Posted by:  Cynthia Tolan

Public opinion surveys show that most Americans incorrectly think Medicare pays for long-term supports and services (LTSS). It does not. But should it? Should Congress add a long-term care benefit to the program’s current package of insurance for hospital care, doctor visits, and drugs?

Three highly respected health researchers, Karen Davis, Amber Willink, and Cathy Schoen, think it should. In a blog post for the journal Health Affairs, they’ve proposed “Medicare Help at Home”. It has three elements: (1) A limited benefit for support at home; (2) a new health delivery model called an Integrated Care Organization that would provide both medical care and LTSS; and (3) team-based home care. The basic framework for their plan is a new Medicare long-term care benefit. It would provide a maximum benefit of about $400/week that could be used for a wide variety of home-based services. Participants would become eligible for benefits if they have severe dementia or need help with at least two activities of daily living, such as bathing, eating or dressing (the same trigger used by private long-term care insurance).

Without personal home care, access to senior day care, or support for family care partners, older adults needing assistance are at risk of losing their ability to live independently and being institutionalized in a long-stay nursing facility, with costs eventually covered by Medicaid. The lack of integration and accountability for both medical care and LTSS also contribute to avoidable hospitalization and emergency room use, and hinders the substitution of less costly social services for high-cost medical care.

Moving forward, adoption of a home and community based benefit in Medicare would constitute an important first step to helping beneficiaries afford the services and support they need to continue living independently. Adoption of innovative models of care emphasizing care at home or in independent living settings would reduce the difficulty and risk of obtaining services in traditional health care settings such as physician offices and hospitals. It would also reduce beneficiary reliance on Medicaid’s safety-net coverage of institutional care. It is a policy proposal worthy of serious consideration as the nation grapples with Medicare redesign to meet the needs of an aging population.

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