Democratic Presidential Hopeful Cory Booker Proposes A Long-Term Care Plan
Democratic presidential candidates finally are beginning to talk about long-term care for older adults and younger people with disabilities. That’s good. Their ideas, not so much.
This week, New Jersey senator and presidential contender Cory Booker became the first Democrat in the race to propose a relatively detailed long-term care plan. He deserves credit for raising an issue that, until now, has mostly been ignored by the nearly two-dozen presidential hopefuls. His idea is based largely on a major expansion of Medicaid long-term services and supports (LTSS). It is ambitious, probably very expensive, and built around the wrong government program.
So far, the only other candidate who has addressed long-term care is Senator Bernie Sanders (I-VT). He’d include home-based care in Medicare for All but says little about either the benefit design or who would be eligible. Those living in nursing homes or other facilities would continue to receive Medicaid, assuming they were otherwise eligible. Booker, along with at least two other Democratic presidential hopefuls, has signed on to the Sanders plan as well.
But with his own proposal, Booker is much more specific. His idea: Make Medicaid LTSS available to millions more older adults and nearly all younger people with disabilities. He’d do it through a major expansion of Medicaid’s financial eligibility rules. He would not change eligibility standards for level of frailty or medical need.
While Medicaid’s financial rules vary by state, an unmarried older adult generally is not eligible for LTSS benefits if she has income of more than about $770-a-month and total financial assets of more than $2,000 (the rules for married couples are more generous). Booker would increase Medicaid’s income limit to 300 percent of the federal poverty line (about $36,000 for a single or $49,000 for a couple in 2019) and the boost the asset cap to $200,000. Those with higher income and assets could buy into Medicaid LTSS, with their out-of-pocket costs rising with their ability to pay.
A rough back-of-the envelope calculation: Booker’s Medicaid LTSS benefit would cover something like half of all older adults (assuming they also were sufficiently frail). For example, 80 year-olds—the age when many will need LTSS—have median household income of about $42,000 and net worth (including home equity) of about $245,000, pretty much in the neighborhood of Booker’s new requirements.
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