There's No Place Like Home: How PPACA Falls Short in Expanding Home Care Services to the Elderly

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA). In an effort to rebalance states' spending on long-term services and supports (LTSS) towards home care, PPACA created four new options under Medicaid with which states could provide home care services to their citizens. While PPACA's creation of these four optional Medicaid HCBS programs allows states more flexibility and the capability to provide enhanced home care services to its citizens, it falls short of completely addressing the existing institutional bias in Medicaid by failing to create a mandatory Medicaid state service plan for home care services. Part II describes home care workers, provides a legislative history of home care services, and outlines how Medicaid provides nursing facility care. Part III analyzes the shortcomings of PPACA's plan to improve access and delivery of home care services. Part IV proposes recommendations to better provide the elderly with reliable and affordable home care service.