CAPABLE is an assistance program available in 26 states that primarily helps anyone 60 or older with tasks to enable them to remain in their homes. Rather than moving to some type of senior housing or assisted living facility, recipients get help in bathing, dressing and moving around their living space safely.
CAPABLE has existed for nearly 15 years, but it has only provided assistance to an estimated 4,600 clients. Despite the increasing desire for older Americans to remain in their homes as they age, it is not often covered by insurance programs, the Post explained.
“Insurance seldom covers the program, although the typical cost of $3,500 to $4,000 per client is less than many health-care interventions,” the article stated. “Traditional Medicare and most Medicare Advantage private insurance plans don’t cover it. Only four states use funds from Medicaid, the federal-state insurance program for low-income and disabled people.”
Instead, CAPABLE operates primarily through grants from state agencies for aging, philanthropic donations and other case-by-case funding programs.
“The payment obstacles are an object lesson in how insurers, including Medicare, are built around paying for doctors and hospitals treating people who are injured or sick — not around community services that keep people healthy,” according to the Post.
For instance, Medicare does not have a specific payment application for preventive care or home maintenance designed to prevent falls. Despite that, falls kill about 41,000 older Americans each year, according to the Centers for Disease Control and Prevention (CDC), and they cost Medicare about $50 billion per year.
On its website, CAPABLE hosts a list of studies that aim to corroborate its cost-savings potential in addition to fulfilling the desires of older Americans to remain in their homes. Cost savings could be significant if guidelines around government-assisted health care programs change, according to professionals who have worked with CAPABLE.
“To us, it’s so obvious the impact that can be made just in a short amount of time and with a small budget,” Amy Eschbach, a St. Louis-based nurse who has worked with the program, told the Post.
But any legislative path toward federal reimbursement would need to be carefully crafted, according to a senior Democratic House aide who requested anonymity when speaking with the Post.
“Medicare would have to establish careful parameters to broadly cover CAPABLE,” according to the aide. “For instance, CMS would have to decide which beneficiaries would be eligible. Everyone in Medicare? Or only those with low incomes?
“Could Medicare somehow ensure that only necessary home modifications are made — and that unscrupulous contractors don’t try to extract the equivalent of a ‘co-pay’ or ‘deductible’ from clients?”
