Transcript What the Affordable Care Act Means for Aging Consumers Alliance for Health Reform Briefing October 1, 2010 JoAnn Lamphere, DrPH Director, State Government Relations Health & Long-term.

What the Affordable Care
Act Means for Aging
Consumers
Alliance for Health Reform Briefing
October 1, 2010
JoAnn Lamphere, DrPH
Director, State Government Relations
Health & Long-term Care Issues
AARP
Significance of
Affordable Health Act
(ACA)
> Affordable Care Act -- most significant federal health and long-term
care legislation since Medicare & Medicaid enacted (1965)
> Unprecedented investment in expanding community-based home
care & social supports and improving infrastructure, building care
models for those with chronic conditions, and improving care quality
> As public understanding grows about ACA, specifically its
investment in community-based long-term services & supports
(LTSS) and improved chronic care models, their support for the law
expands
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Preferences of Aging
Population Misaligned
With Long-term Care
System
> Nearly nine in ten individuals ages 50+ assert they want to stay in their
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homes & communities as long as possible
Becoming a family burden is seniors’ greatest fear
Family caretakers now shoulder the overwhelming responsibility of care;
value of unpaid services = $375+ bil (2008)
Medicaid long-term care spending still is heavily weighted toward institutional
care
Designing patient-centered & coordinated long-term supports & services is a
critical goal to improve system performance given
> dramatic population growth among aged
> constrained public resources
Source: AARP Public Policy Institute
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The Value of Home
and Community-Based
Services (HCBS)
> Medicaid dollars spent on HCBS can support nearly three adults and
individuals with disabilities, on average, for every one person in a nursing
home (AARP Public Policy Institute)
> States that invest in HCBS can, over time, slow their rate of growth in
Medicaid spending on LTC. While expansion of HCBS does require an up
front investment, a reduction in institutional spending and long-term cost
savings results (Kaye, LaPlante, and Harrington, 2009)
> Across USA, public and private sector leaders in health sector designing &
testing expanded and integrated models of community care
> New federal health law supports these developments
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Implementing Care
Improvements Under
ACA
> The ACA provides important opportunities for states to improve the structure
and setting of care, between institutional and HCBS, even in the current tight
fiscal environment
> ACA creates new Medicaid initiatives that offer financial incentives to states
to improve access to HCBS.
• Balancing Incentives Payment Program – 2 or 5 percentage
increase in FMAP
• Community First Choice – consumer-controlled new Medicaid
option, 6% enhanced FMAP, for attendant services
• Money Follows the Person Rebalancing Demonstration grants
• Other
> ACA uses Medicaid to transform health care delivery – health homes,
workforce, quality, care transitions, etc.
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State Implementation
of HCBS Provisions
> States are awaiting CMS guidance so they can evaluate how these options
will interact with each other and current system
> Helpful to have BIPP and CFC guidance at same time so states can look at
together, not in isolation
> How will all the puzzle pieces fit together? States must consider how new
provisions will interact with current state programs (waivers, etc.) and current
fiscal environment
> CMS’ Guidelines will inform states’ thinking on how to implement. Example:
Balancing Incentives Payment Program (2% vs. 5% enhanced FMAP)
• What services are included?
• Definitions of “institutionally based” vs. “non-institutionally based”?
• Population issue – disparities in balance between populations (older people
and adults w/ physical disabilities)
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Achieving the Promise
of Health Care Reform
> Home and community-based services are vulnerable in tough
economic times (Medicaid “optional” services)
> At the state level, required Medicaid population expansions combined
with constrained state revenues and the current “optional” status of
Medicaid HCBS create opportunities to now forge consensus on the
imperative to design new model(s) of community-based services for
long-term care consumers
> Now is the time for creative and bold innovation: encourage the
design & testing of new approaches that are patient-focused and
cost-effective
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