Positive Impacts of the ACA on the Long-term Care Industry
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Solution
Positive Impacts of the ACA on the Long-term Care Industry
Introduction
Health care in America has been on an evolutionary path, particularly in the last decade. As with most matters to do with public policy, health care in America has dramatically been affected by the dominant political atmosphere. Changes in administrative regimes have led to changes in public policy issues, health care included. One of the most significant policy changes to occur in health care over the last decade is the legislation of the Affordable Care Act, popularly known as ‘Obamacare’. The Obama administration conceived the Affordable Care Act with the central aim being to make health care affordable for all Americans, and especially those who need it the most. The Affordable Care Act primarily targets the cost aspect of health care. The impact of the Affordable Care Act on long-term care is evaluated. The aim will be to establish how the act has positively or negatively affected the long-term care industry.
Positive Impacts of the ACA on the Long-term Care Industry
The Affordable Care Act was passed in 2010, with its primary aim being to provide access to affordable health care. According to Health care.gov, the Act had three primary goals. First, it sought to enhance access to affordable health insurance cover for more people. In this regard, the law provides individuals earning incomes that fall between 100% and 400% of the federal poverty level with health subsidies thus lowering the cost of health care. Secondly, the Act also expands the cover of the Medicaid program so that all adults earning below 138% of the federal poverty level are covered. Finally, the act also supports the implementation of innovative health care delivery methods that subsequently lower the cost of health care. The Affordable Care Act targets various frameworks and institutions pertaining to health care, such as Medicare, Medicaid, and state governments. Additionally, the Affordable Care Act also has provisions based on specific domains of care such as in-patient care, chronic care and long-term care.
Long-term care is one of the domains of healthcare in which the Affordable Care Act has occasioned changes. These changes have occurred based on provisions of the Act that impose responsibilities and mandates on various health actors. The first effect of the ACA on the long-term care industry is that it influences the structure of long-term care delivery. According to Caldwell (2016), the ACA provides an opportunity for older people to receive healthcare in their homes rather than in nursing homes and institutions. The ACA facilitates this option through a program known as the Community First Choice (CFC) option. This is an optional program which states can choose to adopt or not. Caldwell indicates that while states are required to cover nursing home care, the coverage of community-based services and supports is optional. Through the CFC, however, older people have an option to make a choice as to where they would receive their care. Ironically, community-based care and home-based care are cheaper in comparison to nursing home care.
As noted, CFC is optional. If a state chooses to adopt CFC, then that states receives (6%) additional federal funding to cater for personal attendant services. Caldwell notes that the additional financing is an important incentive in motivating states to adopt the CFC, mainly because of the initial investment required for the program. States often have to invest in services targeted at home and community-based care, with savings accruing in the long term. As noted, the CFC is optional. Individual states make a decision as to whether or not to adopt the program. Caldwell goes on to indicate that as of 2016, eight states had adopted it while four more were considering adopting it. Given the political nature of this legislation, it is noteworthy that adoption was not based on the political party affiliations of governors.
The effects of the ACA are especially pronounced when it comes Medicaid. The Kaiser foundation carried out an evaluation of changes to long-term services and supports of Medicaid that have resulted from the Affordable Care Act. In particular, the report highlights six opportunities which the ACA has either created or enhanced. Some of the findings of this report are briefly discussed.
The first opportunity addressed in the report is similar to the Community First Choice program that has already been discussed. The program discussed here, however, is slightly different. Titled Money Follows the Person (MFP), this program involves the provision of federal government funding to states to facilitate the transition of Medicaid beneficiaries from institutionalized health settings, and back into their homes or into community-based settings. The shift from institutional settings towards community-based or home-based care settings is similar to the CFC program. The Kaiser Commission states receive funding for 12 months for certain qualified services, for each of the patients who transitions out of an institutional setting (Watts, Musumeci, & Reaves, 2013). This program has also received wider acceptability, having been accepted by 46 states.
The CFC program is also discussed by the Kaiser commission, as one of the new opportunities for states under the ACA. Some of the specifics of this program have already been discussed. The Kaiser Commission report goes on to elaborate that the main aim of the CFC is to provide patients with not just health related assistance (Watts, Musumeci, & Reaves, 2013). Rather, the option also provides states with assistance which targets daily living activities as well as instrumental activities of daily living. States are required to provide such CFC services as opportunities for self-direction, and backup systems. Apart from the CFC, the Kaiser Commission report also indicates that the ACA facilitates a new option for states to provide health home services (Watts, Musumeci, & Reaves, 2013). Some of the services which states can offer patients at home. They include the coordination of care and case management. Currently, 8 states have received approval for home State Plan Amendments (SPAs), with the SPAs of four other states being under review. In addition to these twelve states, the Kaiser Commission reports that a further 3 states have submitted draft proposals, while 16 states have had their funding requests to develop home health spas approved.
Another positive effect of the ACA on long-term care is increased funding for those states that implement structural reforms to facilitate home care and community based long term care as opposed to institutional care. Under this program, states receive additional funding after spending a particular proportion of funding on community based LTSS. For instance, states that spend between 25 to 50 per cent of the LTSS allocation on community based programs receive an additional 2% on their federal medical assistance percentage (FMAP). The ACA increases the federal matching funds available for states by up to $3 billion. Another way in which the ACA improves long term care services for the elderly is through the expansion of the home and community-based services (HCBS) state plan option. The ACA enhances this plan in several ways. First, it increases the prospects of funding by expanding financial eligibility. Secondly, the ACA also creates a new Medicaid eligibility group targeting individuals who would otherwise not be eligible for full Medicaid benefits. Finally, the ACA also expands the services that are available under this option.
Conclusion
Overall, one can argue that the Affordable Care Act has had
a positive impact on the long term care industry. Enacted in 2010, the ACA has
mainly sought to improve the affordability of health care, thereby improving
the access of individuals to health care services. There are numerous ways in
which the ACA has positively affected the long term care services industry. One
of the main mechanisms of improvement has been funding. The ACA has facilitated
greater amounts of funding at the state level, as well as for individuals. At
the state level, the ACA has facilitated greater funding through various
mechanisms. This include the Money Follows the Person (MFP) program, federal
matching funds for budgetary balancing purposes, and Community First Choice
programs. Under these programs, states receive funding to enable home-based
care and community-based care alternatives. The facilitation of these
alternatives is the second way in which the ACA has enhanced the long term care
services industry. The ACA overall promotes home based and community based care
alternatives, in place of institutionalized care. This is through the expansion
of certain existing programs, as well as through the introduction of new ones.
One of the best examples of a new program is the CFC, through which states
receive an additional 6% funding.
References
Affordable Care Act (ACA) – HealthCare.gov Glossary. (n.d.). Retrieved December 10, 2017, from https://www.healthcare.gov/glossary/affordable-care-act/
Caldwell, J. (2016, December 19). Threats to the ACA & Long-Term Care in 2017 – Public Policy Blog. Retrieved December 10, 2017, from https://www.ncoa.org/blog/straight-talk-affordable-care-act-long-term-care/
Watts, M. O, Musumeci, M., and Reaves, E., (April 2013) How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options, The Henry J. Kaiser Family Foundation, available at: http://www.kff.org/medicaid/issuebrief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supportsltss-today-state-adoption-of-six-ltss-options/; updated July 2013.