Long-term care benefit bill receives all supportive testimony in hearing

The House Health & Wellness Committee today heard a line-up of supportive public testimony on House Bill 1087, also known as the Long-Term Care Trust Act. The bipartisan bill would establish a public long-term care benefit that Washington workers would pay into, and eventually be able to benefit from should they have difficulty completing the tasks of daily life.

Here’s how it works: Starting in 2022, if you’re a Washingtonian working at least 10 percent of full-time, you pay 0.58 percent of your wages into the trust program. Once you meet minimum qualifications for the amount of time you’ve paid in, you’re eligible to claim benefits. Eligible, that is, if the Department of Social and Health Services (DSHS) determines you need help with at least three activities in daily life (eating, bathing, cooking, etc.). Starting in 2023, self-employed people could elect to pay in.

An eligible person could use up to $36,500 total in benefits over their lifetime, in “benefit units” of $100, toward services and supports provided by a qualified caregiver. Examples that could qualify include: skilled nursing care, meal preparation, meal delivery, environmental modifications (e.g. building a wheelchair ramp), adult family homes, and home health services.

The 2015-17 Operating Budget funded an outside study, conducted by national actuarial firm Milliman, which modeled a public benefit like the one in the bill alongside a public-private reinsurance model. Milliman found that 70 percent of people over age 65 will need long-term care at some point, and that about 830,000 unpaid family caregivers were providing long-term care to loved ones in their homes in Washington.

Long-term care — often needed due to age, chronic illness, or disability — isn’t covered by Medicare, except in cases when the care is medically oriented, according to Milliman.

And if people turn to the private market for long-term care insurance, as Legislative Director at the Office of the Insurance Commissioner Lonnie Johns-Brown said at the hearing, they find a market that is “not thriving.”

“There are very few providers in the market, it is quite expensive, and it’s pretty simple why that is,” Johns-Brown testified. “Those of us, when we’re younger, do not take up this insurance. You cannot spread insurance risk with this type across the market when the only people buying it are the people that need to use it pretty soon.”

But Johns-Brown said the bill’s trust program would “probably help the market that still exists stabilize, and may also lead to a new market where people are buying supplemental long-term care insurance above and beyond this very basic and important benefit.”

With the system as it is now, according to the Milliman study, individuals who need long-term care pay out of pocket until they “impoverish themselves to qualify for Medicaid,” which funds about 60 percent of Washington’s nursing home residents.

Ultimately, Milliman found that a public benefit like the one in the bill “has the potential to generate savings to the Medicaid program.”

According to the bill, those savings could amount to $898 million in the 2051-53 biennium.

The program would be administered by the Department of Social and Health Services, the Employment Security Department, and the Health Care Authority. A Commission of legislators, leadership in the aforementioned agencies, and representatives from various stakeholder organizations would issue recommendations for and help maintain the program.

After the hearing, Rep. Laurie Jinkins, who sponsored the bill and cares for her mother-in-law, explained that they still have a bit of work they want to do to “tighten up the agency relationships” so there’s no overlap in agency responsibility, and that she expects the bill to be execed out of committee next week.

“I’m way more over-the-moon about this bill than I probably should be,” Jinkins said. “I cannot see how this is a losing deal for anybody: Everybody wins. The state wins. Individual people win. Families win. Everybody wins.”

At the bill’s hearing, Johns-Brown of OIC joined caregivers and representatives of organizations like AARP, the Alzheimer’s Association, and the Washington Health Care Association to testify in support of the bill. Committee Chair Rep. Eileen Cody said 17 people had signed up to testify in favor of the bill, and two signed up to testify “other” — nobody signed up to testify against it.