Provisions for Long-Term Care

The Patient Protection and Affordable Care Act, the health care reform law, includes provisions that will allow more people to receive long-term care at home rather than in a nursing facility or another institution.

The Patient Protection and Affordable Care Act, the health care reform law, includes provisions that will allow more people to receive long-term care at home rather than in a nursing facility or another institution.

Community Living Assistance Services and Supports (CLASS) Program
The law establishes the CLASS program, a national long-term care insurance program which will provide a cash benefit to enrollees for the purchase of long-term care services. An individual must be 18 or older to enroll. In order to receive benefits, an enrolled individual must:
• Be unable to perform activities of daily living; and
• Have paid premiums for at least five years.

State Balancing Incentive Payments Program
The law creates the State Balancing Incentive Payments Program to provide additional federal Medicaid money to states which currently spend less than 50 percent of their total Medicaid long-term care expenditures on home- or community-based care (HCBS). In order to receive the funds, a state must submit a plan to the federal government outlining how it will expand coverage for HCBS and, if approved, the state may not make eligibility requirements for HCBS more restrictive than they are as of December 31, 2010. Participating states must also:
• Establish a simple, central information system for individuals seeking long-term care;
• Provide conflict-free case management services for individuals who need long-term care; and
• Establish a state-wide standardized assessment for HCBS eligibility.
The program duration is from October 1, 2011 through September 30, 2015.

Community First Choice Option
The health care reform law establishes a program called the “Community First Choice option.” States may choose to participate in this program for purposes of providing community-based supports and services to individuals with disabilities who:
• Are Medicaid-eligible;
• Require an institutional level of care; and
• Have income below 150 percent of the federal poverty level (unless the state’s income eligibility standard for nursing facility care is higher, in which case the state may apply the latter).
States may use program funding to cover:
• Assistance with activities of daily living;
• Health related tasks; and
• Transition costs (rent/utility deposits, first month’s rent and utilities, bedding; basic kitchen supplies) for an individual currently living in a nursing facility who moves into the community.
States that choose to participate will be eligible to receive additional federal Medicaid money for the program’s expenses. Community First Choice is a five year program which starts on October 1, 2011.

Money Follows the Person
The law extends federal funding for the Medicaid Money Follows the Person (MFP) program through September 2016. The MFP program provides a financial incentive to states to help Medicaid-enrolled individuals to move out of nursing facilities and into the community.
Under MFP, Medicaid coverage follows the person to the community and pays for the home and community-based services they require. The law also reduces from 180 days to 90 days the amount of time an individual must reside in a nursing facility in order to qualify for the MFP program.
Extension of Spousal Impoverishment
Protections to HCBS
Federal law requires that the spouse of any Medicaid-enrolled nursing facility resident be allowed to keep a minimum share of the couple’s combined income and assets. The law mandates that from January 1, 2014 until December 31, 2019, states must extend these spousal impoverishment protections to participants in HCBS waiver programs, the HCBS state plan benefit, and Community First Choice benefit. It also requires that spouses of all HCBS waiver participants, including those who qualify as medically needy, receive the protections.

Additional Funds for Aging and Disability Resource Centers (ADRCs)
The health care reform law authorizes
$10 million per year in additional federal funds for state ADRC programs from 2010 through 2014

This information is provided as a public service and is not intended as legal advice. Such advice should be obtained from a qualified Elder and Special Needs Law attorney.

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About the National Academy of Elder Law Attorneys (NAELA)

Members of the National Academy of Elder Law Attorneys (NAELA) are attorneys who are experienced and trained in working with the legal problems of aging Americans, individuals of all ages with disabilities, and their families. Established in 1987, NAELA is a non-profit association that assists lawyers, bar organizations and others. The mission of NAELA is to establish NAELA members as the premier providers of legal advocacy, guidance and services to enhance the lives of people with special needs and people as they age. NAELA currently has members across the United States, Canada, Australia and the United Kingdom.

About Elder and Special Needs Law

Elder and Special Needs Law are specialized areas that involve representing, counseling and assisting seniors, people with disabilities and their families in connection with a variety of legal issues, with a primary emphasis on promoting the highest quality of life for individuals. Typically, Elder Law and Special Needs Law address the convergence of legal needs with the social, psychological medical and financial needs of individuals. The Elder Law and Special Needs Law attorney handles estate planning and counsels clients about planning for incapacity with health care decision-making documents. The Elder and Special Needs Law attorney also assists clients in planning for possible long-term care needs, including at-home care, assisted living or nursing home care. Locating the appropriate type of care, coordinating public and private resources to finance the cost of care and working to ensure the client’s right to quality care are all part of the Elder and Special Needs Law practice.



National Academy of Elder Law Attorneys (NAELA)
Non-profit association for attorneys specializing in Elder Law and Special Needs Law
Established in 1987
Over 4,200 members nationwide
Mailing Address
National Academy of Elder Law Attorneys (NAELA)
1577 Spring Hill Rd., Suite 220
Vienna, VA 22182  
General Contact Information
Phone: 703-942-5711*
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*Please note NAELA's office staff CANNOT assist the public with their legal needs. Please seek the advice of a professional and go to NAELA's member directory for advice.