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Straight Talk for Seniors®: The Affordable Care Act and Long-Term Care

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Most people know that the Affordable Care Act (ACA) helps millions of individuals pay for their doctor and hospital visits.

What many don’t know is that the ACA also helps thousands of older Americans and people with disabilities get long-term care at home—instead of in nursing homes and institutions.

One such program is called the Community First Choice (CFC) option—and it’s at serious risk of being repealed next year.

Community First Choice helps people get care at home

No one wants to go into a nursing home. And studies show that providing care to people in their own homes and communities is less expensive and offers better quality.

Yet, Medicaid—which is the primary federal program that pays for long-term care—favors nursing home coverage. Federal law requires states to cover nursing home care, but community-based services and supports are optional and very limited in most states, with long waiting lists.

The Community First Choice option helps to correct this bias, gives seniors and people with disabilities a real choice to remain at home, and supports family caregivers.

Community First Choice is completely optional for states. If a state adopts CFC, it receives extra federal funding (6%) to pay for personal attendant services. This additional funding is a critical incentive because states often must make an initial investment in home and community-based services before they see savings over the long run.

Community First Choice has broad support

If it seems like a common-sense idea with broad support, it is. Community First Choice was born out of bipartisan legislation that was pending in Congress for more than 15 years. Over 100 national aging, disability, and faith-based organizations fought for its passage.

Both the Republican and Democratic National Platforms support home and community-based services. The Republican Platform states: “Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and will implement programs to protect against elder abuse.”

CFC has been very successful. So far, eight states have adopted it (CA, CT, MD, MT, NY, OR, TX, WA), and at least four more have submitted applications or are considering adoption (AR, CO, MN, WI)—including states with Republican and Democratic governors.

Unfortunately, CFC is now facing repeal, along with other ACA provisions early next year.

We think repealing the Community First Choice Option will make it harder for older Americans and people with disabilities to remain at home and age with dignity and independence. What do you think? Please tell us in the comments section below.

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Joe Caldwell

About Joe Caldwell

Joe Caldwell is Director of Long-Term Services and Supports Policy at NCOA. He co-chairs the Disability and Aging Collaborative, a group of national aging and disability organizations working to advance long-term services and supports for older adults and individuals with disabilities.

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