By Donna Gordon Blankinship JUNE 7, 2019
Nearly
a decade after federal officials discarded a provision in the Affordable Care
Act that would have provided Americans with long-term care insurance benefits,
two states — Washington and Hawaii — are experimenting with taxpayer-funded
plans to help older residents remain in their homes.
Washington
state’s ambitious plan, signed into law in May, will employ a new 0.58% payroll
tax (or “premium,” as policymakers prefer to call it) to fund a $36,500 benefit
for individuals to pay for home health care, as well as other services — from
installing grab bars in the shower to respite care for family caregivers.
Hawaii’s
Kupuna Caregivers Program, which was initiated in 2017, is
also publicly funded, but state budget allocations limit enrollment and
benefits. It provides up to $210 a week for
services when family caregivers work outside the home at least 30 hours a week.
Other
state policymakers are closely watching both experiments because, as seniors
account for a greater proportion of the American population, the need for long-term
care will increase. Josephine Kalipeni, director of policy and partnerships for
Caring Across Generations, a national group that advocates for long-term care
policy improvements, said, “What’s most exciting for us and for the country is
to have a working model we can learn from.”
The
need is great. The number of Americans 65 and older will double to 98 million
by 2050, and studies show few have the financial resources to pay for care in
old age. More than half of adults 65 and up will require long-term assistance
at some point with everyday activities, for an average duration of about two
years, according to a 2015 study by the
Department of Health and Human Services. Finding a way to help people stay in
their homes — and not move to nursing homes — can keep them happier and save
them and the state money. Medicaid programs help cover the costs of 62% of
nursing home residents.
Sixteen
percent of Americans have private long-term care insurance, according to the
American Association for Long-Term Care Insurance. But that is an expensive
option, with premiums averaging as much as $3,000 a year in 2019.
Affordability
and sustainability are the two main challenges to public long-term care
insurance programs. The federal ACA originally included the long-term care
provision — sponsored by Sen. Ted Kennedy (D-Mass.), who did not live to see it
enacted — called the Community Living Assistance
Services and Supports (CLASS) Plan. The voluntary program would have
provided benefits of up to $50 a day for home assistance or to help with
nursing home care for people who paid into the system. But critics said the
program was unlikely to draw healthy people to help pay premiums, and the Obama
administration in 2011 said it could not find a way to
make it solvent. Congress later repealed the provision.
Initially,
Washington state officials considered an alternative plan — shoring up the
private long-term care insurance market — but determined that option was
neither affordable nor likely to succeed.
Instead,
they created a benefit system with a broad definition of covered services, from
paying someone to build a wheelchair ramp to helping a caregiver learn how to
deal with aggressive or violent patients. They could have shrunk this list to
make the program less expensive, but Washington policymakers believed offering
a wide menu of services would help keep people out of nursing homes.
The
state will begin collecting the payroll tax in 2022, and starting in 2025
residents can collect benefits if they have paid into the system for at least
three of the previous six years or five consecutive years within a decade. The
details will be set over the next few years, but to qualify for a benefit of up
to $100 a day, which will be adjusted for inflation, a person must show they
need help with at least three activities of daily living.
The
Long-Term Care Trust Act is expected to save $3.9 billion in state Medicaid
costs by 2052.
Setting
up a new state-run tax and benefit system is complicated. And figuring out how
to determine who qualifies and how the money can be spent could take Washington
state officials the next five years.
“The
challenge is just the enormity of the insurance product itself,” said Bea
Rector, director of the home and community services division of the Washington
Department of Social and Health Services, one of four agencies involved in
implementing the new program. State feasibility studies estimate the Long-Term
Care Trust Act provisions will eclipse long-term care benefits paid through the
state Medicaid program, which helps about 66,000 people at any time. The number
expected to seek the new benefit is estimated at 15,000 in the first year of
operation in 2025, growing to 97,000 by 2050.
Jason
McGill, Gov. Jay Inslee’s senior health policy adviser, is not concerned about
implementation. “We’ve been working on this for five years now,” he said,
adding that the Trust Act is a modest benefit that will cover what most people
need without breaking the state budget. “It’s not like we just cooked this up.
This has been thoroughly thought through.”
Rector
said the new state program for paid family leave, which also involves a payroll
tax, has laid the groundwork for administering the new long-term care fee.
“We’ve
got a long way to go before we start paying benefits,” said McGill, who
believes the biggest challenge will be communicating with the public why
they’re paying this new tax. Self-employed people can voluntarily join the new
program and workers with private long-term care insurance can opt out;
otherwise, all public and private employees will be assessed the new tax.
Other
states are also grappling with long-term care.
Minnesota
is considering allowing people to convert life insurance plans to long-term
care insurance.
Last
November, Maine voters rejected a ballot proposal to provide free long-term
care to residents, funded by a 3.8% income tax on residents making more than
$128,400 a year. Instead, the state government is educating people about the
need to buy long-term care insurance, including an awareness campaign in high
schools.
The
California Aging and Disability Alliance, an advocacy group, is considering
a ballot initiative for
a state program to provide long-term services and support, but it is still
researching how to pay for and run this program. Michigan and Illinois are also
studying proposals.
New
York lawmakers have debated a graduated income tax to pay for comprehensive
long-term care for its citizens. The Assembly has passed such a bill
repeatedly, but the state’s Senate has refused to approve it.
https://khn.org/news/payroll-tax-is-one-states-bold-solution-to-help-seniors-age-at-home/?utm_campaign=KFF-2019-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=73475680&_hsenc=p2ANqtz-9toyPo0kvaMcPDhbROUq8pmEj1Hc473qvmORsL06JupXbDmJAmXjXjPzai0q_iOd9zD2y05--iy5VshnEUIUxbs5i2dw&_hsmi=73475680
No comments:
Post a Comment