Long-Term Care Trust Act Brings Services and Support to Washington Residents

It may be a ways off, but it’s coming: In 2019, the Washington State Legislature passed 2SHB 1087 (Chapter 363, Laws of 2019), also known as the Long-Term Care Trust Act. This bill creates a new, employee-financed program to provide payment or partial payment for long-term services to qualified individuals who have paid into the program and need assistance.

While benefits begin in 2025, premiums will be collected beginning January 1, 2022. Premiums will be assessed against employees and there will be no contribution by employers.

Background

Noting that long-term care is not covered by Medicare or health insurance plans, and that private long-term care insurance is both expensive and unaffordable to most citizens, the 2019 legislature adopted 2SHB 1087.

The bill, signed into law by the Governor in May, will provide some relief for qualified citizens who require services and have paid premiums into a state-operated trust account. Testimony given to the Health Care and Wellness Committee reported that 7 out of 10 people over age 65 will need long-term care, and 90% of those people have no savings for this type of care. According to the testimony, people are being forced into poverty to get care through Medicaid. The testimony also reported that 850,000 Washingtonians are serving as family caregivers, with some required to quit their jobs in order to provide this support.

Who Qualifies?

To qualify for benefits, a person must be living in the state, be at least 18 years old, not have become disabled before age 18, and the person must have paid premiums into the program. The initial premium, 0.58% of a worker’s wage must have been paid for either 3 years within the last 6 years or for a total of 10 years, with at least 5 of those 10 years paid without interruption. (For a year to count, the employee must have worked at least 500 hours during the year.) Premiums are not required if a person can demonstrate he or she has long-term care insurance.

Program qualifications also stipulate that an applicant must require assistance with at least three activities of daily living, such as such as bathing, dressing, medication administration, personal hygiene, or other health-related tasks.

Benefits Available

What benefits are available under the program? Approved services include adult day services, care transition coordination, memory care, adaptive equipment and technology, personal emergency response systems, respite for family caregivers, home-delivered meals, transportation, dementia support, and eligible relative care.

Services that may assist paid and unpaid family members who are caring for eligible elderly relations include training, in-home personal care, assisted-living services, adult family home services, and nursing home services. As defined under the program, potential providers of long-term services and support for program beneficiaries includes a variety of individuals and institutions, such as a home care aide, an assisted living facility, an adult family home, a nursing home, an in-home services agency, an adult day health program, a vendor, an instructor, a qualified family member, or another entity.

Payments of up to $100 (adjusted annually) are made upon each “benefit unit” used to reimburse approved services provided on a specific date. A beneficiary may receive up to 365 benefit units over his or her lifetime. Eligible beneficiaries can combine their individual benefit units to receive more approved services per day if the lifetime benefit units are not exceeded. Partial benefit units may be retained if the cost of the covered care is less than the value of the benefit unit. Benefit units may be used to reimburse a long-term care provider who is a spouse or registered domestic partner if, within the first 120 days of becoming a long-term care worker, the caregiver receives 15 hours of basic training and 6 hours of focused training based on the spouse or domestic partner's needs.

Program Oversight

The program will be administered by the Department of Social and Health Services, the Employment Security Department, the Health Care Authority, and the Office of State Actuary.