On October 8, 2024, Vice President Harris proposed to develop Medicare to supply residence care to assist households who’re scuffling with the prices of long-term care. If enacted, this may be the primary main enlargement of Medicare because the Medicare Modernization Act of 2003 that added a prescription drug profit to this system.
Vice President Harris proposes to create a brand new residence care profit for eligible Medicare beneficiaries. Underneath the proposal, Medicare beneficiaries can be eligible for the brand new profit if they’re unable to carry out actions of day by day residing comparable to bathing and consuming or have a critical cognitive impairment, comparable to Alzheimer’s illness. Though the proposal is just not totally specified, it “acknowledges that the overwhelming majority of seniors with long-term care wants are nonetheless capable of dwell of their houses with a mean of 20 hours or much less per week of care,” suggesting that the profit shall be round 20 hours per week. The brand new profit consists of value sharing necessities that change by revenue. The proposal notes that comparable residence care proposals have been estimated to value about $40 billion per 12 months, previous to accounting for potential financial savings from lowered use of hospital and nursing facility care.
As well as, the proposal would develop Medicare to cowl imaginative and prescient and listening to, and finish a observe referred to as “property restoration” when Medicaid recoups the prices of residence care from the sale of decedents’ houses and estates (described under). The proposal would fund the extra prices of the brand new advantages by increasing Medicare drug negotiation provisions included within the Inflation Discount Act; rising the reductions lined by drug producers for sure brand-name medicine; strengthening necessities for pharmacy profit managers associated to cost transparency and competitors; and by implementing worldwide tax reforms.
KFF estimates that 14.7 million Medicare beneficiaries (23% of these residing in the neighborhood) would doubtlessly be eligible for the brand new Medicare residence care profit. This estimate relies on eligibility standards utilized in comparable proposals: having two or extra limitations in actions of day by day residing and/or a critical cognitive impairment. The variety of individuals eligible for this profit might be larger or decrease relying on how eligibility standards are outlined, and never all people who find themselves eligible for this system will use the brand new advantages. This estimate relies on an evaluation of the 2022 Medicare Present Beneficiary Survey and excludes beneficiaries residing in nursing houses and different long-term settings (see Strategies).
Former President Trump has endorsed “at residence Senior Care” however has not put ahead a particular proposal. Former President Trump proposes “shifting assets again to at-home Senior Care,” addressing disincentives that contribute to workforce shortages, and supporting unpaid household caregivers by tax credit. It’s unclear whether or not the Trump proposals would apply to individuals with disabilities who use residence care, if they’d make adjustments to Medicare or Medicaid, or how they align with broader proposed cuts to the Medicaid program. Though Vice President Harris’ reality sheet focuses on older adults, the proposal would develop Medicare, which incorporates each adults ages 65 and older and youthful adults with disabilities, suggesting that Medicare beneficiaries with disabilities would even be eligible for the brand new profit.
Underneath present legislation, Medicare protection of residence care is sort of restricted. Medicare covers residence well being aide providers for individuals who want expert providers on a part-time or intermittent foundation, comparable to nursing or bodily remedy, and are “homebound.” Due to the expert care requirement, Medicare doesn’t cowl residence look after many individuals who need assistance on an ongoing foundation resulting from limitations in actions of day by day residing or cognitive impairments, however don’t additionally require expert providers.
Medicaid pays for two-thirds of all spending on residence care within the U.S., however protection guidelines are advanced and protection is for individuals with restricted monetary assets. Most residence care providers in Medicaid are offered on the possibility of states, and optionally available providers end in variability of accessible advantages. Roughly 700,000 are on ready lists for residence care as a result of the variety of individuals looking for providers exceeds the variety of individuals states can serve.
Individuals who want residence care and different long-term care providers usually pay substantial quantities out-of-pocket (see Determine 1). These prices usually exceed the median revenue for Medicare beneficiaries (about $36,000 per beneficiary in 2023) and will rapidly exhaust the median financial savings ($103,800 per beneficiary in 2023). KFF polling finds over half of all individuals who used long-term care or paid for a member of the family’s care reported having to scale back their spending on meals, clothes, or fundamental home items on account of these prices.
Vice President Harris’ proposal would additionally develop Medicare to cowl imaginative and prescient and listening to. Underneath present legislation, conventional Medicare doesn’t cowl prescription eye put on (eyeglasses/contacts) or listening to aids, which might be prohibitively costly for individuals residing on fastened incomes. Issue with listening to and imaginative and prescient is comparatively widespread amongst Medicare beneficiaries, with near half (44%) of beneficiaries reporting issue listening to and multiple third (35%) reporting issue seeing in 2019. Restricted listening to and imaginative and prescient advantages are usually provided by Medicare Benefit plans however the scope, worth and supplier networks of those advantages varies broadly throughout plans. Beneficiaries in conventional Medicare could have entry to some listening to and imaginative and prescient advantages if additionally they have supplemental protection beneath Medicaid, employer or union-sponsored retiree well being advantages, or different sorts of insurance coverage.
Past adjustments to Medicare, Vice President Harris is proposing to finish a observe by which Medicaid recoups the prices of residence care from the sale of decedents’ houses and estates. Underneath Medicaid property restoration, states are required to recoup the prices of long-term care and associated hospital and prescription drug providers for Medicaid enrollees ages 55 and older, and have the choice to get better the prices for different providers and populations. The Harris proposal proposes to work with Congress to finish Medicaid property restoration or use administrative motion to develop the circumstances by which households could also be exempted, if Congress fails to take motion.
Property restoration practices have been criticized for a number of causes, together with that it falls totally on people with restricted incomes, raises little income, and is utilized very erratically throughout the states. Democrats have lately proposed eliminating property restoration whereas Republicans have lately proposed modifying the principles and prohibiting it beneath sure circumstances.
Almost all provisions in Vice President Harris’ proposal would require a change in legislation. With out Congressional motion, a brand new Administration can be unable to determine and fund new Medicare advantages for residence care, imaginative and prescient, and listening to; generate financial savings by enacting adjustments to the Inflation Discount Act’s Medicare prescription provisions; remove Medicaid property restoration; or set up new taxes. Each Democrats and Republicans have proposed laws to scale back the variety of individuals ready to obtain Medicaid residence care and tackle the problem of Medicaid property restoration, suggesting which may be an space of potential compromise. There may be additionally bipartisan curiosity in beefing up oversight and transparency for pharmacy profit managers (PBMs).
Because the proposal winds its means by Congress, many coverage particulars must be labored by. For instance, along with laying out extra specifics about how one can totally fund the profit expansions, lawmakers would face questions on how eligibility for the brand new advantages can be decided; who might be paid to supply the brand new advantages; and the way the brand new advantages would work together with current Medicare advantages, and with supplemental protection offered by Medicaid or personal insurance policies. Lawmakers would additionally doubtless debate how one can assist care staff, enhance their wages, and tackle ongoing workforce shortages within the residence care trade. The solutions to those and different questions would impression how many individuals can be helped and the associated fee.
The proposal features a small variety of adjustments that might be enacted with out new laws, comparable to strengthening necessities for pharmacy profit managers associated to cost transparency and competitors and increasing the circumstances by which households could receive exemptions from Medicaid property restoration.
Strategies
This evaluation makes use of the Facilities for Medicare & Medicaid Companies’ Medicare Present Beneficiary Survey (MCBS), 2022 Survey File (the newest 12 months accessible) to acquire information on the quantity and share of Medicare beneficiaries who would doubtlessly be eligible for the proposed residence care profit. The evaluation assumed that Medicare beneficiaries with both two or extra limitations in actions of day by day residing (ADLs) or a cognitive impairment can be eligible. The MCBS is a nationally consultant survey of Medicare beneficiaries.
The evaluation is restricted to community-dwelling Medicare beneficiaries and excludes beneficiaries who dwell in long-term care or different residential services comparable to expert nursing services or assisted residing services.
For Medicare beneficiaries in the neighborhood, cognitive impairment is outlined as no less than one optimistic response to:
Having critical issue concentrating, remembering, or making choices due to a bodily, psychological, or emotional situation
Hassle concentrating greater than half the times or practically each day in the course of the previous two weeks
Medicare beneficiaries in the neighborhood have been outlined as doubtlessly eligible for the proposed residence well being care profit in the event that they reported issue performing two or extra of the next ADLs due to a bodily, psychological, emotional, or reminiscence drawback: bathing or showering, getting in or away from bed or chairs, dressing, consuming, utilizing the bathroom (together with getting up and down), or strolling. These difficulties could have been non permanent or power on the time of the survey.
