119-hr2082

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2082 Introduced in House

    (IH) ]

<DOC>

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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