Katie Smith Sloan

Improving access to Medicaid home- and community-based services; reducing senior falls and managing chronic disease under the Prevention and Public Health Fund; and combating elder abuse and neglect are among the “critical provisions” of the Affordable Care Act that have bipartisan support and should remain intact even if the healthcare law is repealed and replaced, members of the Leadership Council of Aging Organizations said in a three-page letter to President-elect Donald Trump dated Jan. 10 and an expanded 10-page document addressed to his transition team.

The group, which counts as members more than 60 national nonprofit organizations, is chaired by LeadingAge President and CEO Katie Smith Sloan.

“If changes to the ACA affecting older Americans are considered, we respectfully request that you engage and work with LCAO and its member organizations to ensure that the needs of America’s seniors are met,” Sloan wrote, noting that the LCAO “strongly opposes” repeal of the ACA.

The transition team document outlined additional policy recommendations outside of the ACA.

To assist states in building better infrastructure through which to offer HCBS, Sloan said, LCAO suggests extending Medicaid’s Balancing Incentive Program. The program provided financial incentives to 21 states to increase access to non-institutional long-term services and supports, including those provided in assisted living communities through Medicaid waivers, by authorizing grants to serve more people in home- and community-based settings from Oct. 1, 2011, to Sept. 30, 2015. After the deadline, 13 of the states continued to participate in the program by spending the grant funds to increase access to new or expanded services and infrastructure.

Additionally, Sloan wrote, “We recommend that all congregate care settings be re-examined to be consonant with what Americans want and expect: person-centered, individualized services that are delivered in settings that resemble a home, that are designed to afford ample privacy and autonomy, that are not isolated from community life, and that have appropriate numbers of well-trained and competent staff.”

LCAO members also oppose block grants and per-capita caps for Medicaid, believing that they would “stifle innovation” in care delivery, tempt states to “underserve” high-cost beneficiaries, such as those with Alzheimer’s disease, and ultimately result in higher costs for the healthcare system, Sloan said.

“Many of the HCBS services that Americans of all ages with disabilities rely on are optional services for states, which can decide whether to offer them, or to offer only to certain populations or those in certain areas,” she wrote. “This means that states tend to cut back on HCBS services first, which can force more seniors into nursing homes, where costs are higher and where many do not want to be. Moreover, research clearly shows that when basic assistance with the needs of daily life is not available, frail elders wind up in high-cost settings, notably hospitals, and overall costs increase.”

Sloan, on behalf of the LCAO membership, urged the incoming Trump administration to preserve “critical consumer protections embedded in federal law,” including having minimal or no co-insurance for HCBS provided to frail seniors with income at the poverty line.

LCAO also provided recommendations related to Medicare, community services provided through the Older Americans Act, family caregiver support, elder justice, retirement security and other topics.