Financing Long-Term Care
The Community Living Assistance Services and Supports (CLASS)
Act, enacted as a part of health care reform on March 23, 2010, is
a voluntary nationwide long-term services and supports financing
program for persons with disabilities and seniors with chronic illness.
in its current form, the CLASS program bears little resemblance to
Medicaid, the government program that has dominated long-term care
financing since 1965. Consider the differences:
So, hurray for the CLASS Act’s goals!
What remains to be seen, however, is
whether it will resolve or aggravate
shortcomings in the current system. how did the united states come to have a welfare-based long-term care system that serves so few people well?
■ ■ While Medicaid is a means-tested
public welfare program, CLASS
is social “insurance” into which
people pay premiums and earn
“entitlement” to benefits.
■ ■ While Medicaid pays mostly
for nursing home care, CLASS
provides funds that can be used
for “long-term services and
supports,” including home and
■ ■ While Medicaid reimburses care
providers directly, CLASS puts
money into the hands of patients
and their families to purchase care
as they see fit.
■ ■ While Medicaid has different
benefits and eligibility rules in
every state, CLASS is consistent
throughout the nation.
C L A S S
■ ■ While Medicaid shortchanges
younger disabled people in favor of
frail and infirm elders, CLASS targets
the working disabled for coverage.
The CLASS program, in fact, attempts to correct or ameliorate major
problems with America’s long-term
care service delivery and financing system—problems that often are associated
causally with Medicaid. These include
limited access to care, dubious quality,
inadequate provider reimbursements,
discrimination against Medicaid recipients, institutional bias, and the loss of
independence and control.
the root of the Problem
One of the biggest mistakes policy analysts and legislators make is attacking the
symptoms of social problems instead of
their causes. The only way to avoid that
error is to understand how those problems came to exist in the first place. How,
for instance, did the United States come
COCO MASUDA / STOCk iLLUSTRATiON SOURCe