Where does U.S. stand with public long-term care? States to watch

Since Washington successfully launched its publicly funded long-term care insurance program, six more states have begun eyeing possible public financing options for seniors in their respective states.

Two West Coast states have steamrolled ahead with LTCI legislation, and a few states in other regions have begun to follow suit. But, with the absence of federal activity, it remains to be seen how states plan to handle care of their rapidly aging populations.

“While there is much talk within the long-term care insurance industry, I’d say the crystal ball is still cloudy in terms of how it will all impact long-term care insurance,” Jesse Slome, director of the American Association for Long-Term Care Insurance, said.

However, he acknowledged that whatever the method of funding, states “definitely” need to address the issue.

Washington, California lead the way

Washington became the first state to introduce publicly funded LTC with its WA Cares Fund launched last July. The program recently made accommodations for benefit portability, and, this coming November, voters will decide whether WA Cares will be mandatory or voluntary going forward.

California has been close behind. A task force reviewing the feasibility of a public long-term care insurance program just submitted findings to the Department of Insurance in December 2023, although lawmakers have yet to come to a decision.

These two states have largely set the standard, and all eyes are on them to see how well this approach works and whether similar initiatives could be introduced elsewhere.

Other states with active legislation

Most activity is in the Northeast

Outside of California and Washington, most states weighing options to publicly fund long-term care are in the northeast.

In New York, SB 4682 proposes a long-term care trust program that would help eligible residents access long term. It was just introduced this January, so it is still active and under consideration by New York legislators.

Pennsylvania’s House Bill 2779 proposes LTCI coverage similar to Washington’s WA Cares. That bill was introduced in 2022 but has not seen much movement since then. If enacted, disbursement could begin as early as 2026. However, officials were unable to advise where progress stands as of right now.

In the meantime, Massachusetts has two active bills: House Bill 4193, which aims to improve quality and oversight of long-term care in the state; and House Bill 652, which has established a special commission to assess the feasibility of a public long-term care insurance program.

The state is also undertaking an actuarial study on financing for long-term care services and support.

“The truth is, the long-term care industry was in crisis well before the pandemic,” Thomas Stanley, D., state representative, 9th Middlesex, said. “Staffing shortages, bad actors, abrupt closures, patient abuse and diminished care all existed prior to March 2020 and created serious hardships for thousands of individuals and families across the Commonwealth in need of quality care.”

Stanley, who has worked to help advance both bills and sponsored House Bill 652, said he hopes they will see swift action in the Senate.

Connecticut, however, has seemingly bowed out of the equation. A representative from the Connecticut Insurance Department told InsuranceNewsNet that the state does not currently have plans to introduce publicly funded LTCI.

However, the representative said the CID is keenly aware “most, if not all, states are experiencing an aging population” and closely watching states that have introduced public programs.

Midwestern, Southern states slow on the pick-up

In the Midwest and southern United States, Minnesota is leading the charge on public funding for long-term care. It has already established a Task Force on Aging that is currently researching the issue.

That task force is expected to submit a report with its initial findings by January 15, 2025. Reena Shetty, director, Department of Human Services Aging and Adult Services, said legislation is expected to be submitted for consideration shortly thereafter.

She added that state policymakers have been looking at the issue through multiple initiatives and research that gives them “a solid foundation” through which to understand and address it.

“Minnesota has long been a proactive leader in providing services and supports to its older adults. It would be wise to once again compare the costs and benefits of doing something proactively now, against the costs of not doing anything,” Shetty said.

In the south, Kentucky is one of the few states that could be considering public funding for long-term care. Just this February, the state introduced House Joint Resolution 100, which directs the Kentucky Department of Insurance to establish a Long-term Care Insurance Task Force to study the feasibility of publicly funded LTCI.

If the resolution is passed, it would require the task force to submit initial findings by September 1, 2026, with an actuarial study to follow by September 1, 2027. However, there has been no movement on the resolution since it was introduced, and it has not been passed to date.

Maryland legislators previously considered House Bill 349, which would have mandated a study on the issue, but legislators have already shut it down.

However, Craig Ey, chief, communications and public relations, Maryland Insurance Administration, suggested that the issue may not be off the table completely.

“The bill was withdrawn, but legislators plan to put a working group together for the interim period between legislative sessions to discuss what kind of study would be most beneficial,” he said.

Although just a handful of states are actively moving to address long-term care through public funding to date, Slome said he is “mildly optimistic” about the future of long-term care in America.

“Ultimately, a partnership that benefits all parties and is acceptable to taxpayers who vote is the optimal solution,” he said. “But that’s much more easily said than accomplished.”

The AALTCI is a national trade organization that seeks to increase consumer awareness and promote education related to long-term care insurance.

Rayne Morgan is a content marketing manager with PolicyAdvisor.com and a freelance journalist and copywriter.

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Rayne Morgan is a journalist, copywriter, and editor with over 10 years' combined experience in digital content and print media. You can reach her at [email protected].