Long-term care What's Buzzing

Washington and Hawaii rely on public funds to cover cost of home care for older adults

Written by Diane Archer

Kaiser Health News reports on two states that have passed laws to help cover the cost of home care for older adults. Washington and Hawaii are relying on public funds to pay for long-term services and supports that enable more older adults to age in place.

In Washington, a 0.58 percent payroll contribution will pay for a $36,500 long-term services and supports (LTSS) benefit under the Long-Term Care Trust Act. Everyone must pay this tax except self-employed people and people with private long-term care insurance. They can opt to pay in or not. The state government passed this new law after considering and rejecting the idea of strengthening commercial long-term care insurance.

The LTSS benefit begins in 2025 for people who pay in at least three years. Contributions will be collected beginning 2022. People who need help with at least three activities of daily living–bathing, dressing, toiletting, eating, and transferring– will be eligible for the benefit.

Up to $100 a day, adjusted for inflation, will cover home care and related services, including home modifications and respite care for family caregivers. It could also cover the cost of a wheelchair ramp or training a family caregiver on how to best care for someone with a particular condition. Washington authorities believe that the broader the range of covered services, the more likely older adults will be able to remain in their own homes.

The state projects Medicaid savings of $3.9 billion over 30 years. And, it predicts 15,000 residents will take advantage of the benefit in 2025. By 2052, they project 98,000 residents will use the LTSS benefit. Today, 66,000 residents get long-term supports and services through Medicaid.

In Hawaii, public funds pay for a caregiver program that covers $210 a week in home care services. The program restricts enrollment to people whose family caregivers work outside the home for at least 30 hours each week.

These two states’ innovative ways to help older adults age in place could be a model for the rest of the country. Nearly 100 million Americans will be 65 or older by 2050. And, the data suggests that the vast majority will not be able to afford long-term services and supports. But, as many as 70 million could need them.

Older adults often need help with bathing, feeding, toiletting, dressing and/or transferring from their bed to a chair. And, they typically need that help for two years. If they can stay out of nursing homes, they are not only likely to be happier, but it should save the government money.

Fewer than one in six Americans have long-term care insurance to cover the cost of LTSS. Those policies cost around $3,000 a year. And, it is not at all clear they are a good investment.

So far, the federal government has not passed legislation to cover long-term services and supports. Most recently, it tried to do so through the Affordable Care Act. The Community Living Assistance Services and Supports (CLASS) Plan, a provision of the ACA that was jettisoned, would have delivered as much as $50 in daily benefits for home care or nursing home care. It was a voluntary government insurance program that would have charged people a premium.

For now, several states are looking into a variety of ways to help their residents age in place. In Minnesota, the state may let people convert life insurance policies to long-term care insurance. In Maine, the state is promoting long-term care insurance. Mainers recently voted against a ballot proposal to provide free long-term care to residents. It would have been paid through a 3.8% income tax on people with annual incomes above $128,400.

In California, Michigan and Illinois, state long-term services and support programs are also under consideration. Over the years, the New York State Assembly has passed a bill that would increase income taxes to pay for LTSS. But, the New York State Senate has not passed it.

Medicare for All would cover long-term care for everyone in the country.

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