Health Reform Amendment Would Benefit Assisted Living Residents

Senator Ben Cardin (D-Md.) took steps in December to make sure that pending health reform legislation gives assisted living residents the help they need to pay for prescription drugs. The Patient Protection and Affordable Care Act, passed by the Senate in late December, includes a provision – Section 3309 – that would eliminate drug co-pays for individuals who are eligible for both Medicare and Medicaid and who receive assisted living and residential care services under state Medicaid waivers. Cardin was concerned that individuals who receive benefits directly through state Medicaid plans might be left out of Section 3309. His amendment authorizes the U.S. Department of Health and Human Services (HHS) to investigate ways to prevent this from happening.

Cardin's amendment calls for two federal studies. The first would compare the needs and income of dual-eligible individuals for whom cost-sharing is eliminated under Section 3309 with the needs and income of dual-eligible individuals whose Medicare Part D co-pays are not covered by the section. Based on the study results, HHS could recommend that Congress eliminate cost sharing for the uncovered individuals, who reside in community-based settings, including assisted living.

The second study would evaluate whether Supplemental Security Income could be used to pay for assisted living, and would explore other possible funding alternatives. The National Center for Assisted Living, which applauded Cardin’s amendment, maintains that the two studies could ultimately improve some assisted living residents’ access to the Medicare Prescription Drug program and Medicaid benefits.