Democratic presidential candidate Kamala Harris has backed an earth-shattering idea: For the first time, traditional Medicare would pay for personal assistance at home and related long-term care. Currently, only Medicaid and certain Medicare managed care programs provide long-term care benefits.
Harris endorsed the idea in an appearance on the television show The View and her staff heavily promoted her initiative to news organizations. She’d break down the six-decade wall between traditional Medicare and long-term care and potentially vastly expand government support for frail older adults and their families.
In her television appearance, Harris spoke passionately about being a caregiver for her own mother. She proposed having “Medicare cover in-home health care,” but it was clear from the rest of her remarks that she meant in-home long-term care. Medicare already covers home health care, though with many limitations.
No Details
But Harris has not offered any details of a plan. We don’t know who would be eligible, what services would be covered, or what dollar limits, if any, would be placed on benefits. How would the program interact with Medicaid or with private long-term care insurance? She did say she’d pay for at least some of her initiative with Medicare savings from negotiating drug prices. A Harris staffer did not respond to a request for more information about her idea.
While Harris is not willing to disclose details of a plan, if she indeed has settled on any, we may be able to see hints of what she has in mind from new two papers written by influential policy experts who are well connected to top Democratic lawmakers.
Some Hints
One, published by the Brookings Institution in September, proposed making long-term care available to all Medicare beneficiaries who need assistance with at least two activities of daily living (such as eating, bathing, and transferring from a bed to a chair). Benefit amounts would be linked to income and assets so that higher-income, wealthier beneficiaries would pay more of the cost of their care than low-income people. Care would only be covered if it is provided through a licensed home care agency.
The paper’s authors include Wendell Primus, a former top domestic policy aide to then-House Speaker Nancy Pelosi; Jonathan Gruber, who served as a senior Treasury Department official in the Clinton Administration; and Sherry Glied and Richard Frank, who held senior policy positions in the Department of Health and Human Services during the Obama Administration.
The second paper, published by Georgetown University in late September, was authored by Judy Feder, who served as a senior policy aide at HHS during the Clinton Administration, and Nicole Jorwic of the advocacy group Caring Across Generations.
They proposed a benefit that would cover those with a somewhat lower need for assistance, including those with cognitive limitations, as well as support for family members. They also said any plan should include “a significant investment in building the workforce”—presumably through increased compensation or career advancement opportunities.
More Ambitious Than Biden
Whatever she does, Harris would be moving well beyond existing government support for long-term care and be far more ambitious than President Biden.
In 2021, the Biden Administration proposed increasing the federal government contribution to Medicaid long-term care by $400 billion over 10 years. Medicaid, which is run by the states with funding assistance from the federal government, does pay for long-term care, but only for those with very low incomes and very few financial assets.
But Biden’s plan died in Congress. More recently Biden and Harris proposed a scaled down $150 billion version of the same idea. It too went nowhere.
Harris would take a very different path. Rather than expanding Medicaid long-term care, she’d create a long-term care benefit through traditional Medicare.
Medicare Managed Care
Despite common misconceptions, traditional Medicare does not pay for long-term care, except under very limited circumstances.
Various forms of Medicare managed care may pay for long-term care, however. Special Needs Plans do so. The PACE program, which generally benefits those eligible for both Medicare and Medicaid, provides fully integrated long-term care and managed health care. But both have limited enrollment.
Medicare Advantage managed care plans, which currently insure more than half of all Medicare beneficiaries, may provide very limited long-term care-like services. But they are very modest, averaging less than $50-a-month.
Dipping A Toe
In 2023, the Biden Administration dipped its toe in the traditional Medicare long-term care world. It created a program called GUIDE, which pays Medicare providers such as physicians and therapists a monthly supplement for providing care navigation services and limited social supports to traditional Medicare recipients living with dementia and their families.
But that effort also is quite modest, limited only to those with dementia, and focused mostly on care coordination rather than personal care.
In her tight race for president, Harris is trying to win support of tens of millions of family caregivers. Creating a viable Medicare long-term care benefit surely would be an enormous help to those caregivers and a stunning shift in federal policy. But, poorly designed, it could be unworkable or a massively expensive give-away. If only we knew how Harris would turn her talking point into a real plan.
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