The New Health Care Law and Access to Home Care

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Q. Will the health reform law help me live in my own home longer and avoid a nursing home if I get sick or need help?

A: Yes. The vast majority of people over 50 say in recent polls they want to live in their homes as long as possible. But many find it difficult to manage on their own. Several little-known provisions of the health care law will provide additional support for people who want to remain at home.

The law has generated nearly three dozen experimental or pilot projects testing ways to help older people avoid institutional care. For example, the "Independence at Home" pilot is testing whether incentive payments to primary care doctors and nurses will promote better care coordination for Medicare patients with two or more chronic illnesses. Another project is looking at ways to reduce hospital readmissions.

The law is already paying for ways to improve home services, including $4.2 million to train more than 5,100 new personal-care and home-health care workers in six states by 2013. Under another provision, health care organizations in seven states received $3.8 million to train "patient navigators" to help Medicare patients with chronic diseases who live independently get the care they need in their own homes.

Medicaid, the federal-state program that funds health services for low-income Americans, also will see new incentives to shift its spending away from nursing home care and toward services in the home and community. That change will expand the availability of those services such as home health care, home-delivered meals and transportation to doctors' appointments for all older people, regardless of income.

That means more help for the growing market of aging boomers, says Larry Minnix, president of the American Association of Homes and Services for the Aging, which has over 5,700 members.

"The Affordable Care Act signals it's a new day," he says.

The law encourages more home and community services in several ways. It makes it easier for states to add home care services to their Medicaid programs, and streamlines the process by making the new services permanent Medicaid benefits. In the past, states that wanted to supplement Medicaid had to get federal approval every three to five years.

The new law also makes home services available to more people by removing the requirement that recipients be so physically or mentally impaired that they qualify for nursing home care. You don't have to have "one foot in a nursing home" to stay out of a nursing home, says Suzanne Bosstick, deputy director for disabled and elderly health programs at the Centers for Medicare & Medicaid Services.

Another provision in the law helps people leave nursing homes and return home if they wish, and allows states to use Medicaid money to provide care in their own homes.

The law also offers states a big incentive to change how they deliver care. The federal government will pay 90 percent of the cost for Medicaid services that are provided within a care system designed to better coordinate primary medical care, long-term care services and mental health care.

Susan Jaffe of Washington, D.C., covers health and aging issues.