The health care reform bill signed into law March 23 by President Barack Obama contains strong provisions for increased access to home-based care for older adults and people with disabilities. LEAP’s Center for Public Policy advocated for the most high-profile of these provisions, the Community Living Assistance Services and Supports (CLASS) Act.

Originally a separate piece of legislation, the CLASS Act was opposed by the long-term care insurance industry, said Deborah Nebel, LEAP’s director of public policy. “Inclusion of the CLASS Act in health care reform was a victory for persons with disabilities,” Nebel said. “Advocates broadened the national debate to include long-term care, so that health care is seen now as extending from cradle (and even before with prenatal care) to grave. By including the CLASS Act, there was a recognition that health care is not just about preventative care, or acute care, or covering the uninsured, but about the whole life span.”

Roughly 9 out of 10 senior adults hope to “age in place,” according to surveys done by the American Association of Retired People (AARP), but in many instances, health issues eventually force them to live in nursing facilities. The same fate often befalls younger adults with disabilities.

Currently, the Medicaid program is the only way for many people to gain coverage for home-based services that would allow them to remain independent. These supports and services are provided primarily through Medicaid Waivers. Unfortunately, Ohio spends 76 percent of its long-term care dollars on institutional care and only 24 percent on home- and community-based care like waivers.

Beginning in January 2011, CLASS will help address this situation.

A private-public partnership, CLASS will assist individuals by providing insurance payments when a person expects to have a disabling condition for at least 90 days. The program will be funded by individual premiums and will pay enrollees who need daily assistance at least $50 per day for home care. The amount will be increased for higher levels of disability. CLASS requires enrollees to be employed and pay into the system for five years before they are eligible for benefits. CLASS funds can also be used to pay for transportation, adult day care, and such safety features as grab bars, handrails, and wheelchair ramps. They can also be used to help pay for assisted-living facilities and nursing homes. Employees who do not wish to participate must opt out of the program.

Nebel said that under the CLASS Act, people cannot be denied coverage for preexisting conditions, and there are no financial caps on benefits. CLASS includes protections ensuring the program will be solvent for 75 years and could result in Medicaid savings over the long term.

To help ensure passage of health care reform, Nebel said LEAP undertook a number of initiatives. Nebel spoke with Ohio’s members of Congress, and she joined the larger disability community to advocate for the inclusion of the CLASS Act provisions in the final bill. LEAP also mobilized its network of advocates, asking them to contact legislators and to educate the general public about the issue. Finally, whenever she was at a meeting where health care reform came up, Nebel brought up the CLASS Act. “Let me tell you about an aspect of reform that will benefit everyone,” she’d say. “This provision gives people choice and responsibility and gives them a way to plan for their own futures.”

No one was happier than Nebel when President Obama signed the historic legislation.

“The time has come for a national program like this, one that will promote independence, responsibility, choice, and family unity in a fiscally responsible way,” Nebel said.