HR2082-119

1. Short title This Act may be cited as the Well-Being Insurance for Seniors to be at Home Act or the WISH Act.

3. Long-term care insurance benefits Title II of the Social Security Act (42 U.S.C. 401 et seq.) is amended by adding at the end the following: Every individual who— has attained retirement age (as defined in section 216(l)(1)); has filed an application for long-term care insurance benefits; is insured for long-term care insurance benefits (as determined under subsection (c)) at the time such individual’s application is filed; and 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)), Such individual’s long-term care insurance benefit for each month shall be an amount equal to the product of— 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 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. 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. For purposes of this subsection, the term applicable base period means the period that begins with the 1st quarter of 2026. 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. For purposes of subsection (a), a substantial period of time means— 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 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). The Commissioner of Social Security shall establish a table, for each calendar year beginning with calendar year 2026, setting forth— 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 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. 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— 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 in paragraph (2)(B)(ii), by striking 1950 and inserting 2025. The time described in this paragraph is— 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 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. 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). 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. 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. 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— the payment of a minimum wage; and the withholding of payroll taxes and other employment-related taxes. 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— affirming that the individual— continues to have a continual serious functional disability (as defined in subsection (d)); and is in compliance with the laws described in paragraph (1); and specifying the country of residence of the individual. No long-term care insurance benefit shall be payable to an individual for any month— with respect to which the individual fails to satisfy any of the requirements described in the preceding paragraphs of this subsection; or 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). Section 1143(a)(2) of the Social Security Act (42 U.S.C. 1320b–13) is amended— in subparagraph (D), by striking and at the end; in subparagraph (E), by striking the period at the end and inserting ; and; and by adding at the end the following: an estimate of the potential long-term care insurance benefits payable to the individual. 235.Long-term care insurance benefits(a)In generalEvery 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 amountSuch 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 generalFor 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 periodFor 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 disabilityFor 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 generalFor 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 generalThe 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 careFor 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 calculationThe 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 careThe 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 personAny 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 paymentsA 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 rulesAn 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 statementAn 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 casesNo 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).. (F)an estimate of the potential long-term care insurance benefits payable to the individual..

235. Long-term care insurance benefits Every individual who— has attained retirement age (as defined in section 216(l)(1)); has filed an application for long-term care insurance benefits; is insured for long-term care insurance benefits (as determined under subsection (c)) at the time such individual’s application is filed; and 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)), Such individual’s long-term care insurance benefit for each month shall be an amount equal to the product of— 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 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. 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. For purposes of this subsection, the term applicable base period means the period that begins with the 1st quarter of 2026. 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. For purposes of subsection (a), a substantial period of time means— 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 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). The Commissioner of Social Security shall establish a table, for each calendar year beginning with calendar year 2026, setting forth— 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 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. 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— 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 in paragraph (2)(B)(ii), by striking 1950 and inserting 2025. The time described in this paragraph is— 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 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. 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). 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. 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. 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— the payment of a minimum wage; and the withholding of payroll taxes and other employment-related taxes. 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— affirming that the individual— continues to have a continual serious functional disability (as defined in subsection (d)); and is in compliance with the laws described in paragraph (1); and specifying the country of residence of the individual. No long-term care insurance benefit shall be payable to an individual for any month— with respect to which the individual fails to satisfy any of the requirements described in the preceding paragraphs of this subsection; or 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).

5. Education and outreach 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. 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). 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— 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 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; 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 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. A notice described in paragraph (1) shall be provided— by mail— to each eligible individual not later than 540 days of the date of enactment of this Act; and 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 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. In this subsection, the term eligible individual means an individual— who has a social security account number; and who has wages or net earnings from self-employment; or with respect to whom the Commissioner has information that the pattern of wages or self-employment income indicate a likelihood of noncovered employment.

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— a description of the likelihood of manipulation of eligibility criteria by beneficiaries or beneficiary advisors and recommendations as to the merits of possible remedies; 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 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.

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— 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 proposed strategies and costs of mitigating unmet needs for such individuals.