HR2082-119

What This Bill Does

The WISH Act builds a federal catastrophic long-term services and supports insurance program. Findings cite average LTSS costs of $298,000 for about two years of serious self-care disability, a rapidly growing 85-plus population, low private LTSS coverage, and Medicaid impoverishment risk. New Social Security section 235 would pay monthly long-term care insurance benefits to individuals who have reached retirement age, applied, are insured with at least six quarters of coverage beginning with the first quarter of 2026, and have a continual serious functional disability expected to last at least one year or until death. The benefit equals HHS's estimate, in consultation with Labor, of the median cost of six hours per day of paid personal assistance, indexed to long-term care wages, multiplied by a quarters-of-coverage ratio capped at 40 quarters. The waiting period is 12 months for people at or below the 40th percentile of average indexed monthly earnings for long-term care, plus one month for each 1.25 percentile interval above that. Benefit payments are not counted as income or resources for federal, state, or local assistance programs. Beneficiaries hiring non-family paid care workers must comply with minimum wage and payroll-tax laws, file annual statements, and lose payments after five consecutive years reporting residence outside the United States. The bill creates a Federal Long-Term Care Insurance Trust Fund, appropriates $12 million for each of fiscal years 2026 through 2028 for startup and benefits, and provides $50 million for public education. HHS and Social Security must run outreach, GAO must report after five years and every three years on manipulation, exploitation, and market understanding, and the Administration for Community Living must report every three years on remaining LTSS needs for people outside the benefit.

Who Benefits and How

Retirement-age adults with serious functional disabilities benefit from monthly long-term care insurance payments after the statutory waiting period. Middle-income seniors benefit because catastrophic LTSS costs are less likely to force complete spend-down into Medicaid. Family caregivers benefit if federal payments help pay for personal assistance and reduce unpaid care pressure. Direct care workers benefit because beneficiaries who hire non-family workers must comply with wage and payroll-tax rules. Aging and Disability Resource Centers benefit because beneficiaries receive contact information and referrals for care planning and management.

Who Bears the Burden and How

The Social Security Administration must determine insured status, earnings percentiles, waiting periods, benefit estimates, annual statements, and notices. HHS must estimate national personal-assistance costs, publish a 10-year education plan, and coordinate outreach. The Federal Long-Term Care Insurance Trust Fund and federal taxpayers bear startup, benefit, and education costs. Beneficiaries hiring paid care workers must meet minimum wage, payroll-tax, and annual certification requirements. GAO and the Administration for Community Living must produce recurring oversight and unmet-needs reports.

Key Provisions

• Creates Social Security long-term care insurance benefits for retirement-age insured individuals with continual serious functional disability.
• Provides a benefit formula based on the median cost of six hours per day of paid personal assistance and quarters of coverage.
• Establishes a waiting period starting at 12 months and increasing with long-term-care earnings percentiles.
• Creates a Federal Long-Term Care Insurance Trust Fund and appropriates startup, benefit, and education funding.
• Requires public education, Social Security notices, GAO performance reports, and recurring reports on unmet LTSS needs.