5 Republican Senator Ideas for Supporting Home Care

Lawmakers and witnesses focused mainly on ways to beef up Medicaid home care benefits and caregiver pay Wednesday, at a Senate Special Committee on Aging hearing on home care. Sen. Tim Scott, R-South Carolina, talked about another strategy, based on a self-directed care proposal released last summer: using Medicaid or other public and private programs to give care recipients and their loved ones cash or spending cards that they can use to buy their own care-related products and services. Scott also called for Medicaid home care benefits programs to give care recipients and family caregivers more flexibility about where they can spend their money. And Scott urged colleagues to look for ways to encourage consumers with the ability to plan for long-term care expenses to do so. Expanding the private long-term care insurance market "is a critical piece," Scott said at the hearing, which was streamed online. "The earlier you purchase this insurance coverage, the cheaper it is and the longer it will last for most American families." For a look at five of the ideas for supporting self-directed care included in Scott's proposal, see the gallery above.

What It Means

Scott is a conservative Republican senator, but he appears to have a cordial relationship with many Democrats. He appears to have played a major role in shaping the life insurance-related provisions in the Tax Cuts and Jobs Act of 2017. He may have a good shot at getting modest long-term care provisions passed into law. The programs could be aimed at relatively low-income Americans, but it's possible that any provisions passed into law could create opportunities for financial professionals and their clients. Scott's proposals come out of the political tradition that helped create the health savings account program, and that program has been popular with higher-income families as well as lower-income ones.

Tim Scott

Scott is closer to the financial services community than most members of Congress: He is a former insurance agent who was a member of the National Association of Insurance and Financial Advisors. At the hearing, he noted that he also has a connection with home care. "My mother is a nurse's assistant," Scott said. "She's in her 49th year of full-time employment providing care. ... When I'm back in town, she talks about how important it is for us to address this issue."

Medicaid and Home Care

Traditionally, Medicaid — a program for the poor that is funded with a combination of state and federal money — has paid for nursing care for people who qualified for help based on their states' eligibility criteria. Medicare paid for home medical care for people with serious medical problems. States have tiptoed into the non-medical care services arena by developing special programs aimed at people who have serious enough problems to be eligible for Medicaid nursing home benefits but who still live at home. Congress has encouraged Medicaid to provide more support for home care in recent years. The devastating effects of the COVID-19 pandemic on nursing homes has accelerated the shift toward home-based care. Sen. Bob Casey, D-Pa., said at the hearing on Wednesday that he would like to see Congress send President Joe Biden S. 2210 — the Better Care Better Jobs Act bill. That bill could increase public support for home care workers, family caregivers and home care quality programs, Casey said. Sen. Tim Scott, R-S.C. (Photo: Scott)