WASHINGTON – Sen. Chuck Grassley of Iowa and Sen. Ben Cardin of Maryland today re-introduced their bipartisan legislation allowing older Americans to receive individualized care that would help them continue to stay in their own homes rather than nursing homes.
“I’ve never met anyone who can’t wait to move into a nursing home,” Grassley said. “Everybody wants to stay in their own homes as long as they can, with the comforts of home. Unfortunately, our current system doesn’t have a bridge for those who are on a fixed income but would have to sell their house to become eligible for Medicaid and get nursing home care. Our bill sets up a demonstration project to build a bridge for those who need care but otherwise would have to go to a nursing home to get it.”
“Allowing seniors to age in place, to stay in their homes as long as possible, takes an enormous financial and emotion burden off of families,” said Cardin, a member of the Senate Finance Health Care Subcommittee. “Community-based services are proven to be cost-effective, culturally-responsive, and allow older Americans to receive essential support that is tailored to their unique needs. As our nation continues to age and grow, our legislation will help ensure that Medicare beneficiaries are able to live fulfilled lives and successfully manage medical conditions with dignity.”
Today, the federal government does not pay for long-term services and supports, unless an individual is poor enough to be on Medicaid. What frequently happens is that seniors on Medicare go into a nursing home, spend down their assets and then go on Medicaid for their long-term care. These seniors don’t want to be in an institution, and they don’t want to be on Medicaid. But that is what the system forces upon them.
The Grassley-Cardin bill would establish a new Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program. This program would target home- and community-based services for low-income, Medicare-only beneficiaries who need help with two or more activities of daily living, the usual criteria for nursing home eligibility.
The goal is to prevent these Americans from having to enter an institution and spend down their remaining assets, thereby becoming eligible for Medicaid. It would help them remain in their own homes where studies show they wish to remain.
The demonstration would operate in up to five states initially, building on Medicare Advantage plans that have experience caring for this frail population. The plans would tailor services to beneficiaries, depending on individual needs. For instance, they might provide assistance with bathing or dressing, housekeeping or transportation, or even respite care for their primary caregiver.
The demonstration would generate evidence to support an alternative payment methodology that could produce savings for both states and the federal government. One estimate shows four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members by postponing or preventing hospitalization and institutionalization.
Grassley and Cardin said the legislation will give hope to some of the nation’s most vulnerable individuals and at the same time offer a path toward state and federal budget savings.
The bill will be assigned to the Finance Committee, with jurisdiction over Medicare and Medicaid, where Grassley and Cardin are members. Grassley is former chairman.
The text of the Community Based Independence for Seniors Act, S. 309, is available here.