I 
117TH CONGRESS 
1ST SESSION H. R. 4289 
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 
JUNE 30, 2021 
Mr. SUOZZI 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-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Well-Being Insurance 
for Seniors to be at Home Act’’ or the ‘‘WISH Act’’. 
SEC. 2. FINDINGS; PURPOSE. 
(a) FINDINGS.—Congress finds the following: 
(1) More than half of Americans entering old 
age today will have a long-term need for constant at-
tendance by another person, averaging $298,000 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
costs per person for about 2 years of serious self- 
care disability (as defined in HIPAA), and more 
than half will be out-of-pocket, according to the U.S. 
Department of Health and Human Services (HHS). 
(2) The AARP report that the population age 
85 or older is set to double between 2015 and 2032, 
and triple by 2050. This aging will outpace the num-
ber of working-age family members who can help 
seniors financially or with unpaid care. 
(3) Research has shown that the typical U.S. 
senior could afford only about 12 months of nursing 
home care, assisted living care, or extensive home 
care using their financial wealth. Some can get by 
using unpaid (family) care, but most rely on a com-
bination of paid and unpaid care. 
(4) More than 1 in 5 middle-income seniors will 
end up impoverished, Medicaid eligible, and using 
Medicaid to cover their long-term services and sup-
ports (LTSS) costs, according to Altarum analysis 
of HHS projections. 
(5) Millions of older Americans—1 in 5—will 
need LTSS for more than 5 years, with a price tag 
that would impoverish nearly all American house-
holds if they faced that need. HHS projections show 
that older adults who need LTSS for more than 5 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
years incur nearly half of all LTSS expenses and 60 
percent of Medicaid’s LTSS spending. 
(6) An older adult with high LTSS needs is 
about 50 percent more likely to enter Medicaid when 
compared to seniors with similar finances earlier in 
life. 
(7) Long-term care insurance (LTCI) is rarely 
available, and premiums have pushed plan-holders to 
drop out. Only 6 percent of seniors had any private 
coverage for LTSS expenses in 2018, leaving almost 
all middle-class American families to exhaust their 
nest-eggs and become impoverished before qualifying 
for Medicaid. 
(8) The nation urgently needs to create meth-
ods for ordinary Americans to be able to take re-
sponsibility for planning for the risk of a substantial 
period of disability during retirement years. 
(9) Those methods must also responsibly sup-
port the workforce providing supports and services. 
(b) PURPOSE.—The purpose of this Act is to enable 
most Americans to make plans that protect themselves 
and their families, to enable disabled older adults to sup-
port themselves in their communities during periods of se-
rious disability, to support the workforce providing direct 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
services to elders living with disabilities, and to reduce 
what is now necessary reliance on Medicaid. 
SEC. 3. LONG-TERM CARE INSURANCE BENEFITS. 
(a) IN GENERAL.—Title II of the Social Security Act 
(42 U.S.C. 401 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 235. LONG-TERM CARE INSURANCE BENEFITS. 
‘‘(a) IN GENERAL.—Every individual who— 
‘‘(1) has attained retirement age (as defined in 
section 216(l)(1)); 
‘‘(2) has filed an application for long-term care 
insurance benefits; 
‘‘(3) is insured for long-term care insurance 
benefits (as determined under subsection (c)) at the 
time such individual’s application is filed; and 
‘‘(4) has a continual serious functional dis-
ability (as defined in subsection (d)) and, at the time 
such individual’s application is filed, has had such 
disability for a substantial period of time (as deter-
mined under subsection (e)), 
shall be entitled to a long-term care insurance benefit for 
each month beginning with the 1st month in which the 
individual meets the criteria specified in paragraphs (1) 
through (4), and ending with the earlier of the month in 
which the individual dies or the 1st month in which the 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
individual no longer has a continual serious functional dis-
ability (as so defined). 
‘‘(b) BENEFIT AMOUNT.—Such individual’s long- 
term care insurance benefit for each month shall be an 
amount equal to the product of— 
‘‘(1) an estimate, to be determined by the Sec-
retary of Health and Human Services in consulta-
tion with the Department of Labor, of the median 
cost of 6 hours per day of paid personal assistance 
in the United States, indexed to wages in the long- 
term care sector, multiplied by 
‘‘(2) the ratio (not greater than 1) of the num-
ber of quarters of coverage the individual has during 
the applicable base period (as defined in subsection 
(c)(2)) to 40. 
‘‘(c) DEFINITION OF INSURED STATUS.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a), an individual shall be insured for long-term care 
insurance benefits in any month if the individual has 
6 quarters of coverage during the applicable base pe-
riod. 
‘‘(2) APPLICABLE BASE PERIOD.—For purposes 
of this subsection, the term ‘applicable base period’ 
means the period that begins with the 1st quarter of 
2022. 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(d) DEFINITION OF CONTINUAL SERIOUS FUNC-
TIONAL DISABILITY.—For purposes of subsection (a), an 
individual shall be considered to have a continual serious 
functional disability if the person is a chronically ill indi-
vidual (as determined under section 7702B(c)(2) of the 
Internal Revenue Code of 1986) and is expected to remain 
a chronically ill individual (as so determined) for at least 
1 year or until the individual’s death. 
‘‘(e) DEFINITION OF SUBSTANTIAL PERIOD.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a), a substantial period of time means— 
‘‘(A) in the case of an individual who, at 
the time described in paragraph (3), has aver-
age indexed monthly earnings for long-term 
care equal to or less than the dollar amount 
representing the 40th percentile in the table es-
tablished under subsection (f) for such calendar 
year, 12 months; and 
‘‘(B) in the case of an individual who, at 
such time, has average indexed monthly earn-
ings for long-term care greater than such dollar 
amount, 12 months plus 1 additional month for 
each 1.25 percentile interval above the 40th 
percentile for which the individual’s average in-
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
dexed monthly earnings for long-term care 
would attain (as specified in such table). 
‘‘(2) TABLE OF EARNINGS.— 
‘‘(A) IN GENERAL.—The Commissioner of 
Social Security shall establish a table, for each 
calendar year beginning with calendar year 
2022, setting forth— 
‘‘(i) the dollar amount representing 
the 40th percentile among the average in-
dexed monthly earnings for long-term care 
(as determined under subparagraph (B)) 
of each individual who has attained age 62 
and whose primary insurance amount is 
first computed during such calendar year 
(or, for calendar year 2032, during any 
previous calendar year); and 
‘‘(ii) the dollar amounts representing 
percentiles over 40 (increasing linearly 
from 40 in intervals of 1.25) among the 
average indexed monthly earnings for long- 
term care (as so determined) of each such 
individual. 
‘‘(B) DETERMINATION
OF
AVERAGE
IN-
DEXED MONTHLY EARNINGS FOR LONG-TERM 
CARE.—For purposes of this subsection, the av-
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
erage indexed monthly earnings for long-term 
care of an individual shall be determined under 
section 215(b) as if such section were amend-
ed— 
‘‘(i) in paragraph (2)(A), by striking 
‘reduced—’ and all that follows through 
the end and inserting ‘reduced by the num-
ber of benefit computation years for which 
no wages were paid in and no self-employ-
ment income credited.’; and 
‘‘(ii) in paragraph (2)(B)(ii), by strik-
ing ‘1950’ and inserting ‘2021’. 
‘‘(3) TIME
OF
CALCULATION.—The time de-
scribed in this paragraph is— 
‘‘(A) in the case of an individual who has 
40 quarters of coverage during the applicable 
base period (as defined in subsection (c)(2)) 
prior to becoming entitled to old-age insurance 
benefits, the time at which the individual’s pri-
mary insurance amount was first computed 
with respect to the individual’s application for 
such benefits; and 
‘‘(B) in the case of any other individual, 
the time at which the individual files an appli-
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
cation for long-term care insurance benefits 
under this section. 
‘‘(f) PROVISION OF INFORMATION RELATING TO OB-
TAINING LONG-TERM CARE.—The Commissioner of So-
cial Security shall provide to each individual entitled to 
a long-term care insurance benefit under this section, as 
soon as practicable following the first day of the first 
month of such entitlement, information describing the 
steps the individual may take to obtain long-term care, 
including an explanation of the services (including care 
planning, care management, and administrative services 
for hired care providers, by referral or in-house, for a fee) 
provided by, and the appropriate contact information for, 
the Aging and Disability Resource Centers described in 
section 202(b)(8) of the Older Americans Act of 1965 and 
the area agencies on aging (as defined in section 102(6) 
of such Act). 
‘‘(g) PROVISION OF BENEFICIARY INFORMATION BY 
ANY PERSON.—Any person may submit applicable infor-
mation with respect to an individual’s application for long- 
term care insurance benefits, an annual statement de-
scribed under subsection (i)(2), or any other information 
required to be submitted by the individual under this title, 
including, as applicable, the individual’s representative, or 
any family member or other appropriate person. 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(h) TREATMENT OF LONG-TERM CARE INSURANCE 
BENEFIT PAYMENTS.—A long-term care insurance benefit 
payment shall not be regarded as income and shall not 
be regarded as a resource for any month, for purposes 
of determining the eligibility of the recipient (or the recipi-
ent’s spouse or family) for benefits or assistance under 
any Federal program or under any State or local program 
financed in whole or in part with Federal funds. 
‘‘(i) ADDITIONAL REQUIREMENTS.— 
‘‘(1) RELATING TO WAGES AND WITHHOLDING 
RULES.—An individual entitled to a long-term care 
insurance benefit for a month during a calendar 
year shall, in any case in which such individual hires 
an employee who is not a family member to provide 
paid personal care to the individual during such 
month, comply with all applicable State and Federal 
laws relating to— 
‘‘(A) the payment of a minimum wage; and 
‘‘(B) the withholding of payroll taxes and 
other employment-related taxes. 
‘‘(2) ANNUAL STATEMENT.—An individual enti-
tled to a long-term care insurance benefit for a 
month during a calendar year shall submit a state-
ment to the Commissioner of Social Security at least 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
once during such calendar year, as directed by the 
Commissioner— 
‘‘(A) affirming that the individual— 
‘‘(i) continues to have a continual se-
rious functional disability (as defined in 
subsection (d)); and 
‘‘(ii) is in compliance with the laws 
described in paragraph (1); and 
‘‘(B) specifying the country of residence of 
the individual. 
‘‘(3) NONPAYMENT OF BENEFITS IN CERTAIN 
CASES.—No long-term care insurance benefit shall 
be payable to an individual for any month— 
‘‘(A) with respect to which the individual 
fails to satisfy any of the requirements de-
scribed in the preceding paragraphs of this sub-
section; or 
‘‘(B) beginning after the fifth consecutive 
year with respect to which the individual has re-
ported, in the annual statement required under 
paragraph (2), a country of residence other 
than the United States (including any territory 
of the United States).’’. 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
(b) ESTIMATES OF BENEFITS.—Section 1143(a)(2) 
of the Social Security Act (42 U.S.C. 1320b–13) is 
amended— 
(1) in subparagraph (D), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(F) an estimate of the potential long-term care 
insurance benefits payable to the individual.’’. 
SEC. 4. ESTABLISHMENT OF FEDERAL LONG-TERM CARE 
INSURANCE TRUST FUND. 
(a) IN GENERAL.—There is hereby created on the 
books of the Treasury of the United States a trust fund 
to be known as the ‘‘Federal Long-Term Care Insurance 
Trust Fund’’. The Federal Long-Term Care Insurance 
Trust Fund shall consist of such gifts and bequests as 
may be made as provided in section 201(i)(1) of the Social 
Security Act (42 U.S.C. 401(i)(1)) and such amounts as 
may be appropriated to, or deposited in, the Federal Long- 
Term Care Insurance Trust Fund as provided in this sec-
tion. 
(b) APPROPRIATION.— 
(1) IN GENERAL.—There is appropriated to the 
Federal Long-Term Care Insurance Trust Fund out 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
of moneys in the Treasury not otherwise appro-
priated— 
(A) for each of fiscal years 2022, 2023, 
and 2024, $12,000,000 for the initial establish-
ment of the Long-Term Care Insurance pro-
gram and payment of benefits during such fis-
cal years; 
(B) $50,000,000 for public education re-
lating to the Long-Term Care Insurance pro-
gram as described in section 6(a); 
(C) 100 percent of the taxes imposed by 
sections 3101(c) and 3111(c) of the Internal 
Revenue Code of 1986 with respect to wages 
(as defined in section 3121 of such Code) re-
ported to the Secretary of the Treasury pursu-
ant to subtitle F of such Code, as determined 
by the Secretary of the Treasury by applying 
the applicable rate of tax under such sections to 
such wages; 
(D) 100 percent of the taxes imposed by 
section 1401(c) of such Code with respect to 
self-employment income (as defined in section 
1402 of such Code) reported to the Secretary of 
the Treasury on tax returns under subtitle F of 
such Code, as determined by the Secretary of 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
the Treasury by applying the applicable rate of 
tax under such section to such self-employment 
income; and 
(E) the portion of the taxes imposed by 
sections 3201(a), 3211(a), and 3221(a) of such 
Code with respect to compensation (as defined 
in section 3231 of such Code) reported to the 
Secretary of the Treasury on tax returns under 
subtitle F of such Code, as determined by the 
Secretary of the Treasury by applying the ap-
plicable rate of tax under such sections to such 
compensation, that relate to the taxes imposed 
with respect to wages described in subpara-
graph (C). 
(2) REPAYMENT OF INITIAL APPROPRIATION.— 
Amounts appropriated under subparagraphs (A) and 
(B) of paragraph (1) shall be repaid to the Treasury 
of the United States not later than 10 years after 
the first appropriation is made under each such sub-
paragraph. 
(3) TRANSFER TO TRUST FUND.—The amounts 
appropriated by paragraph (2) shall be transferred 
from time to time from the general fund in the 
Treasury to the Federal Long-Term Care Insurance 
Trust Fund, such amounts to be determined on the 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
basis of estimates by the Secretary of the Treasury 
of the taxes, specified in such paragraph, paid to or 
deposited into the Treasury. Proper adjustments 
shall be made in amounts subsequently transferred 
to the extent prior estimates were inconsistent with 
the taxes specified in such paragraph. 
(c) MANAGEMENT OF TRUST FUND.—The provisions 
of subsections (c), (d), (e), (f), (i), and (m) of section 201 
of the Social Security Act (42 U.S.C. 401) shall apply with 
respect to the Federal Long-Term Care Insurance Trust 
Fund in the same manner as such provisions apply to the 
Federal Old-Age and Survivors Insurance Trust Fund and 
the Disability Insurance Trust Fund, except that the Man-
aging Trustee (within the meaning of subsection (d) of 
such section) may invest such portion of the Federal 
Long-Term Care Insurance Trust Fund as the Managing 
Trustee considers appropriate in conservative market se-
curities. 
(d) BENEFITS PAID FROM TRUST FUND.—Benefit 
payments required to be made under section 3 shall be 
made only from the Federal Long-Term Care Insurance 
Trust Fund. 
(e) ADMINISTRATION.—There are authorized to be 
made available for expenditure, out of the Federal Long- 
Term Care Insurance Trust Fund, such sums as may be 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
necessary to pay the costs of the administration of section 
3, including start-up costs, technical assistance, outreach, 
education, evaluation, and reporting. 
(f) REPORT.—Not later than 5 years after the date 
of enactment of this Act and every 5 years thereafter, the 
Board of Trustees (as defined for purposes of title II of 
the Social Security Act) shall submit a report to Congress 
evaluating the impact of long-term care insurance benefits 
under section 235 of such Act and making recommenda-
tions relating to potential geographical adjustments of the 
amount of such benefits. 
SEC. 5. INTERNAL REVENUE CODE PROVISIONS. 
(a) IN GENERAL.— 
(1) TAX ON EMPLOYEES.—Section 3101 of the 
Internal Revenue Code of 1986 is amended— 
(A) by redesignating subsection (c) as sub-
section (d), and 
(B) by inserting after subsection (b) the 
following: 
‘‘(c) LONG-TERM CARE INSURANCE.— 
‘‘(1) IN GENERAL.—In addition to other taxes, 
there is hereby imposed on the income of every indi-
vidual a tax equal to the applicable percentage of the 
wages (as defined in section 3121(a)) received by the 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
individual with respect to employment (as defined in 
section 3121(b)). 
‘‘(2) APPLICABLE PERCENTAGE.—For purposes 
of paragraph (1), the term ‘applicable percentage’ 
means 0.3 percent in the case of wages received in 
any calendar year after 2021.’’. 
(2) TAX ON EMPLOYERS.—Section 3111 of such 
Code is amended— 
(A) by redesignating subsection (c) and (d) 
as subsection (d) and (e), respectively, and 
(B) by inserting after subsection (b) the 
following: 
‘‘(c) LONG-TERM CARE INSURANCE.— 
‘‘(1) IN GENERAL.—In addition to other taxes, 
there is hereby imposed on every employer an excise 
tax, with respect to having individuals in his employ, 
equal to the applicable percentage of the wages (as 
defined in section 3121(a)) paid by the employer 
with respect to employment (as defined in section 
3121(b)). 
‘‘(2) APPLICABLE PERCENTAGE.—For purposes 
of paragraph (1), the term ‘applicable percentage’ 
means 0.3 percent in the case of wages paid in any 
calendar year after 2021.’’. 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
(3) TAX ON SELF-EMPLOYMENT INCOME.—Sec-
tion 1401 of such Code is amended— 
(A) by redesignating subsection (c) as sub-
section (d), and 
(B) by inserting after subsection (b) the 
following: 
‘‘(c) LONG-TERM CARE INSURANCE.— 
‘‘(1) IN GENERAL.—In addition to other taxes, 
there is hereby imposed for each taxable year, on the 
self-employment income of every individual, a tax 
equal to the applicable percentage of the amount of 
the self-employment income for such taxable year. 
‘‘(2) APPLICABLE PERCENTAGE.—For purposes 
of paragraph (1), the term ‘applicable percentage’ 
means 0.6 percent in the case of self-employment in-
come in any taxable year after 2021.’’. 
(4) APPLICATION OF LONG-TERM CARE INSUR-
ANCE TAX TO FEDERAL, STATE, AND LOCAL EM-
PLOYMENT.—Section 3121(u) of such Code is 
amended— 
(A) in the heading, by striking ‘‘hospital 
insurance tax’’ and inserting ‘‘hospital insur-
ance tax and long-term care insurance tax’’; 
(B) by striking ‘‘sections 3101(b) and 
3111(b)’’ each place it appears and inserting 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
‘‘subsections (b) and (c) of section 3101 and 
subsections (b) and (c) of section 3111’’; and 
(C) in paragraph (2)(C), in the matter pre-
ceding clause (i), by inserting ‘‘(except for pur-
poses of the taxes imposed by sections 3101(c) 
and 3111(c))’’ after ‘‘subparagraph (A)’’. 
(b) RAILROAD RETIREMENT TAX ACT.— 
(1) 
EMPLOYEE
CONTRIBUTION.—Section 
3201(a) of such Code is amended by striking ‘‘sub-
sections (a) and (b)’’ and inserting ‘‘subsections (a), 
(b), and (c)’’. 
(2) EMPLOYEE
REPRESENTATIVE
CONTRIBU-
TION.—Section 3211(a) of such Code is amended by 
striking ‘‘subsections (a) and (b)’’ each place it ap-
pears and inserting ‘‘subsections (a), (b), and (c)’’. 
(3) 
EMPLOYER
CONTRIBUTION.—Section 
3221(a) of such Code is amended by striking ‘‘sub-
sections (a) and (b)’’ and inserting ‘‘subsections (a), 
(b), and (c)’’. 
(4) APPLICATION OF CONTRIBUTION BASES.— 
Section 3231(e)(2)(A)(iii) of such Code is amend-
ed— 
(A) in the heading, by inserting ‘‘and long- 
term care insurance taxes’’ after ‘‘Hospital in-
surance taxes’’, 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
(B) in subclause (I), by striking ‘‘the rate 
of tax in effect under section 3101(b)’’ and in-
serting ‘‘the sum of the rates of tax in effect 
under subsections (b) and (c) of section 3101’’, 
and 
(C) in subclause (II), by striking ‘‘the rate 
of tax in effect under section 1401(b)’’ and in-
serting ‘‘the sum of the rates of tax in effect 
under subsections (b) and (c) of section 1401’’. 
(5) CONFORMING AMENDMENT.— 
(A) Section 15(a) of the Railroad Retire-
ment Act of 1974 (45 U.S.C. 231n(a)) is 
amended by inserting ‘‘(other than sections 
3201(c), 3211(c), and 3221(c))’’ before the pe-
riod at the end. 
(c) TAXATION
OF LONG-TERM CARE INSURANCE 
BENEFITS.—The Internal Revenue Code of 1986 is 
amended by inserting after section 86 the following: 
‘‘SEC. 86A. LONG-TERM CARE INSURANCE BENEFITS. 
‘‘Gross income shall not include any amount received 
by the taxpayer by reason of entitlement to a benefit under 
section 235 of the Social Security Act.’’. 
(d) CONFORMING AMENDMENTS.—The following sec-
tions of the Internal Revenue Code of 1986 are amended 
as follows: 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
(1) Section 1402(a)(12)(B) is amended by 
striking ‘‘subsections (a) and (b)’’ and inserting 
‘‘subsections (a), (b), and (c)’’. 
(2) Section 3121(z)(5) is amended by striking 
‘‘sections 3101(c) and 3111(c)’’ and inserting ‘‘sec-
tions 3101(d) and 3111(d)’’. 
(3) The last sentence of section 6051(a) is 
amended by striking ‘‘sections 3101(c) and 3111(c)’’ 
and inserting ‘‘sections 3101(d) and 3111(d)’’. 
(4) Section 6413(c) is amended— 
(A) in paragraph (1)— 
(i) by inserting ‘‘, section 3101(c),’’ 
after ‘‘by section 3101(a)’’; and 
(ii) by striking ‘‘both’’ and inserting 
‘‘each’’; and 
(B) in paragraph (2), by inserting ‘‘or 
3101(c)’’ after ‘‘3101(a)’’ each place it appears. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to taxable years begin-
ning after 2021. 
SEC. 6. EDUCATION AND OUTREACH. 
(a) PUBLIC EDUCATION PLAN.— 
(1) IN GENERAL.—Not later than 90 days after 
the date of enactment of this Act, the Secretary of 
Health and Human Services, in consultation with 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
the Commissioner of Social Security, shall publish in 
the Federal Register a 10-year plan to educate the 
public about the likelihood of needing long-term 
care, the nature of the experience of long-term care 
in various situations, the costs of long-term care, the 
availability of long-term care insurance benefits, and 
the importance of planning and considering private 
insurance coverage alongside family support and 
savings (especially during the first years of a serious 
disability). Such plan shall be modified as necessary 
based on research on the effectiveness of various 
strategies and modifications with experience. 
(2) FUNDING.—There are appropriated, out of 
the Federal Long-Term Care Insurance Trust Fund, 
to the Secretary of Health and Human Services 
$50,000,000 to carry out paragraph (1). 
(b) INDIVIDUAL NOTICES.— 
(1) IN GENERAL.—Beginning 1 year after the 
date of enactment of this Act and in accordance with 
paragraph (2), the Commissioner of Social Security 
shall provide to each eligible individual a notice that 
specifies— 
(A)(i) the average indexed monthly earn-
ings for long-term care that would be calculated 
for the individual under paragraph (2)(B) of 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
section 235(e) of the Social Security Act if such 
average indexed monthly earnings for long-term 
care were calculated in the month before the 
month such notice is provided; and 
(ii) for purposes of applying such section 
to the individual, the percentile in which such 
average indexed monthly earnings for long-term 
care of the individual would fall among the av-
erage indexed monthly earnings for long-term 
care (as determined under such paragraph 
(2)(B)) of each individual whose average in-
dexed monthly earnings for long-term care are 
calculated in such month; 
(B) the number of quarters of coverage the 
individual has in the month before the month 
such notice is provided for purposes of attaining 
insured status for long-term care insurance 
benefits under such Act; and 
(C) in any case in which the individual has 
a continual serious functional disability (as de-
fined in section 235(d) of such Act), the date 
on which such disability began. 
(2) TIMING.—A notice described in paragraph 
(1) shall be provided— 
(A) by mail— 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
(i) to each eligible individual not later 
than 540 days of the date of enactment of 
this Act; and 
(ii) to each eligible individual in the 
month the individual attains age 45, age 
55, age 65, and retirement age (as defined 
in section 216(l) of such Act); and 
(B) for each eligible individual who has at-
tained age 35, by making such notice available 
on the individual’s account on the website of 
the Social Security Administration, to be up-
dated annually. 
(3) ELIGIBLE INDIVIDUAL.—In this subsection, 
the term ‘‘eligible individual’’ means an individual— 
(A) who has a social security account num-
ber; and 
(B)(i) who has wages or net earnings from 
self-employment; or 
(ii) with respect to whom the Commis-
sioner has information that the pattern of 
wages or self-employment income indicate a 
likelihood of noncovered employment. 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
SEC. 7. GAO REPORT ON PERFORMANCE OF THE WISH PRO-
GRAM. 
Not later than 5 years after the date of enactment 
of this Act and every 3 years thereafter, the Comptroller 
General shall submit a report to Congress including— 
(1) a description of the likelihood of manipula-
tion of eligibility criteria by beneficiaries or bene-
ficiary advisors and recommendations as to the mer-
its of possible remedies; 
(2) a description of the likelihood of financial 
exploitation or elder mistreatment by others on 
whom a beneficiary is dependent or otherwise con-
nected and recommendations as to the merits of pos-
sible remedies, including the merits of imposing a fi-
nancial management service or fiscal intermediary as 
has often been implemented by states in Medicaid’s 
Cash and Counseling program; and 
(3) a description of the marketplace and con-
sumer understanding of long-term insurance offer-
ings and recommendations as to the merits of pos-
sible remedies, including the merits of standardizing 
insurance offerings to improve consumer under-
standing. 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS
SEC. 8. REPORT ON REMAINING LONG-TERM SUPPORTS 
AND SERVICES NEEDS. 
Not later than 3 years after the date of enactment 
of this Act and every 3 years thereafter, the Secretary of 
Health and Human Services, acting through the Adminis-
trator of the Administration on Community Living and in 
consultation with the Commissioner of Social Security, 
shall submit a plan to Congress that includes— 
(1) estimates of the long-term services and sup-
ports needed by individuals who are not eligible for 
benefits under section 235 of the Social Security 
Act, including individuals disabled in childhood, indi-
viduals living with disabilities before retirement age, 
and individuals who are not insured for benefits 
under such section; and 
(2) proposed strategies and costs of mitigating 
unmet needs for such individuals. 
Æ 
VerDate Sep 11 2014 
22:38 Jul 26, 2021
Jkt 019200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6301
E:\BILLS\H4289.IH
H4289
pamtmann on DSKBC07HB2PROD with BILLS