Harris floats ‘Medicare at home’ proposal

Vice President Kamala Harris unveiled a plan Tuesday that would allow Medicare beneficiaries to receive some long-term care services at home, regardless of other medical needs.

The presidential candidate's announcement, made during an appearance on the ABC television program "The View," was met with applause and cheers.

"This issue is personal and one I care deeply about," she told co-host Sunny Hostin. Harris described caring for her mother, who had cancer, and said, "It's about giving folks dignity and independence for that person."

Harris was responding to Hostin's question about people caught in the so-called sandwich generation - middle-aged adults caring for aging loved ones and simultaneously raising their families. Pew Research estimates that more than half of

Americans in their 40s and 50s fall into this group. Many caregivers must cut work hours or leave the workforce to meet caregiving obligations. Could a Medicare at home option make a difference?

Why this matters

Women over 50 make up the largest group of undecided voters, according to NPR. Harris said in-home care could alleviate some financial and emotional pressure on these caregivers. A plan to address caregiver burden might also help sway some undecided caregivers towards Harris.

Journalists can use this policy announcement as a jumping-off point to look at many different aspects of the long-term care crisis in the U.S., including:

• Economic implications of family caregivers leaving the workforce.
• Lack of or inconsistent home care benefits among Medicare Advantage plans.
• Variations in home- and community-based services by community and state.
• Lack of access to adult day care in some communities.
• Disparities in home care services among some underserved populations.
• Home care workforce shortages, the growing demand for services and pay rates.
• Potential for fraud among home care providers who contract with Medicare or designated agencies
• How would this plan be administered - for example, as one national plan similar to hospice benefits or left up to states to implement and regulate?
• Personal stories of Medicare beneficiaries and family caregivers.

A strong desire to age at home

More than three-quarters of older Americans (77%) want to age in place, according to AARP. But many need help with basic activities like getting dressed, bathing or cooking meals. They often turn to family members, usually adult children, for assistance. As we recently reported, 67% of caregivers say they struggle with work-life balance, with most providing at least 20 hours a week of care.

Over half of adults 65 and older will need in-home services for less than two years, but 60% of them, or about 33 million households, can't afford it, according to the National Council on Aging. In 2023, the median yearly cost of a home care aide was $75,504, according to data from Genworth Financial.

"Medicare coverage of home care would be a game changer for the millions of families who are caring for older loved ones with few options or support," said Ramsey Alwin, National Council on Aging president and CEO.

Current Medicare benefits

Traditional Medicare only pays for home care services if they are provided in conjunction with skilled care, such as nursing or physical therapy, and the recipient is homebound. They do not pay for stand-alone home care, which assists people with activities such as bathing, dressing, eating, toileting, cooking, cleaning or managing finances.

Some Medicare Advantage plans will cover certain home care services but hours are often limited and vary widely between plans, according to Gretchen Jacobson, vice president of the Medicare program at The Commonwealth Fund.

"Although some MA plans provide some coverage of some more benefits at home, there's a lot of variation across plans, and a lot of leeway and flexibility in terms of how the plans design those benefits," said Gretchen Jacobson, vice president of the Medicare program at The Commonwealth Fund. What's available to people depends on where they live, which is generally not how the core Medicare program is structured.

Plans are updated annually, so beneficiaries may not know from year to year how much these benefits may change, Jacobson said. While many people assume Medicare pays for long-term care, it's Medicaid that funds most home care services through waiver programs, but many have income eligibility requirements.

The bottom line

A stand-alone home care benefit would save families and the government money and reduce hospitalizations, according to Harris's campaign. New benefits would be financed by expanding Medicare drug price negotiations and increasing the discounts covered by certain drug makers for brand-name drugs, by further cracking down on Medicare fraud and on pharmaceutical benefit manager (PBMs) practices that increase prices.

The savings will also extend the life of the Medicare Trust Fund. Additional savings would come from cracking down on companies that move jobs overseas to avoid paying taxes. Action on the prescription drug side would generate "significant savings," according to policy analysts at Stanford University.

Proposals similar to the Medicare at home initiative are projected to cost around $40 billion annually before factoring in savings from preventable hospitalizations and institutional care or the additional revenues generated by family caregivers who could return to work, the campaign said. They credited research from Georgetown University and the Brookings Institution, as laying the groundwork for this plan.

"As with many plans, there's a lot of details that would need to be specified to turn this into a real proposal and to understand how much it would cost and who would be helped by it," Jacobson said.

Medicare at Home plan details

Specifics are still slim, but according to information released by the campaign, it would include:

• In-home care: beneficiaries will be independently evaluated by physicians or nurses for the ability to independently perform activities of daily living and/or face serious cognitive impairment. Medicare will designate aides and can include any qualified home health aides, personal care attendants, or direct care workers recognized by their state.
• Tailored services: a vast majority of older people with long-term care needs are still able to live in their homes with 20 hours or less a week of care provided by a home care aide for daily activities. Medicare will design a plan that provides coverage for those of modest incomes with a sliding scale for cost-sharing for older adults with higher incomes.
• Private sector partnerships: The plan would adopt best practices across Medicare plans and the private sector to expand the home care workforce, partner with technology companies in areas such as remote patient monitoring and telehealth services, and create other private sector partnerships.
• Improve conditions for care workers: with access to better wages, and improve quality of care for older adults and those with disabilities while treating them with dignity.

While many questions remain about this proposal, "You don't always hear about long-term care on major platforms like "The View." It's exciting to see that kind of attention. It's been a long time coming, and it's important that we continue to have national news coverage on the need for addressing the long-term care crisis," said Allison Buffett, a senior policy analyst at the Bipartisan Policy Center.

"This is a really complex issue, so it's going to take a really nuanced approach from a Medicare perspective," Buffett said. She also raised questions about how the Harris proposal would integrate with existing state programs, such as Washington's long-term care fund or existing Medicaid home and community-based services.

Changes to current Medicare coverage will require bipartisan Congressional support. And while many lawmakers agree there's a need to improve long-term care options, they disagree on how to get there, Buffett said.

Resources

• AP NORC issue brief.
• Services for Older Adults Aging at Home, National Institute on Aging.
• Cost of care survey, Genworth Financial. Find costs of long-term care options in your area or nationally.
• State Long-term care solutions. Bipartisan Policy Center.
• "The Financial Hardship Faced by Older Americans Needing Long-Term Services and Supports." The Commonwealth Fund.