DRA and Its Effect on Long-Term Care Services

Ellen O’Brien (Public Policy Institute at AARP, Washington, D.C.) has recently published her article entitled What Is Wrong with the Long-Term Care Reforms in the Deficit Reduction Act of 2005?, 9 Marq. Elder’s Advisor 103 (2007).

Here is an excerpt from the conclusion to her article:

The DRA provides some modest relief to the federal, state, and local governments that jointly finance Medicaid, and it promises to target those resources more effectively. Although it is possible to imagine a scenario where public subsidies are reduced for upper middle-class individuals who are able to pay for their own care in order to improve the amount and quality of means-tested assistance for low-income individuals, the DRA is unlikely to deliver it. It remains to be seen how states will implement the DRA and how elderly applicants for Medicaid assistance will be affected. However, it is likely that much of the savings will accrue because those with very modest resources will spend more on care.***

Some may argue that advocates for better long-term care services were somewhat successful due to the DRA reforms that increased flexibility to expand home services, community-based services, and provided additional federal monies to pay for those services. However the fundamental goal of the DRA is to reduce public responsibility and increase private responsibility for long-term care. That is a worrisome trend. Changing course to reduce the already large burdens on those who need care will require better appreciation of the gaps in the current system, the impact of these gaps on individuals and families, and the feasibility and affordability of meaningful alternatives to the inadequate approach to financing that we have today.