Pallone Unveils Proposal for Medicare Long-Term Care Benefit

Edison, N.J. – Today, at a roundtable discussion with aging and disability advocates at the JFK Adult Medical Day Program in Edison, New Jersey, Congressman Frank Pallone, Jr. (NJ-06) released a proposal to create a new Medicare long-term care benefit. The comprehensive discussion draft, the Medicare Long-Term Care Services and Supports Act, would establish a public benefit within Medicare, designed for everyone regardless of income or where they live, to provide long-term care services and supports. Participants in the roundtable provided input on Congressman Pallone's draft bill.

Under the current system, health insurance, including Medicare, only covers very limited long-term care and support for seniors until a senior eventually qualifies for the Medicaid program after they have depleted all of their financial resources. Today, a senior will spend an average of $140,000 in out-of-pocket costs on long-term care and more than 15 percent of seniors will incur costs in excess of $250,000. In 2014, formal out-of-pocket expenses accounted for over $53 billion, and nearly 17 percent of working adults provide unpaid care for family members or friends.

"The growing need for long-term care is one of the greatest threats to retirement security for American seniors, and the adult children who care for them," said Pallone. "It's time to expand Medicare to include a long-term care benefit so that millions of seniors and individuals with disabilities no longer have to face financial ruin before they get assistance. I'm hoping that this proposal will begin an important discussion, and look forward to getting feedback from interested stakeholders."

More than 70 percent of seniors over the age of 65 will need long-term care services and supports in their lifetime, and with 90 million Americans expected to be over age 65 by 2055, long-term care expenses are predicted to double as a share of the economy over the next 30 years. Additionally, beyond seniors, those under the age of 65 with intellectual and developmental disabilities, behavioral health diagnoses, spinal cord or traumatic brain injuries or other disabling chronic conditions and their families struggle to afford the full range or care that is needed.

The Medicare Long-Term Care Services and Supports Act of 2018 creates a strong federal program within Medicare that will be there for those with substantial long-term care costs when they need care. More specifically, the discussion draft:

• Establishes a standard cash benefit within Medicare for anyone who is eligible for Medicare and those under the age of 65 who meet certain disability thresholds. The benefit would begin after a two-year waiting period that functions as a deductible. The discussion draft also solicits comment on a potential cash deductible alternative for certain beneficiaries.
• The self-directed benefit could be used towards all long-term services and supports, including nursing facility care, adult daycare programs, home health aide services, personal care services, transportation, and assistance provided by a family caregiver.
• Includes incentives for people to seek care at home, the setting where most people want to be, and with family support, while also being available for nursing homes.
• Relieves overburdened caregivers. This benefit can be used towards family caregivers and respite care. Caregivers find value in what they do, but may also lose income, other retirement benefits, and career opportunities if they have to cut back on work hours or leave the workforce.

Click here for the text of the discussion draft, here for a section-by-section summary of the discussion draft, and here for a one-pager. Pallone asks that stakeholders who wish to comment on the contents of this draft please submit to ECDem.Comments@mail.house.gov by June 15.

Participants in the round table included:

• Connie Garner - Executive Director, Allies for Independence
• Judy Feder, Georgetown Professor & Urban Institute Fellow
• Adeola Sonaike, Caregivers of NJ/The Family Resource Network
• John Indyk, Vice President of the Health Care Association of New Jersey

• Beverly Roberts, Director – Mainstreaming Medical Care, Arc of NJ
• Douglas A. Struyk, Board Member of Leading Age NJ
• Melissa Chalker, Deputy Director, NJ Foundation for Aging
• Renee Lake, Vice President, Longterm Care Hackensack Meridian Health