Us Congress 2025 2025-2026 Regular Session

Us Congress House Bill HB2082 Introduced / Bill

Filed 03/26/2025

                    I 
119THCONGRESS 
1
STSESSION H. R. 2082 
To amend title II of the Social Security Act to provide for long-term care 
insurance benefits, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH11, 2025 
Mr. S
UOZZI(for himself and Mr. MOOLENAAR) introduced the following bill; 
which was referred to the Committee on Ways and Means 
A BILL 
To amend title II of the Social Security Act to provide 
for long-term care insurance benefits, and for other purposes. 
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Well-Being Insurance 4
for Seniors to be at Home Act’’ or the ‘‘WISH Act’’. 5
SEC. 2. FINDINGS; PURPOSE. 6
(a) F
INDINGS.—Congress finds the following: 7
(1) More than half of Americans entering old 8
age today will have a long-term services and sup-9
ports (in this section referred to as ‘‘LTSS’’) need, 10
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averaging $298,000 costs per person for about 2 1
years of serious self-care disability, and more than 2
half will be out-of-pocket, according to the U.S. De-3
partment of Health and Human Services (in this 4
section referred to as ‘‘HHS’’). 5
(2) The population age 85 or older (which is a 6
proxy for the number of elders needing LTSS) will 7
double between 2022 and 2035, and nearly triple by 8
2050. This aging will outpace the number of work-9
ing-age people, including family members, who can 10
help seniors financially or with unpaid care. 11
(3) Research has shown that most U.S. seniors 12
could only afford less than a year of nursing home 13
care, assisted living care, or extensive home care 14
using their financial resources. Some can get by 15
using unpaid (family) care, but most rely on a com-16
bination of paid and unpaid care. 17
(4) More than 1 in 5 middle-income seniors will 18
end up impoverished, Medicaid eligible, and mostly 19
using Medicaid to cover their LTSS costs. 20
(5) Millions of older Americans—1 in 5—will 21
need LTSS for more than 5 years, with a price tag 22
that would impoverish nearly all American house-23
holds if they faced that need. HHS projections show 24
that older adults who need LTSS for more than 5 25
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years incur nearly half of all LTSS expenses and 60 1
percent of Medicaid’s LTSS spending. 2
(6) Only 1 in 10 American adults (11 percent) 3
have any private coverage for LTSS expenses, leav-4
ing almost all middle-class American families to ex-5
haust their nest-eggs and become impoverished be-6
fore qualifying for Medicaid. 7
(7) The Nation urgently needs to create meth-8
ods for ordinary Americans to be able to take re-9
sponsibility to plan for the risk of a substantial pe-10
riod of disability during retirement years. 11
(8) Given that Americans move and work across 12
State lines so frequently, State-based LTSS plans 13
encounter difficult administrative issues. Therefore, 14
a solution to address LTSS needs for seniors must 15
be anchored in a Federal insurance plan. Addition-16
ally, since the time just after onset of disability is 17
more predictable and manageable, a Federal insur-18
ance plan should cover the risk of especially long pe-19
riods of long-term care, leaving the early period of 20
need to personal responsibility. 21
(9) Those methods must also responsibly sup-22
port the workforce providing supports and services. 23
(b) P
URPOSE.—The purpose of this Act is to enable 24
most Americans to make plans that protect themselves 25
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and their families, to enable disabled older adults to sup-1
port themselves in their communities during periods of se-2
rious disability, to support the workforce providing direct 3
services to elders living with disabilities, and to reduce 4
what is now necessary reliance on Medicaid. 5
SEC. 3. LONG-TERM CARE INSURANCE BENEFITS. 6
(a) I
NGENERAL.—Title II of the Social Security Act 7
(42 U.S.C. 401 et seq.) is amended by adding at the end 8
the following: 9
‘‘SEC. 235. LONG-TERM CARE INSURANCE BENEFITS. 10
‘‘(a) I
NGENERAL.—Every individual who— 11
‘‘(1) has attained retirement age (as defined in 12
section 216(l)(1)); 13
‘‘(2) has filed an application for long-term care 14
insurance benefits; 15
‘‘(3) is insured for long-term care insurance 16
benefits (as determined under subsection (c)) at the 17
time such individual’s application is filed; and 18
‘‘(4) has a continual serious functional dis-19
ability (as defined in subsection (d)) and, at the time 20
such individual’s application is filed, has had such 21
disability for a substantial period of time (as deter-22
mined under subsection (e)), 23
shall be entitled to a long-term care insurance benefit for 24
each month beginning with the 1st month in which the 25
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individual meets the criteria specified in paragraphs (1) 1
through (4), and ending with the earlier of the month in 2
which the individual dies or the 1st month in which the 3
individual no longer has a continual serious functional dis-4
ability (as so defined). 5
‘‘(b) B
ENEFITAMOUNT.—Such individual’s long- 6
term care insurance benefit for each month shall be an 7
amount equal to the product of— 8
‘‘(1) an estimate, to be determined by the Sec-9
retary of Health and Human Services in consulta-10
tion with the Department of Labor, of the median 11
cost of 6 hours per day of paid personal assistance 12
in the United States, indexed to wages in the long- 13
term care sector, multiplied by 14
‘‘(2) the ratio (not greater than 1) of the num-15
ber of quarters of coverage the individual has during 16
the applicable base period (as defined in subsection 17
(c)(2)) to 40. 18
‘‘(c) D
EFINITION OFINSUREDSTATUS.— 19
‘‘(1) I
N GENERAL.—For purposes of subsection 20
(a), an individual shall be insured for long-term care 21
insurance benefits in any month if the individual has 22
6 quarters of coverage during the applicable base pe-23
riod. 24
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‘‘(2) APPLICABLE BASE PERIOD .—For purposes 1
of this subsection, the term ‘applicable base period’ 2
means the period that begins with the 1st quarter of 3
2026. 4
‘‘(d) D
EFINITION OFCONTINUALSERIOUSFUNC-5
TIONALDISABILITY.—For purposes of subsection (a), an 6
individual shall be considered to have a continual serious 7
functional disability if the person is a chronically ill indi-8
vidual (as determined under section 7702B(c)(2) of the 9
Internal Revenue Code of 1986) and is expected to remain 10
a chronically ill individual (as so determined) for at least 11
1 year or until the individual’s death. 12
‘‘(e) D
EFINITION OFSUBSTANTIALPERIOD.— 13
‘‘(1) I
N GENERAL.—For purposes of subsection 14
(a), a substantial period of time means— 15
‘‘(A) in the case of an individual who, at 16
the time described in paragraph (3), has aver-17
age indexed monthly earnings for long-term 18
care equal to or less than the dollar amount 19
representing the 40th percentile in the table es-20
tablished under subsection (f) for such calendar 21
year, 12 months; and 22
‘‘(B) in the case of an individual who, at 23
such time, has average indexed monthly earn-24
ings for long-term care greater than such dollar 25
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amount, 12 months plus 1 additional month for 1
each 1.25 percentile interval above the 40th 2
percentile for which the individual’s average in-3
dexed monthly earnings for long-term care 4
would attain (as specified in such table). 5
‘‘(2) T
ABLE OF EARNINGS.— 6
‘‘(A) I
N GENERAL.—The Commissioner of 7
Social Security shall establish a table, for each 8
calendar year beginning with calendar year 9
2026, setting forth— 10
‘‘(i) the dollar amount representing 11
the 40th percentile among the average in-12
dexed monthly earnings for long-term care 13
(as determined under subparagraph (B)) 14
of each individual who has attained age 62 15
and whose primary insurance amount is 16
first computed during such calendar year 17
(or, for calendar year 2036, during any 18
previous calendar year); and 19
‘‘(ii) the dollar amounts representing 20
percentiles over 40 (increasing linearly 21
from 40 in intervals of 1.25) among the 22
average indexed monthly earnings for long- 23
term care (as so determined) of each such 24
individual. 25
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‘‘(B) DETERMINATION OF AVERAGE IN -1
DEXED MONTHLY EARNINGS FOR LONG -TERM 2
CARE.—For purposes of this subsection, the av-3
erage indexed monthly earnings for long-term 4
care of an individual shall be determined under 5
section 215(b) (as in effect on the date of en-6
actment of this Act) as if such section were 7
amended— 8
‘‘(i) in paragraph (2)(A), by striking 9
‘reduced—’ and all that follows through 10
the end and inserting ‘reduced by the num-11
ber of benefit computation years for which 12
no wages were paid in and no self-employ-13
ment income credited.’; and 14
‘‘(ii) in paragraph (2)(B)(ii), by strik-15
ing ‘1950’ and inserting ‘2025’. 16
‘‘(3) T
IME OF CALCULATION .—The time de-17
scribed in this paragraph is— 18
‘‘(A) in the case of an individual who has 19
40 quarters of coverage during the applicable 20
base period (as defined in subsection (c)(2)) 21
prior to becoming entitled to old-age insurance 22
benefits, the time at which the individual’s pri-23
mary insurance amount was first computed 24
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with respect to the individual’s application for 1
such benefits; and 2
‘‘(B) in the case of any other individual, 3
the time at which the individual files an appli-4
cation for long-term care insurance benefits 5
under this section. 6
‘‘(f) P
ROVISION OFINFORMATIONRELATING TOOB-7
TAININGLONG-TERMCARE.—The Commissioner of So-8
cial Security shall provide to each individual entitled to 9
a long-term care insurance benefit under this section, as 10
soon as practicable following the first day of the first 11
month of such entitlement, information describing the 12
steps the individual may take to obtain long-term care, 13
including an explanation of the services (including care 14
planning, care management, and administrative services 15
for hired care providers, by referral or in-house, for a fee) 16
provided by, and the appropriate contact information for, 17
the Aging and Disability Resource Centers described in 18
section 202(b)(8) of the Older Americans Act of 1965 and 19
the area agencies on aging (as defined in section 102(6) 20
of such Act). 21
‘‘(g) P
ROVISION OFBENEFICIARYINFORMATION BY 22
A
NYPERSON.—Any person may submit applicable infor-23
mation with respect to an individual’s application for long- 24
term care insurance benefits, an annual statement de-25
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scribed under subsection (i)(2), or any other information 1
required to be submitted by the individual under this title, 2
including, as applicable, the individual’s representative, or 3
any family member or other appropriate person. 4
‘‘(h) T
REATMENT OFLONG-TERMCAREINSURANCE 5
B
ENEFITPAYMENTS.—A long-term care insurance benefit 6
payment shall not be regarded as income and shall not 7
be regarded as a resource for any month, for purposes 8
of determining the eligibility of the recipient (or the recipi-9
ent’s spouse or family) for benefits or assistance under 10
any Federal program or under any State or local program 11
financed in whole or in part with Federal funds. 12
‘‘(i) A
DDITIONALREQUIREMENTS.— 13
‘‘(1) R
ELATING TO WAGES AND WITHHOLDING 14
RULES.—An individual entitled to a long-term care 15
insurance benefit for a month during a calendar 16
year shall, in any case in which such individual hires 17
an employee who is not a family member to provide 18
paid personal care to the individual during such 19
month, comply with all applicable State and Federal 20
laws relating to— 21
‘‘(A) the payment of a minimum wage; and 22
‘‘(B) the withholding of payroll taxes and 23
other employment-related taxes. 24
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‘‘(2) ANNUAL STATEMENT .—An individual enti-1
tled to a long-term care insurance benefit for a 2
month during a calendar year shall submit a state-3
ment to the Commissioner of Social Security at least 4
once during such calendar year, as directed by the 5
Commissioner— 6
‘‘(A) affirming that the individual— 7
‘‘(i) continues to have a continual se-8
rious functional disability (as defined in 9
subsection (d)); and 10
‘‘(ii) is in compliance with the laws 11
described in paragraph (1); and 12
‘‘(B) specifying the country of residence of 13
the individual. 14
‘‘(3) N
ONPAYMENT OF BENEFITS IN CERTAIN 15
CASES.—No long-term care insurance benefit shall 16
be payable to an individual for any month— 17
‘‘(A) with respect to which the individual 18
fails to satisfy any of the requirements de-19
scribed in the preceding paragraphs of this sub-20
section; or 21
‘‘(B) beginning after the fifth consecutive 22
year with respect to which the individual has re-23
ported, in the annual statement required under 24
paragraph (2), a country of residence other 25
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than the United States (including any territory 1
of the United States).’’. 2
(b) E
STIMATES OFBENEFITS.—Section 1143(a)(2) 3
of the Social Security Act (42 U.S.C. 1320b–13) is 4
amended— 5
(1) in subparagraph (D), by striking ‘‘and’’ at 6
the end; 7
(2) in subparagraph (E), by striking the period 8
at the end and inserting ‘‘; and’’; and 9
(3) by adding at the end the following: 10
‘‘(F) an estimate of the potential long-term care 11
insurance benefits payable to the individual.’’. 12
SEC. 4. ESTABLISHMENT OF FEDERAL LONG-TERM CARE 13
INSURANCE TRUST FUND. 14
(a) I
NGENERAL.—There is hereby created on the 15
books of the Treasury of the United States a trust fund 16
to be known as the ‘‘Federal Long-Term Care Insurance 17
Trust Fund’’. The Federal Long-Term Care Insurance 18
Trust Fund shall consist of such gifts and bequests as 19
may be made as provided in section 201(i)(1) of the Social 20
Security Act (42 U.S.C. 401(i)(1)) and such amounts as 21
may be appropriated to, or deposited in, the Federal Long- 22
Term Care Insurance Trust Fund as provided in this sec-23
tion. 24
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(b) APPROPRIATION.—There is appropriated to the 1
Federal Long-Term Care Insurance Trust Fund out of 2
moneys in the Treasury not otherwise appropriated— 3
(1) for each of fiscal years 2026, 2027, and 4
2028, $12,000,000 for the initial establishment of 5
the Long-Term Care Insurance program and pay-6
ment of benefits during such fiscal years; and 7
(2) $50,000,000 for public education relating to 8
the Long-Term Care Insurance program as de-9
scribed in section 6(a). 10
(c) M
ANAGEMENT OF TRUSTFUND.—The provisions 11
of subsections (c), (d), (e), (f), (i), and (m) of section 201 12
of the Social Security Act (42 U.S.C. 401) shall apply with 13
respect to the Federal Long-Term Care Insurance Trust 14
Fund in the same manner as such provisions apply to the 15
Federal Old-Age and Survivors Insurance Trust Fund and 16
the Disability Insurance Trust Fund, except that the Man-17
aging Trustee (within the meaning of subsection (d) of 18
such section) may invest such portion of the Federal 19
Long-Term Care Insurance Trust Fund as the Managing 20
Trustee considers appropriate in conservative market se-21
curities. 22
(d) A
DMINISTRATION.—There are authorized to be 23
made available for expenditure, out of the Federal Long- 24
Term Care Insurance Trust Fund, such sums as may be 25
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necessary to pay the costs of the administration of section 1
3, including start-up costs, technical assistance, outreach, 2
education, evaluation, and reporting. 3
(e) R
EPORT.—Not later than 5 years after the date 4
of enactment of this Act and every 5 years thereafter, the 5
Board of Trustees (as defined for purposes of title II of 6
the Social Security Act) shall submit a report to Congress 7
evaluating the impact of long-term care insurance benefits 8
under section 235 of such Act and making recommenda-9
tions relating to potential geographical adjustments of the 10
amount of such benefits. 11
(f) A
LLOWINGGIFTSTOBEMADE TO THEFEDERAL 12
L
ONG-TERMCAREINSURANCETRUSTFUND.—Section 13
201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) 14
is amended— 15
(1) by striking ‘‘, or the Federal’’ and inserting 16
‘‘, the Federal’’; and 17
(2) by inserting after ‘‘in such Trust Fund)’’ 18
the following: ‘‘, or the Federal Long-Term Care In-19
surance Trust Fund established under the Well- 20
Being Insurance for Seniors to be at Home Act’’. 21
SEC. 5. EDUCATION AND OUTREACH. 22
(a) P
UBLICEDUCATIONPLAN.— 23
(1) I
N GENERAL.—Not later than 90 days after 24
the date of enactment of this Act, the Secretary of 25
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Health and Human Services, in consultation with 1
the Commissioner of Social Security, shall publish in 2
the Federal Register a 10-year plan to educate the 3
public about the likelihood of needing long-term 4
care, the nature of the experience of long-term care 5
in various situations, the costs of long-term care, the 6
availability of long-term care insurance benefits, and 7
the importance of planning and considering private 8
insurance coverage alongside family support and 9
savings (especially during the first years of a serious 10
disability). Such plan shall be modified as necessary 11
based on research on the effectiveness of various 12
strategies and modifications with experience. 13
(2) F
UNDING.—There are appropriated, out of 14
the Federal Long-Term Care Insurance Trust Fund, 15
to the Secretary of Health and Human Services 16
$50,000,000 to carry out paragraph (1). 17
(b) I
NDIVIDUALNOTICES.— 18
(1) I
N GENERAL.—Beginning 1 year after the 19
date of enactment of this Act and in accordance with 20
paragraph (2), the Commissioner of Social Security 21
shall provide to each eligible individual a notice that 22
specifies— 23
(A)(i) the average indexed monthly earn-24
ings for long-term care that would be calculated 25
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for the individual under paragraph (2)(B) of 1
section 235(e) of the Social Security Act if such 2
average indexed monthly earnings for long-term 3
care were calculated in the month before the 4
month such notice is provided; and 5
(ii) for purposes of applying such section 6
to the individual, the percentile in which such 7
average indexed monthly earnings for long-term 8
care of the individual would fall among the av-9
erage indexed monthly earnings for long-term 10
care (as determined under such paragraph 11
(2)(B)) of each individual whose average in-12
dexed monthly earnings for long-term care are 13
calculated in such month; 14
(B) the number of quarters of coverage the 15
individual has in the month before the month 16
such notice is provided for purposes of attaining 17
insured status for long-term care insurance 18
benefits under such Act; and 19
(C) in any case in which the individual has 20
a continual serious functional disability (as de-21
fined in section 235(d) of such Act), the date 22
on which such disability began. 23
(2) T
IMING.—A notice described in paragraph 24
(1) shall be provided— 25
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(A) by mail— 1
(i) to each eligible individual not later 2
than 540 days of the date of enactment of 3
this Act; and 4
(ii) to each eligible individual in the 5
month the individual attains age 45, age 6
55, age 65, and retirement age (as defined 7
in section 216(l) of such Act); and 8
(B) for each eligible individual who has at-9
tained age 35, by making such notice available 10
on the individual’s account on the website of 11
the Social Security Administration, to be up-12
dated annually. 13
(3) E
LIGIBLE INDIVIDUAL.—In this subsection, 14
the term ‘‘eligible individual’’ means an individual— 15
(A) who has a social security account num-16
ber; and 17
(B)(i) who has wages or net earnings from 18
self-employment; or 19
(ii) with respect to whom the Commis-20
sioner has information that the pattern of 21
wages or self-employment income indicate a 22
likelihood of noncovered employment. 23
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SEC. 6. GAO REPORT ON PERFORMANCE OF THE WISH PRO-1
GRAM. 2
Not later than 5 years after the date of enactment 3
of this Act and every 3 years thereafter, the Comptroller 4
General shall submit a report to Congress including— 5
(1) a description of the likelihood of manipula-6
tion of eligibility criteria by beneficiaries or bene-7
ficiary advisors and recommendations as to the mer-8
its of possible remedies; 9
(2) a description of the likelihood of financial 10
exploitation or elder mistreatment by others on 11
whom a beneficiary is dependent or otherwise con-12
nected and recommendations as to the merits of pos-13
sible remedies, including the merits of imposing a fi-14
nancial management service or fiscal intermediary as 15
has often been implemented by states in Medicaid’s 16
Cash and Counseling program; and 17
(3) a description of the marketplace and con-18
sumer understanding of long-term insurance offer-19
ings and recommendations as to the merits of pos-20
sible remedies, including the merits of standardizing 21
insurance offerings to improve consumer under-22
standing. 23
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SEC. 7. REPORT ON REMAINING LONG-TERM SUPPORTS 1
AND SERVICES NEEDS. 2
Not later than 3 years after the date of enactment 3
of this Act and every 3 years thereafter, the Secretary of 4
Health and Human Services, acting through the Adminis-5
trator of the Administration on Community Living and in 6
consultation with the Commissioner of Social Security, 7
shall submit a plan to Congress that includes— 8
(1) estimates of the long-term services and sup-9
ports needed by individuals who are not eligible for 10
benefits under section 235 of the Social Security 11
Act, including individuals disabled in childhood, indi-12
viduals living with disabilities before retirement age, 13
and individuals who are not insured for benefits 14
under such section; and 15
(2) proposed strategies and costs of mitigating 16
unmet needs for such individuals. 17
Æ 
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