By upholding the constitutionality of the Affordable Care Act, the Supreme Court has preserved—at least for now—major changes in the way long-term care supports and services are delivered and financed.

Here are some provisions of the law that directly affect the frail elderly and younger adults with disabilities.

Medicaid: The law is filled with important changes to this state/federal program that currently funds nearly half of all paid long-term care services. While the Supreme Court ruled that most of the 2010 health law is constitutional, it threw out one important provision that would have forced states to cover the health care of millions of currently uninsured working people.

States can still insure those people through Medicaid—and the federal government has agreed to pay nearly all of the costs of that expansion for the next decade—but now states can refuse to provide that new coverage if they choose. Whatever choice states make, it will not only effect health benefits for poor families, but also Medicaid benefits for long-term care services.

Home and Community-based Care: The ACA includes important new incentives for states to expand Medicaid long-term care services for people living at home. Today, nursing homes still get the lion’s share of Medicaid long-term care dollars. Yet seniors and adults with disabilities overwhelmingly want to receive assistance at home. The ACA includes a number of new programs to expand those home and community-based programs.  

Medicare: The ACA slowly closes the “donut hole” for seniors who participate in the Part D drug benefit. That extra assistance would go away. It also includes a small increase in the payroll tax that is aimed at increasing revenues for Medicare, which is under great financial pressure. 

Integrated Care: In the long-run, perhaps the most important provisions for seniors are a far-reaching package of experiments aimed at improving the way care is delivered to people suffering from chronic disease, as nearly all seniors do.

For example, the law creates a new office to coordinate the health and long-term care of people who receive both Medicare and Medicaid. These “dual eligibles” are often the poorest and sickest seniors. It also includes important incentives to encourage hospitals, nursing homes, doctors, and other providers to work together to improve care for people with chronic disease.

The CLASS Act: CLASS has already been abandoned by the Obama Administration, but it does remain on the books.

Of course, while the legal battle over the Affordable Care Act is now ended, the political fight is just beginning. Mitt Romney and congressional Republicans vow to repeal the entire law. President Obama and most Democrats would preserve it. While health and long-term care reform will remain a secondary issue to the economy in the coming election, the fate of the 2010 health law will be a very big deal to seniors and those with disabilities.