The Aging at Home Association Policy and Advocacy Platform

  • Ensure the quality of home care providers. As more and more seniors use home care services, there is a growing need to measure and improve the quality of services available in the market so that people can make the best choices for their loved ones.   We support:
    • Development of programs to help states build next-generation approaches for measuring and improving the quality of long-term services and supports (LTSS), including home- and community-based services (HCBS) for the Medicaid population.
    • Creation of guidelines and educational materials by credible, non-profit community-based organizations that help care providers working in home care settings and family caregivers.
    • Initiatives that give patients and their families access to information about home care providers – including personal care aides and social workers – who work in their community and community programs that support the needs of people who are aging at home.
    • Sustainability of the limited Medicare home health program to help patients after an event like a hospitalization and support for the clinical teams who provide care.
  • Enhance the ability of family caregivers to provide important services at home. We support:
    • Funding for development of education and training programs for family caregivers.
    • Changes to federal programs to allow individuals leaving the workforce to care for family members to maintain health insurance coverage, employee benefits, and Social Security.
    • Expansion of respite care programs.
  • Increase and improve access to technology that improves the aging-at-home experience. We support: 
    • Policies that expand and strengthen the use of telemedicine, including continued use of Medicare program flexibilities used during the COVID-19 pandemic to allow more beneficiaries to visit their doctor virtually.
    • Development of clearinghouses of vetted technologies that support and enhance aging at home, with evidence about how they help different kinds of patients. Approaches should be open and accessible to all stakeholders and managed by credible organizations with experience in the aging sector such as Leading Age’s Center for Aging Services Technologies (CAST).              
  • Test new models of home care delivery and bringing best practices to market. We support:
    • Programs that strengthen access to HCBS for Medicaid patients, and flexibility for proven, evidence-based interventions that increase quality and lower the total cost of care.
    • Research and demonstration programs that test the impact of enhanced home care access for the middle class. We envision a multi-state model that tests the impact on Medicaid long-term care spending of greater use of care management, navigation programs, and innovative approaches to financing home care such as short-term care or life-hybrid policies.  
  • Expand financial incentives to encourage and help individuals and families save for their health care needs in retirement. We support:
    • Creation of a new category of tax credits (like child-care credits) for individuals to age at home; eligibility for this kind of credit could be linked to ADLs and enrollment in a qualified program that offers services to support aging at home, such as care planning and navigation, when combined with purchase of a qualified short-term home care product.   
    • Expansion of the current tax deductibility of LTCI premiums to affordable, limited benefit short-term home care models to spur broad purchase and increase opportunities for aging at home.  Qualified models – including life hybrid policies – could be designed to have a cap on deductible coverage amounts, base eligibility on activities of daily living, and include limited underwriting.  
    • Greater use of existing programs that offer individuals tax incentives through employers or on their own to help finance care in the home such as a personal care aide. Approaches could allow individuals to use their HSA savings to pay for premiums for qualified short-term home care plans or expand flexibility of employers to use HRAs to offer employees qualified short-term home care plans.

Legislation

In part due to the challenging impact of the COVID-19 pandemic on facility-based long-term care, Congress is considering legislation to enhance and expand the provision of home-based services for long-term care, including home- and community-based services, an optional benefit under Medicaid.

President Biden’s proposed infrastructure plan under consideration in Congress would add $400 billion to enhance home- and community-based services and offer support to the development and training of caregivers and home-care workers.

FACT SHEET: The American Jobs Plan | The White House

The HCBS Access Act would mandate the provision of home- and community-based services (HCBS) in Medicaid for specific long-term care services, create national, minimum requirements for HCBS, reduce waiting lists for services, and provide funding for support and development of a future long-term care workforce.  A discussion draft of the proposed legislation and request for stakeholder input can be found here:

Dingell, Hassan, Casey, Brown Release Draft Proposal for HCBS Access Act | Congresswoman Debbie Dingell (house.gov)

Other bills propose the creation of new programs to finance long-term care coverage.  One bill would create a federal catastrophic long-term care insurance program.  The legislation – the Well-Being Insurance for Seniors to be at Home (WISH) Act – would establish a new federal program financed by a 0.5% payroll tax to fund catastrophic long-term care services.  The government would provide support for care in the waiting period before benefits begin with waiting periods varying by income.   Beneficiaries would include older adults with some level of assistance needs and the program would pay a monthly cash benefit to pay for 6 hours of direct care per day. 

This bill allows an eligible caregiver a tax credit of up to $3,000 for 30% of the cost of long-term care expenses that exceed $2,000 in a taxable year. The bill defines “eligible caregiver” as an individual who has earned income for the taxable year in excess of $7,500 and pays or incurs expenses for providing care to a spouse or other dependent relative with long-term care needs.

For more information on the Credit for Caring tax credit visit:

https://www.congress.gov/bill/116th-congress/house-bill/2730?s=1&r=5

Advocacy

This blog post from the Center for Medicare Advocacy – a nonpartisan organization advocating for Medicare beneficiaries – underscores the limitations of Medicare’s home health benefit and the need for people to get more help to age at home:

 

Shrinking Medicare Home Health Coverage: It’s Time to Act