Insurance Program for Adults with Special Needs Re-Introduced in Congress

Several members of Congress have once again introduced legislation that would put in place a long-term care insurance program for adults with special needs. On July 10, 2007, Senators Edward Kennedy (D-MA) and Tom Harkin (D-IA) and Representatives John Dingell (D-MI) and Frank Pallone (D-NJ) introduced the Community Living Assistance Services and Supports (CLASS) Act of 2007.

To qualify, individuals must be 18 years or older and have participated in the voluntary payroll deduction program that will finance this insurance for at least five years. Any person who is working will be automatically enrolled in the program unless they opt out. The payroll deduction, which will be approximately $30 a month, will be placed in a fund managed by the Department of Health and Human Services. Any non-working spouse will also have the option of enrolling in the program.

According to the legislation, the benefits are available in two tiers. Under Tier One, individuals who have at least two impairments in performing Activities of Daily Living (ADL) or "equivalent cognitive impairment" would receive $50 a day. A few examples of ADLs are eating, bathing, and dressing. Traumatic brain injury, Alzheimer'™s disease and mental retardation are a few examples of equivalent cognitive impairments. Under Tier Two, individuals with at least four of the ADLs or equivalent cognitive impairments would receive $100 a day.

If the legislation passes, individuals who receive the benefit and do not use the full monthly amount will have the option of rolling over the remaining amount from month-to-month. Also, if a person is eligible for CLASS Act benefits, usually they are also eligible for long-term care benefits under Medicaid. In such cases, the CLASS Act benefits may be used to offset Medicaid costs, which could result in savings for the state.

The purpose of the CLASS Act is to encourage adults with disabilities to be independent and to retain their functionality. It is not intended to be a replacement for basic health insurance.

Sen. Kennedy originally introduced the bill in November 2005, but the legislation never made it out of committee.