THE PEPPER COMMISSION PROPOSAL PROVIDES HOME AND COMMUNITY-BASED LONGTERM CARE SERVICES AND PROTECTION AGAINST IMPOVERISHMENT FOR PEOPLE IN NURSING HOMES. 1. The plan has three components. 2. 3. 4. Severely disabled persons of all ages are eligible for social insurance for home and community-based care. for The plan establishes a Nursing Home Program (NHP) nursing home care to provide an ample floor of financial protection, ensuring that no one faces impoverishment. In addition, all nursing home users are entitled to social insurance for the first three months of nursing home care. This "front-end" insurance allows people who have short stays to return home with resources intact. Financing and administration * The federal government finances the home and community-based care program and the three-month "front-end" nursing home * care. The federal and state governments share financial responsibility for the NHP. All three components of the plan are administered by the states according to federal guidelines. States are responsible for cost containment, quality assurance and consumer protection within federal standards. Private sector role Private long-term care insurance fills gaps not covered by this plan, subject to government standards and oversight. The federal government encourages the development of private long-term care insurance through clarification of the tax code. The benefits will be phased in over time. Net New Federal Costs of the Commission Proposal *Phase-in plan includes the cost of temporary tax credits/subsidies for certain small businesses. Those costs are reflected in these totals, which represent the cost at full implementation. not **Program costs are larger than the net new federal expenditures. On health care, states maintain Medicaid spending on services absorbed by the new public plan. On long-term care, states share in the cost of the Nursing Home Program with initial amounts equivalent to state Medicaid spending on long-term care services covered by the overall plan. PEPPER COMMISSION RECOMMENDATIONS ON ACCESS TO HEALTH CARE Structure of Job-Based/Federal Public Health Insurance Plan 1. 2. Emplover Responsibilities (in businesses with more than 100 employees and smaller businesses only if a specified coverage target is not met): ́All businesses are required to provide private health insurance for at least the specified benefit package to all employees (and non-working dependents) or contribute to the public plan on their behalf. If employers choose to provide private insurance, they must pay at least 80% of the premium for full-time workers and their non-working dependents and a share of the premium for part-time workers and their non-working dependents. Alternatively, employers may contribute to the public plan for coverage for their employees and non-working dependents. The contribution will be equal to a percentage of payroll. The percentage will be set at a level that encourages employers who now purchase private insurance to retain that coverage and establish a fair balance of additional coverage responsibilities between the private and public sectors. Employers may choose to purchase private insurance for their full-time workers and contribute to the public plan for part-time workers. Individual responsibilities * All workers receive the specified benefit package through their own employer, although they may receive extra benefits from their spouse's employer. Rules, consistent with tax policy, determine the plan to which children are assigned. Individuals pay up to 20% of the premium for private are * To participate in the public plan, individuals who women. one one For low income people, whether covered by the public plan or private insurance, premiums and cost-sharing are subsidized by the federal government. Individuals or families whose income is under 100% of the federal poverty level pay no premiums, deductibles or coinsurance. Individuals families whose income is up to 200% of poverty at a minimum will pay premiums, deductibles and coinsurance on a sliding scale. or |