Washington State First-Country Long-Term Care Benefits Re-Tools: Shot

Medicare coverage for long-term care is very limited, while Medicaid usually seeks to impoverish people before taking the tab.

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Medicare coverage for long-term care is very limited, while Medicaid usually seeks to impoverish people before taking the tab.

Mascot / Getty Images

Patricia Key, 71, and needs help with daily chores such as surviving a stroke, dressing and bathing. Her daughter, Christina, who lives with her mother in Vancouver, Wash., Takes care of her in the evenings and pays about $ 3,000 a month to help other caregivers.

Christina Key, 53, was thrilled three years ago when the state of Washington passed a first-country law that created long-term care benefits for residents who paid in a state fund. He hoped it would be a resource for others facing similar challenges.

Benefits, which have a lifetime limit of $ 36,500, would have made a big difference in the first year after his mother’s stroke, Key said. Her mother needed to build a ramp and make other changes to her home, as well as a wheelchair and hospital bed. Extra money can make it easier to hire caregivers. Instead, he quit his job selling technology to look after his mother.

“People are under the cloud of this illusion between your insurance and your retirement [income] You’ll be fine, “he said.” They don’t understand things that insurance doesn’t cover. “

But Washington families will have to wait for relief. The WA Cares Fund, which was set to begin raising money for the program in January, including a mandatory payroll tax on workers, has been delayed by lawmakers in the current legislature. The pay cut will start from July 2023 and the benefits will be available in July 2026

Other states are watching Washington closely because they are offering coverage for their own residents. In California, a task force is examining how a long-term care program can be designed and implemented, according to the National Assembly of the State Legislature. Illinois and Michigan are also studying the problem, according to NCSL.

Christina Keys (left) cares for her mother, Patricia Keys, who suffered a stroke a few years ago and pays about $ 3,000 a month to help other caregivers. “People are under the cloud of this illusion between your insurance and your retirement [income] You’re going to be fine, “he said.

Christina Kiss


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Christina Kiss


Christina Keys (left) cares for her mother, Patricia Keys, who suffered a stroke a few years ago and pays about $ 3,000 a month to help other caregivers. “People are under the cloud of this illusion between your insurance and your retirement [income] You’re going to be fine, “he said.

Christina Kiss

Proponents of her case have been working to make the actual transcript of this statement available online. Proponents of her case have been working to make the actual transcript of this statement available online. The long-term viability of the program, however, is in doubt and the cost of personnel purchased in the program is questionable.

What is beyond doubt is that meeting long-term care needs is crucial. About 70% of people over the age of 65 need some form of long-term care, many need temporary help such as an at-home assistant, others may stay in a nursing home for an average of over $ 90,000 a year but many have good options to cover the cost. No. Medicare coverage is very limited, while Medicaid usually wants people to impoverish themselves before taking the tab. Personal long-term care insurance policy is impossible for most people.

Outcome: Many people rely on unpaid family members to help with medical care as well as daily activities such as bathing and dressing.

The problem is getting worse. The number of people aged 85 and over is expected to double in the next 20 years, while the number of Americans living with Alzheimer’s disease and related dementia is also expected to double, to 13 million.

The Federal Community Living Assistance Services and Support Act (Class Act), which was part of the Affordable Care Act, created a voluntary long-term care purchase program, but it was never implemented due to concerns that it would not be financially viable. . Since then, policymakers in Washington, D.C., have had little appetite for problem solving.

“We don’t have a solution at the federal level, so states are taking it upon themselves to experiment with a solution,” said Bonnie Burns, a California health consultant and longtime care expert based in Washington. The State Committee will assist in the development of a supplementary long-term care insurance product in addition to state benefits.

The maximum benefit of the Washington State program is to cover the one-year cost of 20-hour home care a week, says program director Benjamin Vegeta.

While the rich may be able to pay for their care and the poorest families may qualify for Medicaid, middle-class families may burn out quickly by trying to cover such bills.

“It doesn’t solve all the problems, but with a modest premium and a modest benefit, it makes the problem easier for the family,” Veggie said. It may also give some families time to “maybe they can make a plan” after their benefits expire for long-term care needs, he added.

Although the law was passed in 2019, it was under the radar of many people until it came to compulsory pay cuts. Workers face 0.58% tax for every $ 100 income. For those earning $ 52,000 annually, the cuts would be $ 302 a year, according to state estimates. People realized they were going to start paying for the program, some pushed back.

Employees can get discounts if they have personal long-term care insurance, and thousands of people scrambled for that coverage before the November 1, 2021, opt-out deadline. Many employers in the state quickly offered employees the opportunity to purchase personal plans.

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Since profits are not limited based on withheld income, wealthy individuals may be better off with personal long-term care insurance if they can pass the insurer’s medical assessment.

“We had a lot of high-income, young people who wanted to buy a policy,” said Gary Brooks, a certified financial planner who co-owns Gig Harbor, Wash’s BHJ asset advisory.

As of last month, 473,000 workers had made a one-time proposal to opt out of the program.

Others objected because they had to pay for the system but not benefit. This includes people who work in Washington but live in a neighboring state, spouses of service members who are unlikely to make Washington their permanent home, those who plan to retire three years ago to qualify for benefits, and some workers on temporary visas. The commission overseeing the long-term care program estimates that the number of people eligible to opt out of these groups is about 264,000.

In January, Governor Jay Inslee signed into law a law that addresses many of these issues. This allows certain groups to opt out and allow people close to retirement to receive partial benefits based on how many years the program was paid for.

Another group – those planning to retire elsewhere – has not been addressed, but is making recommendations to the state legislature, Vege said. According to current actuarial estimates, 3.1 million of the total 3.6 million workers will start paying for the program next year, Vegeta said.

Some critics worry that allowing more people to opt out of the program puts them on a growing uncertain financial footing.

“The problem of well-being is getting bigger and bigger,” said Richard Birmingham, a partner at Seattle’s Davis Wright Tremain who is representing employers and workers in a class-action lawsuit that claims the law violates federal and state laws governing employee benefits. “Any change they make increases the cost.”

KHN (Kaiser Health News) is a national newsroom that creates in-depth journalism about health issues. It is an editorially independent operating program KFF (Kaiser Family Foundation).

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