Pardon my ghoulishness with the following hypothetical.
Suppose that you were to slip and fall on your stairs, suffering a paralyzing injury. You want to stay in your home. But to do so, you might need your niece to spend 10 hours a week helping you out. She can’t really do that for free. You might need a modified van or a wheelchair ramp. How would you pay for these things?
If you needed more intensive services, how would you pay for that? Medicare covers some home care services. It doesn’t cover many critical items people will really need to stay independent. Medicare also doesn’t cover long-term nursing home care. Both public and private insurance leave huge coverage gaps. Home care and other services are financially draining. If you faced some disability, how would you cope without depleting your assets and relying on Medicaid?
About ten million Americans face some similar challenge. Maybe they’ve had a stroke or heart attack. Maybe they face early stages of Alzheimer’s. Almost 90 percent of people living with functional limitations live in the general community. It’s all scary stuff, for so many financial and human reasons.
These challenges were left largely unaddressed in health reform, with one little-known exception: the Community Living Assistance Services and Supports Act (CLASS). CLASS was precisely intended to help people live independently in the presence of disability. CLASS was complicated and shamefully under-covered. So you’re forgiven if you’ve never heard of it. (I helped cover this for the New Republic. It was a lonely beat.) Continue Reading…