The Effects of Health Care Reform on Long-Term Care

[This article was originally published on November 19, 2009.  The links were updated on June 12, 2018.]

Most of the discussion about health reform has centered around issues like the "public option" and abortion restrictions. But buried in both the House and Senate reform bills are important provisions that would make long-term care more affordable, help the elderly and disabled remain at home rather than move to a nursing home, and make nursing homes safer for those who have no choice.


ElderLawAnswers has discussed the CLASS Act in earlier articles. This initiative would establish a new national long-term care insurance program offering basic help for the elderly and disabled. After paying a modest monthly premium for five years, Americans would be covered under the program and eligible to receive benefits averaging around $50 a day to pay for a range of long-term care services that would help them stay in their homes, Versions of the CLASS Act are contained in both the health reform bill passed by the House, the Affordable Health Care for America Act, and the bill now being debated in the Senate, the Patient Protection and Affordable Care Act. (For an opinion article calling the CLASS Act "A Flawed But Powerful Game-Changer for Long-Term Care," click here.)

Ending Medicaid's Institutional Bias

The Senate bill contains a number of provisions aimed at ending Medicaid's "institutional bias," which forces elderly and disabled individuals in many states to move to nursing homes because Medicaid won't pay for care that could be provided at home and in the community, often at much less cost.

For starters, the Senate bill includes the Community First Choice Option, which would give states more federal Medicaid money if they set up community services and supports for Medicaid recipients who otherwise would require nursing home care. (The House bill includes a statement of support for the Community First Choice Option.)

The Senate bill also would give increased Medicaid funding to states that can divert more Medicaid recipients from nursing homes and other institutions to home and community based care. And the bill extends for another five years an important demonstration project in 31 states called Money Follows the Person. This program encourages states to transition Medicaid recipients from institutions to the community, where they will continue to receive Medicaid coverage through new community services.



The Senate proposal would give the spouses of Medicaid recipients who are receiving services at home or in their community the same financial protections that the spouses of nursing home residents currently enjoy. However, under the current measure spouses would not become eligible for these protections until 2014 and the protections would disappear in five years unless renewed by Congress.

Finally, a "Sense of the Senate" provision of the bill states that, "(1) during the 111th session of Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need; and (2) long term services and supports should be made available in the community in addition to in institutions."

Nursing Home Protections

Both the House and Senate bills would help protect nursing home residents and other long-term care recipients from abuses, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to.

Both bills would set up a nationwide program for national and state background checks of long-term care employees who have direct contact with patients. Both bills would also require nursing homes to publicly disclose all individuals and entities that own, govern, operate, finance, provide services to, or control them. In addition, information about nursing home staffing levels -- including hours of care per resident day, turnover and retention rates, and facility expenditures for wages and benefits -- would be added to Medicare's Nursing Home Compare Web site.

To read the House-passed Affordable Health Care for America Act, click here.

To download a copy of the Senate's Patient Protection and Affordable Care Act in PDF format, click here.
(If you do not have the free PDF reader installed on your computer, download it here.)