1. The CLASS Act Presented by: Stephen A. Moses The Center for Long-Term Care Reform

2. What is the CLASS Act? CLASS - Community Living Assistance Services and Supports Title VIII Of the Patient Protection and Affordable Heath Care Act – signed into law March 23, 2010

3. What is the CLASS Act? (cont.) Defined by the American Association of Homes and Services for the Aging (AAHSA): New voluntary nationwide long-term services and supports insurance program for persons with disabilities and seniors with chronic illness. http://www.aahsa.org/classact.aspx

4. Note contradictions in terms: “Voluntary” “Insurance for disabled and chronically ill” No: real insurance is for healthy people in case they become disabled or ill

5. Definitions & Provisions http://democrats.senate.gov/reform/patient- protection-affordable-care-act-as-passed.pdf –Actively employed: reporting for work or on active military duty –6 ADLs: ‘‘(A) Eating. ‘‘(B) Toileting. ‘‘(C) Transferring. ‘‘(D) Bathing. ‘‘(E) Dressing. ‘‘(F) Continence

6. Definitions & Provisions (cont.) Eligibility: –enrolled in CLASS –paid premiums for 5 years (vesting period) –have earned in 3 of the 5 years income at least equivalent to Social Security requirement –have paid premiums for at least 24 consecutive months if a lapse has occurred

7. Definitions & Provisions (cont.) Secretary of Health and Human Services decides almost everything –CLASS Independence Advisory Council –CLASS Independence Benefit Plan: Not later than October 1, 2012 –CLASS Independence Fund

8. Definitions & Provisions (cont.) To be invested like the Medicare trust fund, i.e. in Treasury bonds Board of Trustees will examine and report to Congress –Report immediately if actuarially unsound –Consult regularly with the Secretary

9. Definitions & Provisions (cont.) No taxpayer funds to be used to pay benefits (just to pay back the bonds when CLASS has to pay benefits) Annual report by Sec. beginning Jan. 1, 2014 Annual report by DHHS Inspector General on fraud in program

10. Premiums Nominal premiums for the poor (poverty line): $5/mo plus CPI Level premiums unless the Secretary decides they're "insufficient" –No increase if over 65, unemployed or paid premiums for 20 years –Premium recalculated if 90 day or more lapse –Penalty for re-enrollment after a five-year lapse

11. Premiums (cont.) After 10 years, decide on future premiums Administrative costs not to exceed 3% in determining premiums Payment by –Payroll deduction –Alternative: TBD if employer does not participate

12. Triggers 2 or 3 ADLs – requires “substantial supervision” Seems to mirror “federal tax-qualified” requirements

13. Cash Benefit No less than $50 per day increasing with CPI Variable on a scale of functional disability with between 2 and 6 benefit levels Paid daily or weekly No lifetime or aggregate limit

14. Cash Benefit (cont.) Coordination of benefit with insurance exchanges created by the Patient Protection and Affordable Care Act Benefits go into a Life Independence Account to pay for among others: –Home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, and nursing support.

15. Cash Benefit (cont.) Institutionalized beneficiaries keep 5% of their benefit above personal needs allowance under Medicaid, the remainder going to offset Medicaid's cost HCBS recipients keep 50% of their benefit with the remainder offsetting cost to the state

16. Cash Benefit (cont.) Cash benefits received are disregarded in determining eligibility "under any other Federal, State, or locally funded assistance program," i.e. Medicaid, etc. OK to use benefits to pay a family member to provide the care.

17. Underwriting No underwriting, except based on age to determine: –Premiums –Eligibility for the program

18. Enrollment Automatic by employer Alternative enrollment for the –Self-employed –More than one employer –Employer who does not automatically enroll Opt Out Election –Anytime

19. Enrollment (cont.) Qualified individual –18 years or more –Receives taxed wages or taxed self- employment income –Is "actively employed" –Is not... A patient in a hospital, NH or ICFMR and receiving Medicaid In jail

20. Benefits & Tax Treatment Benefits –Sec. establish Elig. Assessment System nlt January 1, 2012 Tax Treatment –same as tax qualified LTCI plans

21. Issues & Problems JH says effective in two years; first benefits five years later One size fits all Guaranteed issue No underwriting Anti-selection or Adverse Selection Pay five years before coverage begins

22. Issues & Problems Moral hazard Phony "trust fund" used to offset health reform deficit Indeterminate premiums –Expensive: $100 or more per month premium depending on Sec. of DHHS –Latest estimates: $180 to $240 per month

23. Issues & Problems (cont.) Minimal benefit: guaranteed $50 per day or more depending on Sec. of DHHS –Advocates say expect average benefit of $75 or $27,000 per year Must remain employed Indefinite triggers: 2, 3 or 4 ADLs depending on Sec. of DHHS

24. Issues & Problems (cont.) Guaranteed eligibility, guaranteed benefit, guaranteed lifetime coverage, but... Actuarially unsound Sec. of DHHS can change everything if funding falls short CMS actuary says only 2% will enroll despite "opt out" system Billed as LTC benefit but more for working disabled

25. Who’s for it? Senior advocates LTC providers desperate for revenue (AAHSA, AHCA)

26. Who challenges it? Deficit hawks worried about unfunded liabilities Advocates for responsible LTC planning Actuaries

27. Likely impact on private LTCI industry Why some think it will help LTCI –Raise awareness –Great comparisons for private LTCI –Safer risk pool to jump into Why some think it won't help –Public already asleep about LTC –CLASS is one more reason to ignore the problem –Extra anesthesia to the body politic

28. Current Status Passed into law How do we make the most of it is the big question now Lemonade from lemons So don't look back; forge ahead But be ready to shift course if and when CLASS is repealed

29. The real LTC problem and the real solution Public ignores LTC because government already pays for most of it But that can't and won't continue much longer CLASS diverts attention from the real risk –Unfunded liabilities of Social Security, Medicare and Medicaid –Now add CLASS

30. For more information Center VP, Damon Moses interviews Claude Thau: Part 1 http://www.youtube.com/ltctv#p/a/u/2/Nb9BnFcZzjw Part 2 http://www.youtube.com/ltctv#p/a/u/1/fL_jARY1wsM http://www.youtube.com/ltctv#p/a/u/2/Nb9BnFcZzjwhttp://www.youtube.com/ltctv#p/a/u/1/fL_jARY1wsM LTC Bullet: "CLASS Dismissed" for Broker World, Thurs, Feb. 11, 2010LTC Bullet: "CLASS Dismissed" for Broker World, Thurs, Feb. 11, 2010 LTC Bullet: DéCLASSé, Wed, Dec. 9, 2009 LTC Bullet: CLASS Consciousness, Wed, Oct. 21, 2009 LTC Bullet: CLASSified, Mon, Oct. 19, 2009

31. For more information (cont.) LTC E-Alert #9-076--A CLASS Half Full, LTC E-Alert #9-104--Will CLASS Pass?, and LTC E-Alert #9-123-- CLASS Dismissed, LTC E-Alert #10-032: SSA and LTC in NYT, OMG! (Translation Follows)LTC E-Alert #9-076--A CLASS Half FullLTC E-Alert #9-104--Will CLASS Pass?LTC E-Alert #9-123-- CLASS DismissedLTC E-Alert #10-032: SSA and LTC in NYT, OMG! (Translation Follows) (You'll need your Center for Long-Term Care Reform user name and password to access these publications in The Zone. Contact info@centerltc.com if you need a reminder or to join the Center and connect to The Zone.)info@centerltc.com

32. For more information (cont.) Al Schmitz and Steve Schoonveld, "Health Reform's CLASS Act," Broker World, February 2010 (subscription required)Al Schmitz and Steve Schoonveld, "Health Reform's CLASS Act," Broker World, February 2010 Summary of the CLASS Act, Affordable Health Choices Act (Title XXXII): http://www.aahsa.org/classact.aspx