Home and Community-Based Long Term Services and Supports: Health Reform's Most Enduring Legacy?
8 Saint Louis University Journal of Health Law & Policy, 2014, Forthcoming
43 Pages Posted: 16 Aug 2014
Date Written: August 14, 2014
In its implementation phase, the Affordable Care Act (ACA) has been beset (to put in mildly) by a plethora of legal, political, technical, economic, and ethical challenges. The ultimate achievement of the ACA’s purported fundamental goal — universal access to affordable, high quality health care — is far from assured. Putting aside the ill-fated Community Living Assistance Services and Supports (CLASS) Act portion of the ACA and some additional public disclosure requirements imposed on nursing facilities, long-term supports and services (LTSS) unfortunately was not a pressing priority of either the ACA drafters or its supporters. It is, therefore, ironic that perhaps one of the most lasting and important legacies of the present health reform era may well be its impact on the permanent expansion of home and community-based long-term services and supports (HCBLTSS). This article discusses the ongoing evolution in the long-term care of older Americans away from institutional arrangements and toward HCBLTSS. More specifically, the actual and potential role of the ACA and other facets of health reform in promoting or inhibiting the success of HCBLTSS in meeting the needs of an aging population are analyzed and future challenges are identified.
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