Make home- and community-based care an entitlement

Year 2 · UHA; state aging & disability agenciesDiscuss this step

Every concrete action this step requires, who is responsible, and when it happens relative to enactment.

#	Action	Owner	When	Trade-off
3.2.1	Eligibility by functional need (needs help with 2+ activities of daily living, or cognitive impairment), with no income or asset test.	UHA	Year 2	Need-based eligibility ends impoverishment but expands demand substantially.
3.2.2	Standardized national needs assessment, performed by independent assessors (not providers).	UHA / states	Year 2	Independent assessors reduce provider gaming but add an administrative layer.
3.2.3	Self-directed care option: people can hire family caregivers (paid at the aide rate).	UHA	Year 2	Paying family caregivers supports families but may replace unpaid care with paid care at public expense.
3.2.4	Nursing facility residents: UHP pays the care component; residents contribute up to 80% of income above a personal-needs allowance toward room and board (as in Canadian provinces).	UHA	Year 2	Room-and-board contributions keep costs down but leave residents with limited personal income.
3.2.5	End Medicaid estate recovery for long-term care.	Congress	Year 2	Ending estate recovery protects heirs but gives up revenue states collected.