In 2010, the Affordable Care Act (ACA) became a law and significant US healthcare system reforms came with it. Ultimately, the goal was to improve healthcare quality, expand affordable care access and decrease healthcare costs overall. While the law’s primary focus is preventative and primary care, there are long-term care implications involved too. Learning more about the coverage, impact and challenges pertaining to long-term care is essential to ensure that you can fully take advantage of what is available.
Understanding the Basics of Long-Term Care
Long-term care is a variety of support methods and services that assist individuals with disabilities, chronic illnesses and cognitive impairments to meet their daily needs. This level of care aids people with their activities of daily living, such as dressing, toileting, bathing, eating and mobility. It also helps with instrumental activities of daily living, such as housekeeping, transportation, meal preparation, medication management and financial management.
Individuals can receive long-term care in numerous settings. Assisted living facilities provide individuals with meals, housing, supportive services and ADL assistance in a setting that is like home. People are able to live independently while still getting help when they need it.
Nursing homes are another long-term care option for those that need more skilled care for complex medical needs. At these facilities, not only do individuals get assistance with their ADLs, but also with rehabilitation services.
Home care is another long-term care method. It allows someone to remain in their home while getting help with their daily needs from professional and family caregivers. Individuals who need daytime supervision might also benefit from adult daycare. This provides supportive and social activities for those with disabilities and older adults.
How the ACA Impacts Long-Term Care
There is no specific focus on long-term care with the ACA, but it did include provisions that have an indirect impact on this level of care. One element of the ACA was the expansion of Medicaid. This involved increasing eligibility to millions more adults throughout the country, many of which needed long-term care. In the US, the primary long-term care payer is Medicaid.
The Community First Choice Option was authorized by the ACA. It makes it possible for states to provide disabled Americans on Medicaid with home and community-based services and nursing home care (HCBS). The goal is to allow disabled individuals with more independent living solutions.
The Balancing Incentive Program is another ACA option which gives states more federal funding for HCBS services so that there is less need for institutional care. It helps to enhance access to community-based and home services for those who receive Medicaid.
Under Medicare, the ACA provides expanded preventative services coverage, including yearly chronic health condition screenings and wellness visits. This can help to reduce the need for long-term care by addressing health issues in the earlier stages.
Long-Term Care Coverage Options
There are a few coverage options that individuals might qualify for to access long-term care. Medicaid is the biggest payer for these services and may help to provide coverage for home health services, HCBS, nursing home care and personal care assistance. People need to demonstrate a need for these services and meet asset and income limitations. The long-term care benefits covered by Medicaid vary by state.
Medicare may provide some coverage for long-term care for home health services or a skilled nursing facility after someone has a hospital stay. It is not uncommon for individuals to need to supplement their Medicare benefits to cover long-term care using methods, such as private long-term care insurance, Medicaid or paying out-of-pocket. The coverage that Medicare does cover is usually limited to only as long as someone requires additional rehabilitation or treatment. Once they are medically cleared, they likely will receive no more long-term care coverage for ongoing personal needs.
A range of long-term care options is usually part of a private long-term care insurance plan, including assisted living, adult day care, nursing home care and home care. The benefit levels, eligibility criteria, coverage options and premiums will vary based on your plan. It is imperative to compare coverage options and review policy terms carefully to ensure that the chosen plan meets your budget and needs.
People with significant financial resources and those who do not qualify for Medicaid may have to explore self-payment options, such as payment plans, to cover long-term care expenses. In these cases, a combination of self-payment and unpaid family care giving might be necessary to ensure adequate long-term care.
Long-Term Care Challenges
Those who are unable to qualify for Medicaid may find challenges with affordability. Many people on Medicaid are unable to get private long-term care insurance since they cannot handle the associated costs. This could make it difficult to afford long-term care without experiencing a significant financial hardship.
Workforce shortages are another challenge for long-term care. There is a significant shortage of trained caregivers, including home health aides, direct support professionals, nurses and personal care attendants. Such shortages can make it difficult for people to get the long-term care that they require.
The ACA may help some people get better access to long-term care, but there are no provisions for care coordination. Because of this, the services are generally poorly coordinated and fragmented, causing duplication of services, gaps in care and care delivery inefficiency. To optimize health outcomes and ensure continuity of care, better care coordination is necessary for long-term care services.
Long-term care quality tends to vary widely due to issues with training, staffing and regulatory compliance. Policymakers, advocates and providers are constantly working to improve care quality in long-term settings, and this remains a priority for those receiving Medicaid and those utilizing other coverage options.
Those seeking long-term care by utilizing the ACA should ensure that they fully understand what is available. This will enable you to understand what the limitations are and how to fully take advantage of the benefits. Make sure that you are working with your doctor so that they can aid you in navigating the long-term care process.
In 2010, the Affordable Care Act (ACA) became a law and significant US healthcare system reforms came with it. Ultimately, the goal was to improve healthcare quality, expand affordable care access and decrease healthcare costs overall. While the law’s primary focus is preventative and primary care, there are long-term care implications involved too. Learning more about the coverage, impact and challenges pertaining to long-term care is essential to ensure that you can fully take advantage of what is available.
Understanding the Basics of Long-Term Care
Long-term care is a variety of support methods and services that assist individuals with disabilities, chronic illnesses and cognitive impairments to meet their daily needs. This level of care aids people with their activities of daily living, such as dressing, toileting, bathing, eating and mobility. It also helps with instrumental activities of daily living, such as housekeeping, transportation, meal preparation, medication management and financial management.
Individuals can receive long-term care in numerous settings. Assisted living facilities provide individuals with meals, housing, supportive services and ADL assistance in a setting that is like home. People are able to live independently while still getting help when they need it.
Nursing homes are another long-term care option for those that need more skilled care for complex medical needs. At these facilities, not only do individuals get assistance with their ADLs, but also with rehabilitation services.
Home care is another long-term care method. It allows someone to remain in their home while getting help with their daily needs from professional and family caregivers. Individuals who need daytime supervision might also benefit from adult daycare. This provides supportive and social activities for those with disabilities and older adults.
How the ACA Impacts Long-Term Care
There is no specific focus on long-term care with the ACA, but it did include provisions that have an indirect impact on this level of care. One element of the ACA was the expansion of Medicaid. This involved increasing eligibility to millions more adults throughout the country, many of which needed long-term care. In the US, the primary long-term care payer is Medicaid.
The Community First Choice Option was authorized by the ACA. It makes it possible for states to provide disabled Americans on Medicaid with home and community-based services and nursing home care (HCBS). The goal is to allow disabled individuals with more independent living solutions.
The Balancing Incentive Program is another ACA option which gives states more federal funding for HCBS services so that there is less need for institutional care. It helps to enhance access to community-based and home services for those who receive Medicaid.
Under Medicare, the ACA provides expanded preventative services coverage, including yearly chronic health condition screenings and wellness visits. This can help to reduce the need for long-term care by addressing health issues in the earlier stages.
Long-Term Care Coverage Options
There are a few coverage options that individuals might qualify for to access long-term care. Medicaid is the biggest payer for these services and may help to provide coverage for home health services, HCBS, nursing home care and personal care assistance. People need to demonstrate a need for these services and meet asset and income limitations. The long-term care benefits covered by Medicaid vary by state.
Medicare may provide some coverage for long-term care for home health services or a skilled nursing facility after someone has a hospital stay. It is not uncommon for individuals to need to supplement their Medicare benefits to cover long-term care using methods, such as private long-term care insurance, Medicaid or paying out-of-pocket. The coverage that Medicare does cover is usually limited to only as long as someone requires additional rehabilitation or treatment. Once they are medically cleared, they likely will receive no more long-term care coverage for ongoing personal needs.
A range of long-term care options is usually part of a private long-term care insurance plan, including assisted living, adult day care, nursing home care and home care. The benefit levels, eligibility criteria, coverage options and premiums will vary based on your plan. It is imperative to compare coverage options and review policy terms carefully to ensure that the chosen plan meets your budget and needs.
People with significant financial resources and those who do not qualify for Medicaid may have to explore self-payment options, such as payment plans, to cover long-term care expenses. In these cases, a combination of self-payment and unpaid family care giving might be necessary to ensure adequate long-term care.
Long-Term Care Challenges
Those who are unable to qualify for Medicaid may find challenges with affordability. Many people on Medicaid are unable to get private long-term care insurance since they cannot handle the associated costs. This could make it difficult to afford long-term care without experiencing a significant financial hardship.
Workforce shortages are another challenge for long-term care. There is a significant shortage of trained caregivers, including home health aides, direct support professionals, nurses and personal care attendants. Such shortages can make it difficult for people to get the long-term care that they require.
The ACA may help some people get better access to long-term care, but there are no provisions for care coordination. Because of this, the services are generally poorly coordinated and fragmented, causing duplication of services, gaps in care and care delivery inefficiency. To optimize health outcomes and ensure continuity of care, better care coordination is necessary for long-term care services.
Long-term care quality tends to vary widely due to issues with training, staffing and regulatory compliance. Policymakers, advocates and providers are constantly working to improve care quality in long-term settings, and this remains a priority for those receiving Medicaid and those utilizing other coverage options.
Those seeking long-term care by utilizing the ACA should ensure that they fully understand what is available. This will enable you to understand what the limitations are and how to fully take advantage of the benefits. Make sure that you are working with your doctor so that they can aid you in navigating the long-term care process.
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