Report: Big Investment in HCBS Needed to Support Long-Term Care Needs

A new report from the Bipartisan Policy Center, Bipartisan Solutions to Improve the Availability of Long-term Care, calls for significant investment in expansion of home and community-based services (HCBS) in order to expand access to long-term care, which will become increasingly necessary in a rapidly aging society.

“For decades, policymakers have sought to improve access to long-term services and supports (LTSS) and to strengthen these services’ financing,” reads the report. “Today, about half of 65-year-olds will need LTSS at some point in their life. This need will grow as baby boomers age and require more care.”

About 14 million U.S. adults reported a need for LTSS in 2018, according to the American Association of Retired Persons.

More than 800,000 senior and disabled Americans are on waiting lists for HCBS, though most observers believe the true number is far higher than that. The average wait time for HCBS is about three years.

“The cost for facility and in-home care services has on average increased faster than the rate of inflation since 2004,” the report reads. “Long-term care providers saw significant cost increases from 2019 to 2020 as demand rose and caregiver shortages in facilities and in the community worsened. The median for the national annual cost of LTSS in 2020 ranged from $19,240 for adult day health care to $105,850 for a private room in a nursing home.”

The report contains five important recommendations for how to achieve a system of LTSS.

I. Expand Access to Home and Community-Based Services

“Congress should make HCBS available for individuals with long-term care needs who are ineligible for Medicaid,” reads the report. Services should be available through fully integrated care models, including improved fully integrated dual
eligible special needs plans (FIDE-SNPs), Programs of All-Inclusive Care for the Elderly (PACE), or other models approved by the secretary of HHS, and would include sliding-scale subsidies.

In addition, the report recommends that Congress develop a transitional program to support the expansion and development of integrated delivery models where they are unavailable, and should build caregiver capacity until the new HCBS program is fully implemented.

II. Address Disparities in the Delivery of HCBS

Congress should direct the secretary of HHS to collect data and issue an annual report on disparities in access to HCBS and make recommendations to Congress to address inequities.

III. Create a Caregiver Tax Credit

The report suggests Congress establish a refundable tax credit for caregivers to help with out-of-pocket costs for paid LTSS-related care.

IV.Improve the Viability of Private Long-Term Care Insurance

The authors recommend Congress standardize and simplify private long-term care insurance to achieve an appropriate balance between coverage and affordability, through “retirement long-term care insurance (LTCI).”

Furthermore, the report urges Congress to incentivize employers to offer retirement LTCI and to auto-enroll certain employees (age 45 and older with minimum retirement savings), with an opt-out like many employer-sponsored retirement savings accounts.

Congress should slso permit early penalty-free withdrawal from retirement savings accounts to pay retirement LTCI premiums and ask NAIC to modify model laws and regulations to accommodate products that convert from life insurance to long-term care, write the authors of the report.

V. Establish a Public Education Campaign for Long-Term Care

The Bipartisan Policy Center report calls for the Financial Literacy and Education Commission and partnering federal agencies to coordinate to strengthen educational resources on LTC and incorporate LTC planning into retirement
education topics.

“No single solution will address the needs of those who require LTSS,” write the report’s authors. “Improving access to these services will require a combination of public- and private-sector options, and an investment of federal resources.”