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
Pros & cons of this step
Pros
- +Ends the requirement to spend down to poverty to get home care.
- +Ends waiting lists, which held about 700,000 people in 2023.
- +Pays family caregivers, who today provide care unpaid.
Cons
- −Expensive, and demand may grow faster than projected as families substitute paid for unpaid care (the 'woodwork effect').
- −The home-care workforce is already short; covered care won't help if no aide is available.
- Paying family caregivers is humane but raises costs sharply if many families opt in.
Trade-off behind each cost item
- Prices rise $8.9B (to raise access or wages) and patients receive $24.2B more care.
- Home health care+$204.5BPrices rise $3.4B (to raise access or wages) and patients receive $31.8B more care.
- Providers of this service receive $2.6B less for the same care; patients receive $8.5B more care.
Trade-off behind each system change
- Medicaid long-term services (nursing homes, HCBS waivers)Ends impoverishment for long-term care; risk of the 'woodwork effect' as paid care replaces family care.
- Disability, long-term-care, and life insurersThe private LTC insurance market, already small, mostly disappears.