Health Care Reform

What it is:
In 2010, the Patient Protection and Affordable Care Act of 2010 was passed by Congress and signed into law. This legislation includes a number of provisions affecting people with spinal cord injury and paralysis. The Christopher & Dana Reeve Foundation is working to ensure that the provisions cited below are implemented in the most effective way or, in some instances, revised to be most beneficial to people with spinal cord injury or paralysis.

CLASS Act
The healthcare bill includes a new voluntary long-term care insurance program called the Community Living Assistance Service and Support (CLASS) program. This program will go into effect in 2011 and is designed to help people who are unable to perform two or more functional activities of daily living pay for nonmedical services and supports – to help them remain within their homes and communities for as long as they can. Individuals pay premiums while they are working and then are eligible for cash benefits if they become functionally impaired. Under the CLASS Program, every American will be able to voluntarily participate in this self-funded, insurance program. Individuals qualify for benefits after paying premiums for five years, and must have worked for at least three of those five years. Beneficiaries receive a lifetime cash benefit, which is expected to pay roughly $75/day or more than $27,000 per year. Benefits can be used to pay for such things as home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, and home care aides.

Working individuals will be given the option of having a small amount of money (yet to be determined) deducted from their paychecks. The money will go into a fund to help the individual purchase nonmedical supports and services needed to maintain independence, should he/she ever become disabled. Unlike Medicaid, the CLASS program does not require people to be impoverished to qualify for the program. The law also requires HHS to develop an actuarially sound benefit plan so that the program is self-sustaining.

Community First Choice Option
The new Community First Choice Option allows States the option of offering home and community based services, rather than institutional care, as the rule rather than as the exception to disabled individuals through Medicaid. This is an optional program, and to encourage states to participate, states that opt in will receive an additional six percent to the federal government's share of Medicaid costs for five years. This program takes effect on October 1, 2011. Although this is an optional program in the Act, it is an important first step towards making it permanent.

Elimination of Medicare first month purchase option for power wheelchairs
The bill restricts the Medicare option to purchase power-driven wheelchairs when they are initially supplied to complex, rehabilitative power-driven wheelchairs. The purchase option is eliminated for other power-driven wheelchairs, which will be reimbursed on a rental basis with ownership title transferring to the individual after 13 months of continuous use. During the 13 months rental period Medicare will pay 80% and the individual 20% of the rental cost.

We are concerned that elimination of the purchase option will make it difficult for individuals to have his/her wheelchair fitted to specific needs. A wide range of advocacy organizations support preserving the first-month purchase option, and there may be efforts to reinstate this provision.