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March 23 marks the two-year anniversary of the passage of the Affordable Care Act (ACA). While some Americans remain confused about what exactly this law really means for them and their families, and others disregard it as just another big political fight, the impact on many direct-care workers has been and will continue to be positive.

Because of the ACA, direct-care workers can no longer have their pre-existing conditions held against them by a health insurance company. They can keep their adult children covered under their employer-provided plan up to the age of 26. And those who get their insurance coverage from Medicare no longer have to pay out of pocket for preventive services.

The ACA has meant better health, better care, and in some cases, a few more dollars in the pockets of direct-care workers. For them, the ACA is not confusing or political — it’s real, and it’s about health and security.

More Health Benefits to Come

Millions of low-income women, including direct-care workers, will continue to benefit as ACA provisions are implemented between now and January 2014. These include:

• The expansion of community health centers that serve low-income communities.
• Expanded Medicaid coverage that will make health care affordable for hundreds of thousands of direct-care workers.
• Public subsidies that will help make health insurance premiums less expensive for those who don’t qualify for Medicaid.
• Free coverage for women’s preventive health care, including birth control.
• An end to discriminatory practices that make insurance premiums at least a third more expensive for women than for men.

Improving Direct-Care Jobs and Care

In addition to greatly expanding access to affordable coverage for direct-care workers, the ACA is improving the quality of direct-care jobs and care for elders and people with disabilities. For example:

• Six states have received three-year grants to develop core competencies, pilot training curricula, and test the viability of certification programs for personal and home care aides.
• More than 30 states developed comprehensive health care workforce development strategies using ACA grants.
• New transparency rules are making information about direct-care worker wages and benefits, staffing levels, and turnover in nursing homes available to the public.
• Training for certified nurse assistants includes new requirements for learning about dementia and abuse prevention.
• States have received additional funding to transition individuals out of nursing homes into their homes or in the community.
• Demonstration programs testing new models of care coordination — including new roles for direct-care workers — are being funded by an innovation center at the U.S. Department of Health and Human Services.

Expanded coverage, new training opportunities for direct care workers, and investments that build an aging and disability services infrastructure to better serve consumers — these are all positive outcomes of the ACA.

But there’s more work to do. Some in Congress have been chipping away at the law, and further budget cuts could undermine implementation, particularly the expansion of the Medicaid program. And the Supreme Court will hear challenges to the individual mandate and the Medicaid provisions in the ACA starting March 26, with a decision expected this summer.

Over the next 18 months, it will be important to remain vigilant, and to remind friends, family, and colleagues that the Affordable Care Act is already providing better care, at lower costs, to millions of Americans.

– by Carol Regan, PHI Government Affairs Director

Kathy Greenlee, Assistant Secretary for Aging, HHS

Assistant Secretary of Aging Kathy Greenlee, who heads up the CLASS Office, announced in a September 28 blog post that the U.S. Department of Health and Human Services (HHS) would be releasing a report and recommendations in mid-October about how to proceed with the CLASS program.

This announcement came after a week of media coverage on the CLASS program left many people in doubt as to whether the voluntary long-term care insurance program created under the Affordable Care Act (ACA) would be implemented in 2012 as planned.

HHS tried to counter reports that the CLASS office was closing, after an actuary from the program disclosed this information in an email that was picked up by the press.

HHS said the staff at the CLASS office was being “reduced,” and reiterated that they were still determining whether the program was “fiscally solvent and self-sustaining into the future,” as the law requires.

Greenlee says in her blog that “we are looking at the CLASS program from every angle.”

She said that a report from the program’s actuaries that provide an “actuarial analysis of a number of potential CLASS benefit plans” would be part of a “comprehensive review of our work on CLASS over the last 18 months.”

Personal Care Attendants Workforce Advisory Panel

The future of the Personal Care Attendant (PCA) Workforce Advisory Panel, which was mandated by a provision in the ACA under the CLASS Office, is still unknown.

The members of the panel were to be announced one year ago. The panel is responsible for advising Congress on the adequacy of the number of personal care aides, their wages and benefits, and access to their services.

– by Deane Beebe

President Obama signing health reform into law, March 23, 2010

March 23 marks the first anniversary of the passage of the health reform law.

The Patient Protection and Affordable Care Act (PPACA) and its companion legislation, the Health Care and Education Act of 2010, have already begun to make health coverage more accessible and change how health care is delivered in the United States.

Dozens of organizations throughout the nation, including the National Council on Aging, National Partnership for Women and Families, and Small Business Majority, are sponsoring events to celebrate the anniversary. The events will highlight the many protections afforded under health reform to people with low incomes, women, children, the elderly, people with pre-existing health conditions, and small businesses.

The “Moving Forward” events will be organized around the following themes:

• March 21: Protecting Small Business’s Care
• March 22: Protecting Seniors’ Care
• March 23: Protecting Patients’ Rights
• March 24: Protecting Women’s Care
• March 25: Protecting Young Adults’ Care

Details of the events will be released before each day. Contact Carol Regan, PHI director of government affairs and the Health Care for Health Care Workers campaign, for event information.

Health Reform and Direct-Care Workers

While the health reform law contains many general provisions that benefit direct-care workers, some of the items specifically address community-based long-term care services and support the direct-care workforce, including:

• Demonstration grants to develop and pilot competency-based training curricula for personal and home care aides.
• Establishment of a Personal Care Attendant Advisory Panel at the Department of Health and Human Services (HHS) as part of the creation of the new voluntary long-term care insurance program called the CLASS Act.
• Additional demonstration provisions to extend the Money Follows the Person rebalancing demonstration, Independence at Home demonstration program, and community-based collaborative care networks and transition programs (pdf).
• Grants to provide career ladders for new and incumbent workers and to help state develop comprehensive health care workforce development strategies (pdf).

Health Reform Law Resources

Visit the PHI Health Reform Resource Center and Health Care for Health Care Workers websites for more information about the law, including the Health Reform Fact Sheet series and a complete PHI summary of direct-care workforce and long-term care provisions (pdf).

– by Deane Beebe

The Friday Morning Collaborative is hosting the second webinar in its series to provide information and resources that may assist state advocates in preventing cuts to home and community-based services (HCBS), while promoting the adoption of new options in the Affordable Care Act.

“Cost Effectiveness of Home and Community Based Services” will take place on March 25 from 2:00 to 3:30 PM EST.

Speakers will include:

• Stephen Kaye, Center for Personal Assistance Services, University of California San Francisco;
• Lisa Alecxih, The Lewin Group;
• K. Charlie Lakin, Research and Training Center on Community Living, University of Minnesota; and
• Dee Mahan, Families USA.

Due to limited space, anyone interested in participating should register early and share lines when possible. The webinar will also be recorded and made available for viewing following the event.

A recent AARP Public Policy Institute report documents how state budget cuts caused by the economic recession pose a serious threat to long-term care services for elders and individuals with physical disabilities.

The webinar series was kicked off in February with “State Budgets: Challenges and Opportunities for Home and Community Based Services.” The series is made possible with support from The Scan Foundation.

The Friday Morning Collaborative — of which PHI is a member — is a national coalition of aging and disability organizations working together to protect and strengthen Medicaid Home and Community Based Services (HCBS).

– by Deane Beebe

The House Committee on Energy and Commerce is holding a hearing on the CLASS Act entitled “The Implementation and Sustainability of the New, Government-Administered Community Living Assistance Services and Supports (CLASS) Program.”

Here are the details on this public event:

Thursday, March 17
9:30 am EST
2322 Rayburn House Office Building
Independence Avenue and South Capitol Street
Washington, DC

Kathy Greenlee, assistant secretary, Administration on Aging, and William Minnix, Jr., chair of Advance CLASS and CEO of LeadingAge, are among the witnesses testifying in support of the CLASS Program.

Advanced CLASS Executive Director Connie Garner issued a statement noting that “HHS is still working on the program design and the group hopes that critics will reserve judgment until the work is complete.”

Advocates are encouraging supporters of the CLASS Program to attend the hearing.

Additionally, Families USA (pdf) is providing a toll-free telephone number, 888-876-6242, that CLASS supporters can call to let members of the House Committee on Energy and Commerce know that 1) CLASS will be invaluable to people with disabilities and older adults in need of long-term services and supports, and 2) according to law, the program will be self-sustaining.

– by Deane Beebe

Many governors are requesting a repeal of the Affordable Care Act‘s maintenance of effort (MOE) provisions, which prohibit states from making changes in Medicaid and State Children’s Health Insurance Program (CHIP) eligibility requirements until 2014 for adults and 2019 for children.

Consumer advocates across multiple constituencies, however, support the MOE provisions and are mobilizing to keep them in place and to counter other efforts to cut Medicaid services.

At The Consequences of Obamacare: Impact on Medicaid and State Health Care Reform, a hearing held by the House Energy and Commerce Committee on March 1, governors Haley Barbour (R-MS) and Gary Herbert (R-UT) requested that the federal government eliminate the MOE provisions.

In contrast, Governor Deval Patrick (D-MA) highlighted (pdf) the success of his state’s health care reform law, which is similar in many ways to the Affordable Care Act.

Mobilizing to Keep MOE Intact

Dozens of advocates, including PHI, voiced opposition to weakening the MOE provisions in a letter (pdf) to the U.S. House of Representatives.

During economic downturns like the current recession, Medicaid and CHIP play a critical role in maintaining access to health care and long-term services and supports for millions of children, elders, and people with disabilities, the advocates wrote. Although state budget problems are serious and warrant attention, advocates say that reducing access to critical services is the wrong response.

More information about why the MOE provisions are important to elders and people with disabilities has been provided by Families USA (pdf) and the Center for Budget and Policy Priorities (pdf).

Tackling Medicaid State Budget Cuts

Advocates are also working to scale back proposed state budget cuts to Medicaid services.

As many as 350 advocates from 48 states participated in the first of a series of webinars hosted by the Friday Morning Collaborative, a network of aging and disability advocates in which PHI participates, on February 25.

The webinar, State Budgets: Challenges and Opportunities for Home and Community Based Services (registration required), featured presentations by Judy Solomon, Center on Budget and Policy Priorities; Wendy Fox-Grage, AARP Public Policy Institute; Jerry Reilly, Eldercare Alliance–Washington State; and Diane Justice, National Academy for State Health Policy.

The Friday Morning Collaborative, which is led by the National Council on Aging and funded by The SCAN Foundation, just launched an online community to share resources (registration required). Medicaid cuts are a serious concern for aging and disability advocates and providers, especially as waiting lists for Medicaid home and community based long-term services and supports grow.

– by Gail MacInnes, PHI National Policy Analyst