1. Age and Disabilities Odyssey June 20, 2011 Is The CLASS Act The Answer to Long-Term Care Financing?

2. Presenters LaRhae Knatterud, Aging 2030 Minnesota Department of Human Services (DHS) Tom Devine, Executive Vice President, The David Agency, Minneapolis, MN Kim Carolan, Manager of Long-Term Care Eligibility, DHS

3. Outline of Presentation What is the CLASS Act? What are the key provisions? What is the status of its implementation? How does it interact with other long-term care financing options? How does it interact with Medical Assistance?

4. What is the CLASS Act? CLASS Act stands for “Community Living Assistance Services and Supports” It is a national, voluntary public long-term care insurance program included in the health care reform legislation It would automatically enroll all workers 18-64 in the program and deduct a premium from paychecks, with that money diverted to a trust fund—much like Social Security—for use when individuals need long-term care Persons not working (retired or disabled) cannot enroll

5. What are the key provisions? Enrollees are vested after paying premiums for five years, but must continue to pay premiums after that period There is no exclusion for pre-existing conditions and benefits are paid on a lifetime basis (no lifetime limit) This cash benefit could be used for any assistance or expenditure that the person prefers

6. What are the key provisions (cont) When they have 2+ Activities of Daily Living (ADLs), enrollees would quality to draw a daily benefit of at least $50 per day or more depending on their level of disability Enrollees with conditions limiting ADLs for >90 days will be eligible for benefits To receive benefits, the HHS Secretary must set a standard that includes: Limitation in at least 2 or 3 ADLs Substantial cognitive impairment, or An impairment equivalent to these two disability levels

7. Impact on LTC Financing Federal estimates assume that < 6 percent of eligible Americans would participate The premium must be set at a level to keep the program solvent for the next 75 years Even at $50/day, this would total $1,500 per month or $18,000 per year Premiums are entirely paid by enrollees, including subsidies for low-income workers and students

8. Impact on LTC Financing (cont) Critics say that the premiums won’t be enough to cover spending and that the government will have to raise premiums or increase the threshold of people who can receive benefits This level of benefit is actually twice the national average now spent per beneficiary for Medicaid HCBS services

9. Options to Encourage Enrollment It will be important to make workers aware of this program and the need to have a “plan” for their long-term care Important to encourage employers to educate their workers about long-term care planning, the role of this program and to set up automatic enrollment There may be other incentives that could be offered to workers or employers to increase take-up rate

10. Medical Assistance (MA) Payment of Long-Term Care (LTC) Services LTC services covered by MA include: skilled nursing facility (SNF) care. nursing facility care in an inpatient medical hospital or intermediate care facility for developmentally disabled (ICF/DD). home and community-based services through a waiver program (Community Alternative Care (CAC), Community Alternative Care for Disabled Individuals (CADI), Developmental Disabilities (DD), Elderly Waiver (EW), and Traumatic Brain Injury Waiver (TBI).

11. How does CLASS interact with MA? MA is the payor of last resort. CLASS benefits reduce MA payments for LTC services. Beneficiary may retain 5% if in a medical facility; 50% if receiving home and community-based services through a waiver program.

12. Minnesota Long-Term Care Partnership (LTCP) public-private program designed to encourage more people to purchase long-term care insurance. enables people who buy certain qualified long- term care (LTC) insurance policies to keep more assets if they later need to request Medical Assistance (MA) to help pay for their LTC services. allows a person with a Partnership policy to designate assets for protection. Protected assets do not count against the MA asset limit. protected assets cannot be recovered from a person’s estate.

13. Long-Term Care Partnership Statistics Based on the Federal Reporting, as of December 31, 2010: The total number of MN LTC Partnership policies was 30,494. 85.6% (26,121) became Partnership policies as of the date of purchase. 14.3% (4,373) were exchanges for existing LTC policies. Source: http://w2.dehpg.net/LTCPartnership/Reports.aspx http://w2.dehpg.net/LTCPartnership/Reports.aspx

14. Where to Get More Information Current Status of CLASS Act, by Congressional Research Service http://www.heartlandltc.com/hltc/Media/Storage/files/Website/CRS_CLASS_ACT_PPACA_05-13-11.pdf http://www.longtermcare.gov