Harris Proposed A Medicare Long-term Care Benefit.

Kamala Harris addressed UNITE HERE hospitality union members on June 21 in New York… [+] 2024 (Photo by Angela Weiss/AFP via Getty Images).
Kamala Harris has made headlines recently by proposing an innovative idea – for the first time ever, traditional Medicare would cover personal assistance at home and related long-term care services – which currently are provided only through Medicaid managed care programs or certain managed Medicare plans.

Harris gave her support of this idea during an appearance on The View and heavily promoted it through news organizations. If implemented, Harris would shatter a six-decade barrier between traditional Medicare and long-term care insurance plans, potentially vastly expanding government assistance for frail older adults and their families.

Harris spoke passionately in her television appearance about being the primary caregiver to her own mother. In response to Medicare covering in-home health care for long-term care at home (the existing Medicare coverage does cover some long-term care options with specific limitations), Harris proposed having it covered fully as she suggested it should already cover Medicare in-home long-term care coverage as an ideal.

But Harris has provided no details of her plan, leaving us uncertain of its scope or details such as who would qualify, what services would be covered or any dollar limits on benefits; how it interacts with Medicaid or private long-term care insurance plans; she did say she plans on financing some of it from Medicare savings from negotiating drug prices however but no response was received regarding further inquiry from Harris staffers regarding this idea.

One publication by the Brookings Institution in September proposed providing long-term care assistance to Medicare beneficiaries who require assistance with at least two activities of daily living (like eating, bathing and transferring from bed to chair). Benefit amounts would depend upon income and assets; higher income beneficiaries with more assets paying a larger proportion than low-income individuals for care cost coverage through licensed home care agencies.

Authors of this paper include Wendell Primus, former top domestic policy aide to then-House Speaker Nancy Pelosi; Jonathan Gruber served as senior Treasury Department official during Clinton Administration; Sherry Glied and Richard Frank both held senior policy roles at Health and Human Services during Obama Administration.

In late September, Georgetown University published another paper by Judy Feder – who served as senior policy aide in HHS during Clinton Administration – and Nicole Jorwic from Caring Across Generations advocacy group.
They proposed an assistance benefit that would cover those with lower assistance needs, including cognitive limitations and family support needs, as well as provide for support of family members. They recommended any plan should include “significant investments in building the workforce”, whether through increased pay or career advancement opportunities. Their proposals are much bolder than what Biden proposed in terms of covering everyone who may require help and being inclusive to everyone regardless of age and background.
Harris would go well beyond current government support for long-term care services and surpass President Biden in her ambition.
In 2021, the Biden Administration proposed increasing federal contributions for Medicaid long-term care by $400 billion over 10 years. Medicaid provides long-term care support through state governments with funding assistance from federal sources; it covers long-term care only when necessary based on low income levels or limited assets.
But Biden’s plan failed in Congress. Recently, however, Biden and Harris proposed an even smaller $150 billion version which also fell flat on its face.
Harris takes an unconventional approach: rather than expanding Medicaid long-term care benefits, she would create one through traditional Medicare’s Managed Care plans.
Contrary to popular belief, traditional Medicare does not cover long-term care services except under special circumstances.
Medicare managed care plans may cover long-term care needs through Special Needs Plans or the PACE program; both programs generally benefit those eligible for both Medicare and Medicaid and offer fully integrated long-term care and managed health services, but have limited enrollment capacities.
Medicare Advantage managed care plans currently cover over half of Medicare beneficiaries and offer long-term care-like services at very limited levels, typically costing under $50 monthly on average.
Starting Out
In 2023, the Biden Administration made an exploratory foray into traditional Medicare long-term care world with their creation of GUIDE program that paid 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 as well as their families.
However, that effort remains rather modest, being limited only to people living with dementia and emphasizing care coordination rather than direct patient support.
Harris’ presidential run has become increasingly tight as she vies for support among tens of millions of family caregivers. Implementing an affordable Medicare long-term care benefit would certainly benefit these caregivers while making federal policy change history; yet poorly designed it may prove unworkable or too expensive to deliver; we wish only we knew more details on her plan to turn her rhetorical promise into actionable policy!