[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2082 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 2082
To amend title II of the Social Security Act to provide for long-term
care insurance benefits, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 11, 2025
Mr. Suozzi (for himself and Mr. Moolenaar) introduced the following
bill; which was referred to the Committee on Ways and Means
_______________________________________________________________________
A BILL
To amend title II of the Social Security Act to provide for long-term
care insurance benefits, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Well-Being Insurance for Seniors to
be at Home Act'' or the ``WISH Act''.
SEC. 2. FINDINGS; PURPOSE.
(a) Findings.--Congress finds the following:
(1) More than half of Americans entering old age today will
have a long-term services and supports (in this section
referred to as ``LTSS'') need, averaging $298,000 costs per
person for about 2 years of serious self-care disability, and
more than half will be out-of-pocket, according to the U.S.
Department of Health and Human Services (in this section
referred to as ``HHS'').
(2) The population age 85 or older (which is a proxy for
the number of elders needing LTSS) will double between 2022 and
2035, and nearly triple by 2050. This aging will outpace the
number of working-age people, including family members, who can
help seniors financially or with unpaid care.
(3) Research has shown that most U.S. seniors could only
afford less than a year of nursing home care, assisted living
care, or extensive home care using their financial resources.
Some can get by using unpaid (family) care, but most rely on a
combination of paid and unpaid care.
(4) More than 1 in 5 middle-income seniors will end up
impoverished, Medicaid eligible, and mostly using Medicaid to
cover their LTSS costs.
(5) Millions of older Americans--1 in 5--will need LTSS for
more than 5 years, with a price tag that would impoverish
nearly all American households if they faced that need. HHS
projections show that older adults who need LTSS for more than
5 years incur nearly half of all LTSS expenses and 60 percent
of Medicaid's LTSS spending.
(6) Only 1 in 10 American adults (11 percent) have any
private coverage for LTSS expenses, leaving almost all middle-
class American families to exhaust their nest-eggs and become
impoverished before qualifying for Medicaid.
(7) The Nation urgently needs to create methods for
ordinary Americans to be able to take responsibility to plan
for the risk of a substantial period of disability during
retirement years.
(8) Given that Americans move and work across State lines
so frequently, State-based LTSS plans encounter difficult
administrative issues. Therefore, a solution to address LTSS
needs for seniors must be anchored in a Federal insurance plan.
Additionally, since the time just after onset of disability is
more predictable and manageable, a Federal insurance plan
should cover the risk of especially long periods of long-term
care, leaving the early period of need to personal
responsibility.
(9) Those methods must also responsibly support the
workforce providing supports and services.
(b) Purpose.--The purpose of this Act is to enable most Americans
to make plans that protect themselves and their families, to enable
disabled older adults to support themselves in their communities during
periods of serious disability, to support the workforce providing
direct services to elders living with disabilities, and to reduce what
is now necessary reliance on Medicaid.
SEC. 3. LONG-TERM CARE INSURANCE BENEFITS.
(a) In General.--Title II of the Social Security Act (42 U.S.C. 401
et seq.) is amended by adding at the end the following:
``SEC. 235. LONG-TERM CARE INSURANCE BENEFITS.
``(a) In General.--Every individual who--
``(1) has attained retirement age (as defined in section
216(l)(1));
``(2) has filed an application for long-term care insurance
benefits;
``(3) is insured for long-term care insurance benefits (as
determined under subsection (c)) at the time such individual's
application is filed; and
``(4) has a continual serious functional disability (as
defined in subsection (d)) and, at the time such individual's
application is filed, has had such disability for a substantial
period of time (as determined under subsection (e)),
shall be entitled to a long-term care insurance benefit for each month
beginning with the 1st month in which the individual meets the criteria
specified in paragraphs (1) through (4), and ending with the earlier of
the month in which the individual dies or the 1st month in which the
individual no longer has a continual serious functional disability (as
so defined).
``(b) Benefit Amount.--Such individual's long-term care insurance
benefit for each month shall be an amount equal to the product of--
``(1) an estimate, to be determined by the Secretary of
Health and Human Services in consultation with the Department
of Labor, of the median cost of 6 hours per day of paid
personal assistance in the United States, indexed to wages in
the long-term care sector, multiplied by
``(2) the ratio (not greater than 1) of the number of
quarters of coverage the individual has during the applicable
base period (as defined in subsection (c)(2)) to 40.
``(c) Definition of Insured Status.--
``(1) In general.--For purposes of subsection (a), an
individual shall be insured for long-term care insurance
benefits in any month if the individual has 6 quarters of
coverage during the applicable base period.
``(2) Applicable base period.--For purposes of this
subsection, the term `applicable base period' means the period
that begins with the 1st quarter of 2026.
``(d) Definition of Continual Serious Functional Disability.--For
purposes of subsection (a), an individual shall be considered to have a
continual serious functional disability if the person is a chronically
ill individual (as determined under section 7702B(c)(2) of the Internal
Revenue Code of 1986) and is expected to remain a chronically ill
individual (as so determined) for at least 1 year or until the
individual's death.
``(e) Definition of Substantial Period.--
``(1) In general.--For purposes of subsection (a), a
substantial period of time means--
``(A) in the case of an individual who, at the time
described in paragraph (3), has average indexed monthly
earnings for long-term care equal to or less than the
dollar amount representing the 40th percentile in the
table established under subsection (f) for such
calendar year, 12 months; and
``(B) in the case of an individual who, at such
time, has average indexed monthly earnings for long-
term care greater than such dollar amount, 12 months
plus 1 additional month for each 1.25 percentile
interval above the 40th percentile for which the
individual's average indexed monthly earnings for long-
term care would attain (as specified in such table).
``(2) Table of earnings.--
``(A) In general.--The Commissioner of Social
Security shall establish a table, for each calendar
year beginning with calendar year 2026, setting forth--
``(i) the dollar amount representing the
40th percentile among the average indexed
monthly earnings for long-term care (as
determined under subparagraph (B)) of each
individual who has attained age 62 and whose
primary insurance amount is first computed
during such calendar year (or, for calendar
year 2036, during any previous calendar year);
and
``(ii) the dollar amounts representing
percentiles over 40 (increasing linearly from
40 in intervals of 1.25) among the average
indexed monthly earnings for long-term care (as
so determined) of each such individual.
``(B) Determination of average indexed monthly
earnings for long-term care.--For purposes of this
subsection, the average indexed monthly earnings for
long-term care of an individual shall be determined
under section 215(b) (as in effect on the date of
enactment of this Act) as if such section were
amended--
``(i) in paragraph (2)(A), by striking
`reduced--' and all that follows through the
end and inserting `reduced by the number of
benefit computation years for which no wages
were paid in and no self-employment income
credited.'; and
``(ii) in paragraph (2)(B)(ii), by striking
`1950' and inserting `2025'.
``(3) Time of calculation.--The time described in this
paragraph is--
``(A) in the case of an individual who has 40
quarters of coverage during the applicable base period
(as defined in subsection (c)(2)) prior to becoming
entitled to old-age insurance benefits, the time at
which the individual's primary insurance amount was
first computed with respect to the individual's
application for such benefits; and
``(B) in the case of any other individual, the time
at which the individual files an application for long-
term care insurance benefits under this section.
``(f) Provision of Information Relating to Obtaining Long-Term
Care.--The Commissioner of Social Security shall provide to each
individual entitled to a long-term care insurance benefit under this
section, as soon as practicable following the first day of the first
month of such entitlement, information describing the steps the
individual may take to obtain long-term care, including an explanation
of the services (including care planning, care management, and
administrative services for hired care providers, by referral or in-
house, for a fee) provided by, and the appropriate contact information
for, the Aging and Disability Resource Centers described in section
202(b)(8) of the Older Americans Act of 1965 and the area agencies on
aging (as defined in section 102(6) of such Act).
``(g) Provision of Beneficiary Information by Any Person.--Any
person may submit applicable information with respect to an
individual's application for long-term care insurance benefits, an
annual statement described under subsection (i)(2), or any other
information required to be submitted by the individual under this
title, including, as applicable, the individual's representative, or
any family member or other appropriate person.
``(h) Treatment of Long-Term Care Insurance Benefit Payments.--A
long-term care insurance benefit payment shall not be regarded as
income and shall not be regarded as a resource for any month, for
purposes of determining the eligibility of the recipient (or the
recipient's spouse or family) for benefits or assistance under any
Federal program or under any State or local program financed in whole
or in part with Federal funds.
``(i) Additional Requirements.--
``(1) Relating to wages and withholding rules.--An
individual entitled to a long-term care insurance benefit for a
month during a calendar year shall, in any case in which such
individual hires an employee who is not a family member to
provide paid personal care to the individual during such month,
comply with all applicable State and Federal laws relating to--
``(A) the payment of a minimum wage; and
``(B) the withholding of payroll taxes and other
employment-related taxes.
``(2) Annual statement.--An individual entitled to a long-
term care insurance benefit for a month during a calendar year
shall submit a statement to the Commissioner of Social Security
at least once during such calendar year, as directed by the
Commissioner--
``(A) affirming that the individual--
``(i) continues to have a continual serious
functional disability (as defined in subsection
(d)); and
``(ii) is in compliance with the laws
described in paragraph (1); and
``(B) specifying the country of residence of the
individual.
``(3) Nonpayment of benefits in certain cases.--No long-
term care insurance benefit shall be payable to an individual
for any month--
``(A) with respect to which the individual fails to
satisfy any of the requirements described in the
preceding paragraphs of this subsection; or
``(B) beginning after the fifth consecutive year
with respect to which the individual has reported, in
the annual statement required under paragraph (2), a
country of residence other than the United States
(including any territory of the United States).''.
(b) Estimates of Benefits.--Section 1143(a)(2) of the Social
Security Act (42 U.S.C. 1320b-13) is amended--
(1) in subparagraph (D), by striking ``and'' at the end;
(2) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(F) an estimate of the potential long-term care insurance
benefits payable to the individual.''.
SEC. 4. ESTABLISHMENT OF FEDERAL LONG-TERM CARE INSURANCE TRUST FUND.
(a) In General.--There is hereby created on the books of the
Treasury of the United States a trust fund to be known as the ``Federal
Long-Term Care Insurance Trust Fund''. The Federal Long-Term Care
Insurance Trust Fund shall consist of such gifts and bequests as may be
made as provided in section 201(i)(1) of the Social Security Act (42
U.S.C. 401(i)(1)) and such amounts as may be appropriated to, or
deposited in, the Federal Long-Term Care Insurance Trust Fund as
provided in this section.
(b) Appropriation.--There is appropriated to the Federal Long-Term
Care Insurance Trust Fund out of moneys in the Treasury not otherwise
appropriated--
(1) for each of fiscal years 2026, 2027, and 2028,
$12,000,000 for the initial establishment of the Long-Term Care
Insurance program and payment of benefits during such fiscal
years; and
(2) $50,000,000 for public education relating to the Long-
Term Care Insurance program as described in section 6(a).
(c) Management of Trust Fund.--The provisions of subsections (c),
(d), (e), (f), (i), and (m) of section 201 of the Social Security Act
(42 U.S.C. 401) shall apply with respect to the Federal Long-Term Care
Insurance Trust Fund in the same manner as such provisions apply to the
Federal Old-Age and Survivors Insurance Trust Fund and the Disability
Insurance Trust Fund, except that the Managing Trustee (within the
meaning of subsection (d) of such section) may invest such portion of
the Federal Long-Term Care Insurance Trust Fund as the Managing Trustee
considers appropriate in conservative market securities.
(d) Administration.--There are authorized to be made available for
expenditure, out of the Federal Long-Term Care Insurance Trust Fund,
such sums as may be necessary to pay the costs of the administration of
section 3, including start-up costs, technical assistance, outreach,
education, evaluation, and reporting.
(e) Report.--Not later than 5 years after the date of enactment of
this Act and every 5 years thereafter, the Board of Trustees (as
defined for purposes of title II of the Social Security Act) shall
submit a report to Congress evaluating the impact of long-term care
insurance benefits under section 235 of such Act and making
recommendations relating to potential geographical adjustments of the
amount of such benefits.
(f) Allowing Gifts To Be Made to the Federal Long-Term Care
Insurance Trust Fund.--Section 201(i)(1) of the Social Security Act (42
U.S.C. 401(i)(1)) is amended--
(1) by striking ``, or the Federal'' and inserting ``, the
Federal''; and
(2) by inserting after ``in such Trust Fund)'' the
following: ``, or the Federal Long-Term Care Insurance Trust
Fund established under the Well-Being Insurance for Seniors to
be at Home Act''.
SEC. 5. EDUCATION AND OUTREACH.
(a) Public Education Plan.--
(1) In general.--Not later than 90 days after the date of
enactment of this Act, the Secretary of Health and Human
Services, in consultation with the Commissioner of Social
Security, shall publish in the Federal Register a 10-year plan
to educate the public about the likelihood of needing long-term
care, the nature of the experience of long-term care in various
situations, the costs of long-term care, the availability of
long-term care insurance benefits, and the importance of
planning and considering private insurance coverage alongside
family support and savings (especially during the first years
of a serious disability). Such plan shall be modified as
necessary based on research on the effectiveness of various
strategies and modifications with experience.
(2) Funding.--There are appropriated, out of the Federal
Long-Term Care Insurance Trust Fund, to the Secretary of Health
and Human Services $50,000,000 to carry out paragraph (1).
(b) Individual Notices.--
(1) In general.--Beginning 1 year after the date of
enactment of this Act and in accordance with paragraph (2), the
Commissioner of Social Security shall provide to each eligible
individual a notice that specifies--
(A)(i) the average indexed monthly earnings for
long-term care that would be calculated for the
individual under paragraph (2)(B) of section 235(e) of
the Social Security Act if such average indexed monthly
earnings for long-term care were calculated in the
month before the month such notice is provided; and
(ii) for purposes of applying such section to the
individual, the percentile in which such average
indexed monthly earnings for long-term care of the
individual would fall among the average indexed monthly
earnings for long-term care (as determined under such
paragraph (2)(B)) of each individual whose average
indexed monthly earnings for long-term care are
calculated in such month;
(B) the number of quarters of coverage the
individual has in the month before the month such
notice is provided for purposes of attaining insured
status for long-term care insurance benefits under such
Act; and
(C) in any case in which the individual has a
continual serious functional disability (as defined in
section 235(d) of such Act), the date on which such
disability began.
(2) Timing.--A notice described in paragraph (1) shall be
provided--
(A) by mail--
(i) to each eligible individual not later
than 540 days of the date of enactment of this
Act; and
(ii) to each eligible individual in the
month the individual attains age 45, age 55,
age 65, and retirement age (as defined in
section 216(l) of such Act); and
(B) for each eligible individual who has attained
age 35, by making such notice available on the
individual's account on the website of the Social
Security Administration, to be updated annually.
(3) Eligible individual.--In this subsection, the term
``eligible individual'' means an individual--
(A) who has a social security account number; and
(B)(i) who has wages or net earnings from self-
employment; or
(ii) with respect to whom the Commissioner has
information that the pattern of wages or self-
employment income indicate a likelihood of noncovered
employment.
SEC. 6. GAO REPORT ON PERFORMANCE OF THE WISH PROGRAM.
Not later than 5 years after the date of enactment of this Act and
every 3 years thereafter, the Comptroller General shall submit a report
to Congress including--
(1) a description of the likelihood of manipulation of
eligibility criteria by beneficiaries or beneficiary advisors
and recommendations as to the merits of possible remedies;
(2) a description of the likelihood of financial
exploitation or elder mistreatment by others on whom a
beneficiary is dependent or otherwise connected and
recommendations as to the merits of possible remedies,
including the merits of imposing a financial management service
or fiscal intermediary as has often been implemented by states
in Medicaid's Cash and Counseling program; and
(3) a description of the marketplace and consumer
understanding of long-term insurance offerings and
recommendations as to the merits of possible remedies,
including the merits of standardizing insurance offerings to
improve consumer understanding.
SEC. 7. REPORT ON REMAINING LONG-TERM SUPPORTS AND SERVICES NEEDS.
Not later than 3 years after the date of enactment of this Act and
every 3 years thereafter, the Secretary of Health and Human Services,
acting through the Administrator of the Administration on Community
Living and in consultation with the Commissioner of Social Security,
shall submit a plan to Congress that includes--
(1) estimates of the long-term services and supports needed
by individuals who are not eligible for benefits under section
235 of the Social Security Act, including individuals disabled
in childhood, individuals living with disabilities before
retirement age, and individuals who are not insured for
benefits under such section; and
(2) proposed strategies and costs of mitigating unmet needs
for such individuals.
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