The Well-Being Insurance for Seniors to be at Home Act (WISH Act) would create a new federal long-term care insurance program under Title II of the Social Security Act. It establishes a federal Long-Term Care Insurance Benefit that would pay eligible individuals monthly benefits beginning in the first month they meet all criteria (retirement age, application filed, insured status, and a continual serious functional disability lasting a substantial period). Eligibility hinges on six quarters of coverage in a base period beginning in 2026, and the monthly benefit amount would be based on the median cost of 6 hours per day of paid personal care (adjusted for long-term care sector wages) multiplied by a factor reflecting the individual’s quarters of coverage relative to 40. The act also creates a new Federal Long-Term Care Insurance Trust Fund to fund start-up costs, ongoing benefits, and public education, and it lays out governance, reporting, outreach, and oversight provisions, including regular GAO and HHS/SSA reporting and plans to address remaining LTSS needs for those not covered. It sets requirements related to notices, annual statements, and certain residency and employment rules for beneficiaries who hire aides.
Key Points
- 1Establishes a new federal long-term care insurance benefit (Section 235) under Title II of the Social Security Act, with eligibility tied to retirement age, an application for benefits, insured status (6 quarters in the base period), and a continual serious functional disability for a substantial period.
- 2Benefit amount formula: monthly payment equals the median cost of 6 hours/day of paid personal assistance (in the U.S.), indexed to long-term care sector wages, multiplied by the ratio of quarters of coverage to 40 (not exceeding 1). The base period starts in the 1st quarter of 2026.
- 3Creation of a Federal Long-Term Care Insurance Trust Fund to finance start-up costs, initial benefits (annual appropriations), and public education, with governance and investment provisions similar to other federal trust funds.
- 4Public education and beneficiary information requirements, including a 10-year SSA/HHS plan, annual notices to eligible individuals about potential benefits and eligibility, and residency/work compliance rules for beneficiaries employing non-family caregivers.
- 5Oversight and evaluation: GAO reports every 5 years (initially) evaluating eligibility manipulation, potential financial exploitation, and consumer understanding; HHS/SSA to periodically plan for remaining LTSS needs for those not covered by the program.