Overview
The new health care law, the Patient Protection and Affordable Care Act was enacted on March 23, 2010. The critical issue is the impact this will have on our elderly population. At first blush, the impact may indeed be positive. However, upon further review, in many instances, it is uncertain how or if this new law will have a positive impact.
Long Term Care Insurance Impact
For one, it creates the first publically funded long term care insurance program (called the Community Living Assistance Services and Supports Act. Whether this will turn into a program with long term care insurance benefits that are better and/or less expensive than what one may find on the open market is entirely unknown.
Medicaid Payments for Nursing Services at Home
Another important aspect of the new law are the provisions intended to end Medicaid’s bias to provide nursing home level of care only in nursing homes rather than for care at one’s home (Act. Sec. 2406(a) of the Affordable Care Act). While this appears at first to be promising, what was actually passed was simply a promise for the next congressional session to address this issue. It is entirely uncertain whether Congress will address this issue and better effectuate the Supreme Court decision in Olmstead v. L.C. (1999) that provided that individuals with disabilities have the right to receive their long term services and support in the community rather than in an institutional setting. For Maryland purposes, such a waiver program exists (i.e. Medicaid or Medical Assistance Waiver). However, it is poorly underfunded with a waiting list measured in years with no realistic application for those folks needing nursing home level of services at their home.
Nursing Home Rating System
A good move with potential impact over the next several years is the directive issued to the Government Accountability Office to conduct a study on the Five-Star Quality Rating System of nursing homes issued by the Center for Medicare and Medicaid Services (Act. Sec. 6107). This launched in December 2008 gives nursing homes a rating between one and five stars. A five-star designation means the facility ranks “much above average” compared to other facilities in its state, while a one-star designation means that a facility ranks “much below average” in the state. The concern over the accuracy and reliability of the rating system was so pronounced that attorney generals from over 30 states sent a letter to CMS asking them to suspend the program. The idea of a five star rating system is ideal for many seniors and their families. Insuring their accuracy and reliability is only in the best interest of members of our elderly population. The administration hit a home run with this section.
This is but a sampling of the various impact items. As greater clarity exists and its precise impact on Maryland seniors is known, it will be posted here.