Home care: A Rare Display of Bipartisanship

Let's face it. If you turned on CNN or FoxNews right now, you would find plenty of evidence to suggest that we are currently a nation that is politically, economically, ideologically, and socially divided. Our politics are ugly, and our politicians on both sides of the aisle can be hostile. However, what's left off the front page headlines are the rare cases of bipartisan agreement and issues that both sides agree on. One of those issues is home care.

Two years ago, Senator Ben Cardin (D-Md.) and Senator Chuck Grassley (R-IA) proposed a bipartisan bill to fund a pilot program that would test-drive expanding Medicare coverage for lower-income Medicare patients for services that are not currently considered traditional healthcare. In the home health care industry, we would call these supports personal care services which are provided by personal care assistants (PCAs). Many Medicaid patients are eligible for these services, but not Medicare patients, who arguably need a PCA the most.

This bill remained stuck in Congress for two years before it was reintroduced this past February. Sadly, the healthcare debate in our country has become so politicized that the only real debates that take place are whether one is for or against Obamacare. The bipartisan Cardin-Grassley bill is one that should be discussed more openly instead of remaining buried in the pages of the Congressional ledger.

Seniors are some of our country's most active political participants, voting at a higher rate than many other age brackets. If Medicare patients knew that expanded coverage for important services was a real topic of debate in Congress, then perhaps they could use their voting power to put pressure on lawmakers to actually bring this bill up for a vote, instead of seeing it remain on some metaphorical desk, buried under a pile of papers. Considering this bill is co-sponsored by a Democrat AND a Republican, you can assume that the well-being of our country's elderly population is one of the few opportunities where Democrats and Republicans may be able to come together and actually agree on something.

For more information, see the press release from Senator Cardin and Senator Grassley below.

WASHINGTON – Senator Ben Cardin (D-Md.) and Senator Chuck Grassley (R-IA)today re-introduced their bipartisan legislation allowing older Americans to receive individualized care that would help them continue to stay in their own homes rather than nursing homes.

“Allowing seniors to age in place, to stay in their homes as long as possible, takes an enormous financial and emotion burden off of families,” said Cardin, a member of the Senate Finance Health Care Subcommittee. “Community-based services are proven to be cost-effective, culturally-responsive, and allow older Americans to receive essential support that is tailored to their unique needs. As our nation continues to age and grow, our legislation will help ensure that Medicare beneficiaries are able to live fulfilled lives and successfully manage medical conditions with dignity.”

“I’ve never met anyone who can’t wait to move into a nursing home,” said Grassley, a member of the Senate Finance Committee. “Everybody wants to stay in their own homes as long as they can, with the comforts of home. Unfortunately, our current system doesn’t have a bridge for those who are on a fixed income but would have to sell their house to become eligible for Medicaid and get nursing home care. Our bill sets up a demonstration project to build a bridge for those who need care but otherwise would have to go to a nursing home to get it.”

Today, the federal government does not pay for long-term services and supports, unless an individual is poor enough to be on Medicaid. What frequently happens is that seniors on Medicare go into a nursing home, spend down their assets and then go on Medicaid for their long-term care. These seniors don’t want to be in an institution, and they don’t want to be on Medicaid. But that is what the system forces upon them.

The Grassley-Cardin bill would establish a new Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program. This program would target home- and community-based services for low-income, Medicare-only beneficiaries who need help with two or more activities of daily living, the usual criteria for nursing home eligibility.

The goal is to prevent these Americans from having to enter an institution and spend down their remaining assets, thereby becoming eligible for Medicaid. It would help them remain in their own homes where studies show they wish to remain.

The demonstration would operate in up to five states initially, building on Medicare Advantage plans that have experience caring for this frail population. The plans would tailor services to beneficiaries, depending on individual needs. For instance, they might provide assistance with bathing or dressing, housekeeping or transportation, or even respite care for their primary caregiver.

The demonstration would generate evidence to support an alternative payment methodology that could produce savings for both states and the federal government. One estimate shows four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members by postponing or preventing hospitalization and institutionalization.

Cardin and Grassley said the legislation will give hope to some of the nation’s most vulnerable individuals and at the same time offer a path toward state and federal budget savings.

The text of the Community Based Independence for Seniors Act, S. 309, is available here.

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