[NYAPRS Enews] Advocates Urge Sponsors for Landmark New Federal Disability Insurance Program

Fri May 25 11:17:24 EDT 2007

NYAPRS Note:  The following alert comes courtesy of JFA; the supporting
info comes from documents obtained from Senator Kennedy's office by
USPRA's Jane Porter.

ACTION ALERT: Show Some CLASS Spirit! Help Secure Co-Sponsors Of CLASS
Act

Disability rights advocates and certain Members of Congress (led by
Senator Kennedy and Representative Dingell) are ready to introduce some
vital legislation that would help fund long-term services and supports
for people with disabilities, but we need help to secure the right mix
of co-sponsors to increase the bill's chances of success once it's
introduced.

It's time to get excited about the Community Living Assistance Services
and Supports Act (CLASS Act)!

Show your CLASS spirit, and call your Members today!!

WHO: All Members of Congress, however, we have particular need to gain
support from Senate Republicans, and we need lots of "CLASS spirit" from
folks in Maine and Pennsylvania, as we're targeting Senators Snowe,
Collins, and Specter specifically for co- sponsorship

WHAT: Contact your Members of Congress and urge them to support the
CLASS Act. (Go to http://www.congress.org and enter in your zip code to
find your Representatives and Senators)

Tell them that people with disabilities and their families want a way to
invest in and plan for their own long-term care needs so they can
maintain independence and live in the community, and that the CLASS Act
will help this happen. 

WHEN: We have a special need for a grassroots rumble now and next week
during the Congressional recess, although showing grassroots support for
the CLASS Act should be ongoing.

BACKGROUND: Today, there are approximately 10 million Americans who need
long-term services and supports to maintain independence, employment,
and remain in their communities. And that number is only going to rise
as the population ages.  

Most private-sector insurance plans are constrained in the protection
they can offer at an affordable price, and neither Supplemental Security
Insurance (SSI) nor Old Age, Survivors, and Disability Insurance (OASDI)
programs take the extent and character of disability into consideration
when providing benefits. 

As a result, most Americans who have or develop significant functional
limitations can only access coverage for the services they need to
maintain their independence through Medicaid. Relying on Medicaid for
critical supports means lots of people with disabilities have to "spend
down" their assets and remain poor and unemployed to maintain their
eligibility. 

The Community Living Assistance Services and Supports Act (CLASS

Act) will offer an alternative to Medicaid by creating a national
insurance program through a voluntary payroll deduction to help adults
who have or develop functional impairments to remain independent,
employed, and stay a part of their communities. Those who are working
and voluntarily contributing to the program will have access to
benefits, on the basis of their ability to perform daily living
activities or an equivalent cognitive impairment. The benefits received
may be spent however the individual feels is most appropriate toward
their long-term needs, be it a housing modification, transportation
modification, assistive technology, or personal assistance services. 

The large risk pool created by this program will make additional
coverage much more affordable than it is today, which will give
individuals a chance to invest in their own futures and gain access to
supports without requiring them to become impoverished to qualify. 

We hope that introduction of the CLASS Act will help generate a broad,
national discussion on how to promote independence and dignity and keep
people out of institutions.

Source: American Association of People with Disabilities

The CLASS Act

Questions and Answers

Why is this bill needed? 

Approximately 10 million people in the United States need long-term
services and supports. No affordable options are currently available for
people who want to purchase coverage to contribute toward paying for the
costs of long-term services and supports. 

What does the CLASS Act do? 

The CLASS Act creates a nationwide public insurance program (the CLASS
Program) financed through payroll deductions to help pay for long-term
services and supports. 

Who can enroll in the CLASS Program?

Working individuals over age 18 who are employed or self-employed and
are actively at work can enroll in the Program. Non-employed spouses can
also enroll in the program. 

No underwriting will be used to determine eligibility to enroll in the
program. A person who is enrolled in Medicaid and residing in a public
institution is not eligible to enroll. 

How does enrollment work?

Participation in the CLASS Program is voluntary. However, enrollment
will be automatic for employed individuals unless they decide to
opt-out. Employers will make payroll deductions for all workers enrolled
in the Program. An alternative payment mechanism (using electronic funds
transfer) will be available for self-employed individuals and spouses of
workers. Self-employed individuals and spouses must actively enroll and
arrange for payment through the alternative payment mechanism.

What happens to funds that are contributed under the Program? 

All premium payments will be deposited in the Independence Fund. The
Independence Fund will be managed and administered by the Department of
Health and Human Services.  Monies in the Independence Fund will be used
to pay for the benefits under the CLASS Program and the administrative
costs of the Program. The money collected will be invested in the same
manner as the money in the Social Security Trust Funds. 

How much do people have to pay to participate in the CLASS Program?

Any person who enrolls during their first eligible year for the program
(the first year of the program or the first year during which they are
over 16 and employed) will pay $30/month. If a person enrolls at any
time after their first eligible year, the premium they pay will be $30,
plus a cost of living adjustment, and an adjustment based on the age of
the enrollee.

How does a CLASS Program enrollee become eligible to apply for benefits?

A person must pay premiums for a total of at least 5 years (60 months)
in order to be eligible to apply for benefits.  The months do not need
to be consecutive. A person must continue to pay premiums even if they
have paid in for more than 60 months in order to be eligible to apply
for benefits. In order for an application for benefits to be approved a
person must be current with their premium payments. 

What if an enrollee stops paying and wants to start again?

A CLASS Program enrollee will pay the same premium as long as there is
no interruption longer than 3 months in premium payments. If a person
stops paying premiums for longer than 3 months they can reenroll, but
they will pay a higher age adjusted premium. They will receive credit
for previous months paid, but must pay in for at least 12 months
regardless of how many months they contributed previously before they
will be eligible to apply for benefits.

Can an enrollee's premium change for any reason other than a lapse of
payment exceeding 3 months? 

The Secretary of HHS may adjust the premiums of all of the participants
in the CLASS Program if it is necessary to ensure the solvency of the
Independence Fund. 

How is eligibility for benefits determined? 

The Secretary of HHS will contract with State Disability Determination
Services to determine if CLASS Program enrollees are eligible for
benefits. Decisions must be made within 30 days. Any application pending
after 45 days will be deemed approved. The Secretary will establish
procedures through which applicants can appeal adverse determinations.
Payments will start as soon as an application is approved.

What is the benefit structure of the CLASS Program? 

Benefits paid under the CLASS Act are cash benefits. Benefits will be
deposited in Life Independence Accounts that can be accessed via a debit
card. There are two tiers of benefits. Tier 1 provides $50/day and Tier
2 provides $100/day. In order to be found eligible for Tier 1, an
enrollee must be unable to perform or need assistance to perform 2 or 3
activities of daily living. For Tier 2, an enrollee must be unable to
perform or need assistance to perform 4 or more activities of daily
living. Benefit amounts for both Tier 1 and Tier 2 will be adjusted
annually by the Consumer Price Index. There is no lifetime limit on
benefits. 

What are activities of daily living?

For the purposes of the CLASS Program, activities of daily living are
defined as eating, toileting, transferring, bathing, dressing and
continence. 

What can CLASS Program benefits be used for? 

Benefits can be used to pay for non-medical services and supports that
the beneficiary needs to maintain his or her independence in the
community. These can include home modifications, adaptive technology,
accessible transportation, homemaker services, respite care, personal
assistance services and home care aides. Benefits can be used to
compensate a family member for the provision of personal assistance
services. 

What effect will CLASS Program benefits have on other benefits a person
might receive?

CLASS Program benefits will not impact a person's eligibility for other
benefits. CLASS benefits will not count as earned or unearned income for
the purposes of determining initial or continuing eligibility for any
other Federal, State or locally funded program, including (but not
limited to) Supplemental Security Income, Social Security Old Age
Retirement or Disability benefits, Medicare, Medicaid, Veteran's
Affairs, low income housing or the food stamp program. A CLASS
beneficiary will also still need health insurance as the CLASS Program
is not health insurance and program benefits cannot be used to pay for
medical services. 

How will HHS make sure people remain eligible for benefits? 

CLASS Program beneficiaries will be required to certify annually by
submitting medical evidence that they continue to need assistance with
the appropriate number of activities of daily living, verify whether or
not they are receiving wages to determine whether they need to make
premium payments and submit verification of benefit expenditures. 

Are there any provisions to make participation more affordable for
people to participate in the CLASS Program? 

Anyone who participates in the CLASS Program is entitled to an above the
line deduction for the full amount of premiums paid. In addition,
workers who earn less than 250% of the Federal poverty level can claim a
refundable tax credit for up to 50% of the premiums they paid. 

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Core Principles of the CLASS Act

1.    Pooled Risk - Make paying for long-term services and supports
affordable through pooling the risk for all workers and their spouses

2.    Voluntary Opt-Out - Give people the choice whether to participate
but make it as convenient as possible through an automatic payroll
deduction.

3.    Consumer Choice - Allow people with functional limitations to
control what services they get, how, where and from whom. 

4.    Universality - Create a program that allows all working people,
including people with disabilities and those near retirement, the
ability to contribute and prepare for the costs of long-term services
and supports should they need them. 

5.    Low Premiums - The premiums must be low enough that all people,
regardless of income, are able to participate should they decide to do
so. 

6.    Non-Medical Model - People should be able to decide what services
and supports they need in order to stay as independent as possible and
remain in the community. Decisions should not be made for them based on
a medical model of disability. 

7.    Relieve Pressure on Medicaid - Provide an alternative funding
mechanism for long-term services and supports funding so that Medicaid
is not the only public source of funds for long-term services and
supports. 

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