Policy and Research Needs to Maximize Independence and Support Community Living Workshop Summary (2016) / Chapter Skim
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5 Financing to Support Community Living
5 Financing to Support Community Living
Pages 55-68
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From page 55... ...
. OPTIONS FOR FINANCING TO SUPPORT COMMUNITY LIVING Richard G
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From page 56... ...
Medicaid LTSS users are in the very lowest income brackets, while LTSS users who incur these costs out of pocket are typically in the highest income brackets. While Frank said this is not surprising, it does explain some of the patterns of insurance purchasing observed today.
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From page 57... ...
The final aim Frank offered was that new models of delivery and their associated payment models should support opportunities to innovate in the areas of assistive technologies and ways of integrating housing and supports. It is also important to recognize that there is an existing safety net program for lower-income individuals that provides meaningful levels of support for some services, Frank added.
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From page 58... ...
The nation is spending 1 The Patient Protection and Affordable Care Act established the Community Living Assistance Services and Supports (CLASS) program -- a fed rally administered, voluntary e insurance program to help workers age 18 years and older pay for long-term services and supports in the event of a disability.
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From page 59... ...
Garner's hope is that electronic health records will eventually be able to house data that can provide this more in-depth picture of individuals with disabilities, although she said that, in her opinion, these useful data are more likely to come in the near term from the insurance industry than from the federal government. Relatedly, one of the challenges of developing the CLASS Act was that the assumptions about individuals with disabilities kept changing.
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The result of this process was a disability insurance model to cover people ages 65 and under, although the country is now extending it to the over-65 population. Australia appropriated several billion dollars in 1 year to create a self-directed disability insurance program that provides an annual capped dollar amount for LTSS.
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From page 61... ...
According to data from the National Health and Aging Trends Study, 60 percent of people who live in the community and have need at a high enough level that they receive paid care report adverse consequences associated with unmet needs (Freedman and Spillman, 2014)
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The hospitalist discovered she was living alone with severe cognitive impairment and eating spoiled food that was causing her gastrointestinal distress; she did not have an underlying chronic condition. Tumlinson said that she believes this type of scenario is what is happening in the health care side of the care delivery system and that it is being driven by a lack of services on the long-term care side of the delivery system.
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From page 63... ...
The LeadingAge Pathways Group, The SCAN Foundation, and AARP are funding a project in which the Urban Institute will analyze how a broad range of insurance options to cover the risk of needing LTSS might affect out-of-pocket spending, Medicaid spending, and coverage. Options include administering the program through a public or federal government system versus a private insurance system; creating a program that is voluntary versus mandatory; or having a model that is cash-based versus services-based.
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From page 64... ...
Garner replied that the ABLE Act was designed to help families save money so that a family member with a disability would have financial resources he or she could use for disabilityrelated expenses without sacrificing Medicaid benefits or other federal entitlements. Garner also noted that the ABLE Act has a limitation that the disability onset has to be before the beneficiary reaches age 26, a limit driven by cost estimates.
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From page 65... ...
Policy Barriers The facilitated table discussions produced the following list of policy barriers for financing to support community living, as noted by the table rapporteurs. Federal Programs • Federal funding of programs to support community living var ies between states, and the delivery system allocations of funds within states differ (Parks)
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From page 66... ...
Research and Policy Priorities The facilitated table discussions produced the following list of research and policy priorities to inform financing for community living, as noted by the table rapporteurs. Areas for Additional Research • Study public and political apathy about LTSS financing, particu larly generational differences (Parks)
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Best Practices The facilitated table discussions produced the following list of best practices, as noted by the table rapporteurs. Program at the Federal Level • The ABLE Act (see Discussion section)
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68 POLICY AND RESEARCH NEEDS TO SUPPORT COMMUNITY LIVING Possible Approaches • Cash-and-counseling models and other self-directed models, used both in the United States and internationally (Patterson) • International models that include public–private partnerships, such as Australia, Denmark, and Philippines have (Brady, Darkins)
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