None of us wants to face it, but our chances of needing a caregiver when we're older are pretty high – about two of out every three older Americans need help with "routine daily activities, such as eating, bathing, dressing, paying bills, and preparing meals."
And, as the population ages, the need for people to provide those services is sharply increasing, even as the affordability and availability of long-term care insurance is diminishing.
The Affordable Care Act tried to provide a solution: the CLASS Act, which stood for Community Living Assistance Services and Supports. That part of the law would have created a federal long-term care insurance program, but it faced opposition as financially unworkable and the Obama administration dropped it.
Some states are trying to step into the breach, testing their own ideas about how to address residents' needs for services and to minimize the strain on Medicaid budgets. (Medicaid, the federal-state health insurance program for the poor, is "the nation's primary payer of long-term services and supports.")
Recently, Connecticut launched My Place CT," an information hub to complement the state's online insurance marketplace, which will be up and running Oct. 1. It includes a website, call center and advertising campaign, as well as career opportunities for caregivers. It asks consumers about their needs and shows how they can pay for care and also lists housing and transportation options.
"The overall goal is that we want people in our state to be able to make an informed choice and we want to have quality infrastructure in place to support that," said Dawn Lambert, project director for Connecticut State Department of Social Services' Money Follows the Person Program, a federal demonstration program run by Medicaid that seeks to eliminate barriers in state law, state Medicaid plans and budgets to let people choose the setting in which they receive long-term care. The program provides partial funding for the initiative as part of the state's strategic plan to rebalance these services in a cost-effective way.
Lambert discussed the initiative with KHN's Kelsey Miller. Here is an edited transcript of the interview.
Q: Why focus on long-term care in the state?
A: In Connecticut, about 7 percent of our Medicaid population receives long-term care. At first glance, it may not seem like a lot of people, but those people utilize 47 percent of expenditures. Also, we know that population is going to grow about 25 percent over the next few years. We did a town-by-town data assessment, we looked at this projection and we mapped it out. That speaks to how many more accessible and affordable housing units we need, how much more workforce we need, if we have the right amount of nursing home beds, etc.
Q: How does the new website, ad campaign and call center make it easier for consumers to access long term care?
A: The website will, by 2015, link directly to the department's ConneCT Medicaid site and we'll help navigate the person through the site. If it is Medicaid that you need, we'll make sure that you're linked behind the scenes or if you actually need health insurance you'll end up in the health exchange. My Place is building on more of the community and local health services.
Q: How does your initiative work with the Affordable Care Act, especially in terms of funding?
A: We see [My Place CT] as being totally integrated with the Affordable Care Act. We see it all under the ACA as access to health care. It's critical for those things to be connected because if you have someone with long-term needs and you're not seeing the person as a whole, then you're going to be missing something.
Q: Part of the initiative focuses on the long-term care workforce, helping to connect those interested in becoming caregivers to training and job opportunities. Why is this a prominent part of the initiative?
A: If we don't grow that workforce people won't have a choice. That's an important thing to do first. If you speed the connection to services first, you won't have that infrastructure in place. Right now, phase one of the website offers descriptions of the different classification of workers that we know we need to grow initially. It offers links to the existing training and a way to link to the personal care directory. In phase two, it will actually link the employer to the employee.
Q: The site has been up for a few weeks now, what are the initial responses to the initiative?
A: We've had really favorable responses and have had several meetings about how we can constantly improve the website. We do envision that the website will electronically link in a secure way to both our Medicaid access database as well as our health insurance marketplace.
We envision that you will be able to go and complete your needs assessment to connect with formal services and informal services. As far as workforce, the campaign is rolling out and we expect there will be videos on the site giving people more of an idea what that job is like. The website is the primary communication tool, it'll constantly be changing.