The Fiscal Cliff Deal: What Does It Mean for Low-income Older Adults?
On Tuesday, January 1, 2013, by a vote of 257-167, the House of Representatives agreed to approve the Senate amendments to H.R. 8, the American Taxpayer Relief Act of 2012, also known as the “fiscal cliff deal.” The President has agreed to sign it. The focus of the deal is the extension of the Bush-era tax cuts for most Americans; however, tucked inside the legislation are a few provisions that may impact health care for low-income older adults. These include extending the funding for low-income outreach programs, the establishment of a Commission on Long-Term Care and the extension of the Qualified Individual program and Special Needs plans.
Extension of funding for low-income outreach programs:
Congress agreed to extend funding outreach and assistance for low-income programs. The Medicare Improvements for Patients and Providers Act of 2008 and the Affordable Care Act (ACA) initiatives to provide outreach and enrollment assistance to low-income beneficiaries were set to expire on January 1. Many aging and disability groups advocated for their extension, and the fiscal deal extended funding for the following programs in 2013:
- State Health Insurance Programs: $7.5 million
- Area Agencies on Aging: $7.5 million
- Aging and Disability Resource Centers: $5 million
- National Center for Benefits and Outreach Enrollment: $5 million
Long-term Services and Supports:
The fiscal deal repeals Community Living Assistance Services and Supports (CLASS) Act. While the Obama Administration halted implementation of the ACA provision to create a voluntary, national long-term care insurance program a year ago, the legislation officially removes CLASS from the ACA.
In a subsequent section, the deal establishes a Commission on Long-Term Care. The purpose of the Commission is to thoughtfully evaluate the current long-term services and supports (LTSS) landscape and craft a plan to establish, implement and finance a coordinated LTSS delivery system. The deal’s creation of this Commission marks the first time Congress has committed to a comprehensive evaluation of LTSS since the Pepper Commission over twenty years ago.
The 15 member Commission will provide recommendations after: 1) analyzing how LTSS currently operates in Medicare, Medicaid, and long-term care insurance, 2) exploring other health programs that interact with LTSS, and 3) examining issues related to the LTSS workforce.
The Commission will consult with MedPAC, MACPAC, the National Council on Disability and relevant consumer groups.
The following individuals will each appoint three members to serve on the commission: the President, the Senate majority leader, the Senate minority leader, the Speaker of the House and the House minority leader. The members must be appointed within one month of the day the law is enacted. The members must represent: consumers of LTSS, older adults, individuals with cognitive and functional limitations, caregivers, the health care workforce, private long-term care insurance, employers, state insurance departments, and state Medicaid agencies.
The commission has the power to hold hearings, commission studies by the Government Accountability Office and the Congressional Budget Office and receive information and technical assistance from federal agencies.
Six months after the Commission is appointed, the Commission must vote on a comprehensive long-term care plan. Any legislative recommendations or proposals included in the plan will become the “Commission bill.” If a quorum of members approve the Commission bill, then ten days after its approval, the Commission will submit the bill to the President, Senate and House. After submission, the Senate majority leader, or one of his or her designees must introduce the bill the next day the Senate is in session. The Commission bill follows the same process in the House, as the majority leader of the House or one of his or her designees must introduce the bill on the next legislative day.
Extension of QI and SNPs
The deal extends the Qualifying Individual (QI) program through December 31, 2013. The QI program pays Medicare Part B premiums for individuals with incomes between 120 and 135 percent of the federal poverty level and resources below $6,940 for an individual and $10, 410 for a couple. With this extension, low-income older adults who may have lost their Part B coverage due to significant out-of-pocket costs should be able to maintain coverage.
In addition, the deal extends Medicare Advantage Plans for special needs individuals (Special Needs Plans) through 2015. This is particularly significant for the dual eligible demonstration, as there have been questions among advocates about the interaction between existing SNPs and plans selected to participate in a demonstration.
The deal still leaves many questions about the health-care future for low-income older adults unanswered. While the deal delays the sequester for two-months, future negotiations over the sequester, spending and the debt-ceiling may signal additional changes to Medicare and Medicaid.
 H.R. 8, The American Taxpayer Relief Act of 2012, Section 610, Extension of Funding Outreach and Assistance for Low-Income Programs (January 1, 2013).
 H.R. 8, Section 642.
 H.R. 8, Section 643.
 Howard Gleckman, “Fiscal Cliff Deal Repeals CLASS Act, Creates Long-Term Care Commission,” (January 1, 2013) available at www.forbes.com/sites/howardgleckman/2013/01/01/fiscal-cliff-deal-repeals-class-act-creates-long-term-care-commission.
 Medicare Savings Program, available at www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html#qi.