By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.2
Make home- and community-based care an entitlement
Year 2 · UHA; state aging & disability agenciesDiscuss this step
Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.
| What | Today | Change | Trade-off |
|---|---|---|---|
| Medicaid long-term services (nursing homes, HCBS waivers) replacedYear 2 Federal programs | The main U.S. payer for long-term care, but only after people spend down to poverty; HCBS waivers capped, with waiting lists. | UHP covers LTSS by functional need, with no asset test; HCBS becomes an entitlement; room and board income-tested. Other health, residential & personal care $320.5B → $353.5B Home health care $169.4B → $204.5B Nursing facilities & continuing-care communities $219.9B → $225.7B | Ends impoverishment for long-term care; risk of the 'woodwork effect' as paid care replaces family care. |
| Disability, long-term-care, and life insurers amendedYear 2 Private sector | Separate products, often bundled with employer benefits. | Continue; private long-term-care insurance shrinks to room-and-board coverage. | The private LTC insurance market, already small, mostly disappears. |