Legal Update

CLASS Provisions: Government Sponsored Long-Term Care

 

  By:  Mark Addison

The Community Living Assistance Services and Supports (CLASS) program, part of the new Health Reform Bill, creates a voluntary government program for eligible participants to receive long-term care benefits.  The Department of Health and Human Services (HHS) will develop details of the CLASS program over the next two years.  Following is a description of the current provisions of this new program.

When the CLASS program becomes available, employers will be able to automatically enroll employees in the CLASS program, as they would in a 401(k) or 403(b) retirement plan.  Employees will be given the opportunity to opt out of the automatic enrollment.  Individuals who are self-employed, have more than one employer or whose employer does not offer automatic enrollment in the CLASS program will also be able to enroll.

Once enrolled, participants will pay a monthly premium set by HHS.  Although HHS has the authority to annually reset the premium, it cannot increase for individuals who: 1) have attained age 65; 2) are not employed; and 3) have paid premiums for 20 years.

After paying the premium for five years, while working for at least three of those years, a participant with a cognitive or functional impairment lasting more than 90 days will be eligible for benefits upon certification by a licensed health care practitioner.  In order to receive the benefit, the participant will have to be actively enrolled in the program.  An individual will not be allowed to stop paying premiums and remain eligible for benefits.

The amount of the benefit received will average at least $50 per day (adjusted for inflation), although the amount may vary depending upon the recipient’s functional abilities.  There are no lifetime or aggregate benefit limits.

Participants receiving cash benefits from the CLASS program must use the cash for qualifying services and supports.  These include, but are not limited to, home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, and nursing support.  Records of a participant's expenditures will have to be periodically submitted to insure that the benefits have been properly used.

The CLASS program will be available for enrollment as soon as HHS provides additional details on the CLASS program, which we expect to happen in the next two years.  Participants will be able to receive benefits five years after enrollment.

Please call us with any questions you may have about the CLASS program.