Medicare Long-Term Care Services and Supports Act of 2018
Overview
Type of Reform: Add-on to Medicare
Description: Create a new Medicare benefit based on a self-directed LTSS cash benefit program. Individuals eligible for Medicare and individuals over age 65 who meet specific disability thresholds would be able to participate. The bill also proposed funding increases for a variety of state-based programs that support individuals needing LTSS such as the Area Agencies on Aging (AAA), Aging and Disability Resource Centers (ADRCs), and the State health Insurance Assistance Programs (SHIPs). Goals included:
- Help those with functional limitations maintain financial and personal independence;
- Protect them from high out-of-pocket costs;
- Address the burden on family caregivers; and
- Help address unmet needs for those with significant expenditures for LTSS
Sponsoring Organization and Key Author(s):
Sponsoring Organization:
- Proposed discussed draft of the bill by Rep. Frank Pallone (D-NJ) on May 2, 2018.
Impact and Action:
Never introduced into law and did not become an official act.
Program Details
Participation Criteria
Individuals eligible or currently enrolled in Medicare Part A. Those who meet the insured status requirements for Social Security Disability Insurance (i.e., under age 65, have appropriate number of work quarters, but also meet the functional disability criteria under this new Medicare Part E.
Universal-Mandatory for all individuals
Conditions for Receiving Benefits Scope of Services
The need for personal assistance in two or more ADLs or cognitive impairment would trigger the start of the elimination period.
Scope of Services
Not specified because the benefit is in the form of a cash payment, giving insured individuals the flexibility to purchase the services and goods they prefer.
Amount of Services
Catastrophic, with a two-year front-end waiting period (or possibly a cash deductible which means benefits would begin after a specified expenditure amount.)
While the total duration of services is not limited, once the elimination period has been met and benefits begin, the amount of benefit is specified based on one’s degree of impairment. Benefits begin at a minimum of five hours of home care services per day. And increase based on functional ability – with at least 2 and possible 4 different benefit levels available. These are adjusted for geography and for inflation.
Benefits paid are deposited into a self-directed cash LTC Account for the individual to use to purchase the LTSS they desire. Benefits can accrue and roll over in the account, but not more than quarterly. Individuals must submit quarterly records of cash benefits received and the expenditures they have made against the payments. The cash benefits are not considered income for purposes of eligibility for benefits under other public programs.
Participant Financial Responsibility
They are responsible for costs of care during the 2-year front-end elimination period. They are also responsible for costs of care that exceed the benefit amounts they receive under the program.
Elimination Period
There is a deductible or elimination period of 2 years. It begins when an individual satisfies the benefit trigger and continues as long as they continue to meet the benefit trigger. Once they have fulfilled the 32 year elimination period, they can begin to receive benefits.
Provider Requirements
None specified
Provider Payment Levels
Not addressed. Payments made to care recipients based on level of functional loss.
Inflation Adjustments
Not specified
Financing & Implementation
Revenue Source(s)
Not specified
Total Program Costs
Not specified
Program Administration
Not specified
Private Sector Role
Designed to encourage private sector offering front-end coverage to support individuals during the 3-year elimination period.
Medicare Long-Term Care Services and Supports Act of 2018
Category: