Choice Option-Medicaid State Plan Option for Attendant Services and Supports (p. 4)

Money Follows the Person Rebalancing Demonstration (p. 4)

Medicaid Home and Community Based Services State Plan Option (p. 4)

Other Long Term Services and Supports Provisions

Spousal Impoverishment: Currently a spouse living in the community can retain some joint income and assets without jeopardizing the ability of the other spouse to become financially eligible for Medicaid nursing home benefits. Beginning in 2014, the PPACA mandates the application of these spousal impoverishment protections to persons whose spouses' qualify for Medicaid funded home and community based services and supports. (p. 5)

Long Term Services and Supports Workforce (p. 5)

Long Term Care Employee Background Checks (p. 5)

Aging and Disability Resource Centers (p. 5)

Chronic Care Coordination

Achieving better care coordination for persons with multiple chronic conditions is an articulated goal of a diverse set of new initiatives enacted through the PPACA. (p. 6)

Federal Coordinated Health Care Office (p. 6)

Medicare Special Needs Plans (p. 6)

Medical (Health) Homes (p. 6)

Independence at Home Demonstration Program (p. 7)

National Pilot Program on Payment Bundling (p. 7)

Community Based Care Transitions Program (p. 8)

Accountable Care Organizations (p. 8)

Nursing Home Reforms (p. 8)

Nursing Home Transparency and Consumer Information (p. 8)

New Approaches to Enhancing Compliance with Federal Rules (p. 9)

Increased Responsiveness to Residents' Concerns (p. 9)


LTC Comment: OK, there you have a list of the new LTC services and supports added by PPACA. But don't miss the mind-numbing details on these prohibitively expensive "policy advances" in their full complexity as explicated here.

Now, I promised you some good news. So, as the little boy who received a barn full of manure for his birthday said: "There must be a pony in here somewhere."

The only pony I can find for long-term care financing in PPACA is that states can't possibly afford to implement much if any of these new goodies. Any citizen with half a sense of economic reality won't be fooled by the fantasy that government will pay for quality long-term care at any level or in any setting as the future unfolds.

What a tragedy that just as we should be reversing course, preserving scarce public LTC resources for people most in need, and encouraging responsible LTC planning, we are doing exactly the opposite.

The sad irony is that expanding welfare-financed long-term care will hurt most the very people who need it most.