averaging $298,000 costs per person for about 2 
years of serious self-care disability, and more than 
half will be out-of-pocket, according to the U.S. De-
partment of Health and Human Services (in this 
section referred to as ‘‘HHS’’). 
(2) The population age 85 or older (which is a 
proxy for the number of elders needing LTSS) will 
double between 2022 and 2035, and nearly triple by 
2050. This aging will outpace the number of work-
ing-age people, including family members, who can 
help seniors financially or with unpaid care. 
(3) Research has shown that most U.S. seniors 
could only afford less than a year of nursing home 
care, assisted living care, or extensive home care 
using their financial resources. 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 mostly 
using Medicaid to cover their LTSS costs. 
(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 
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years incur nearly half of all LTSS expenses and 60 
percent of Medicaid’s LTSS spending. 
(6) Only 1 in 10 American adults (11 percent) 
have any private coverage for LTSS expenses, leav-
ing almost all middle-class American families to ex-
haust their nest-eggs and become impoverished be-
fore qualifying for Medicaid. 
(7) The Nation urgently needs to create meth-
ods for ordinary Americans to be able to take re-
sponsibility to plan for the risk of a substantial pe-
riod of disability during retirement years. 
(8) Given that Americans move and work across 
State lines so frequently, State-based LTSS plans 
encounter difficult administrative issues. Therefore, 
a solution to address LTSS needs for seniors must 
be anchored in a Federal insurance plan. Addition-
ally, since the time just after onset of disability is 
more predictable and manageable, a Federal insur-
ance plan should cover the risk of especially long pe-
riods of long-term care, leaving the early period of 
need to personal responsibility. 
(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 
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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 
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 
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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 
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. 
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‘‘(2) APPLICABLE BASE PERIOD.—For purposes 
of this subsection, the term ‘applicable base period’ 
means the period that begins with the 1st quarter of 
2026. 
‘‘(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 
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‘‘(B) DETERMINATION
OF
AVERAGE
IN-
DEXED MONTHLY EARNINGS FOR LONG-TERM 
CARE.—For purposes of this subsection, the av-
erage indexed monthly earnings for long-term 
care of an individual shall be determined under 
section 215(b) (as in effect on the date of en-
actment of this Act) as if such section were 
amended— 
‘‘(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 ‘2025’. 
‘‘(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 
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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-
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-
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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. 
‘‘(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. 
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‘‘(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 
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 
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than the United States (including any territory 
of the United States).’’. 
(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. 
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(b) APPROPRIATION.—There is appropriated to the 
Federal Long-Term Care Insurance Trust Fund out of 
moneys in the Treasury not otherwise appropriated— 
(1) for each of fiscal years 2026, 2027, and 
2028, $12,000,000 for the initial establishment of 
the Long-Term Care Insurance program and pay-
ment of benefits during such fiscal years; and 
(2) $50,000,000 for public education relating to 
the Long-Term Care Insurance program as de-
scribed in section 6(a). 
(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) 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 
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necessary to pay the costs of the administration of section 
3, including start-up costs, technical assistance, outreach, 
education, evaluation, and reporting. 
(e) 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. 
(f) ALLOWING GIFTS TO BE MADE TO THE FEDERAL 
LONG-TERM CARE INSURANCE TRUST FUND.—Section 
201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) 
is amended— 
(1) by striking ‘‘, or the Federal’’ and inserting 
‘‘, the Federal’’; and 
(2) by inserting after ‘‘in such Trust Fund)’’ 
the following: ‘‘, or the Federal Long-Term Care In-
surance Trust Fund established under the Well- 
Being Insurance for Seniors to be at Home Act’’. 
SEC. 5. 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 
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Health and Human Services, in consultation with 
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 
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for the individual under paragraph (2)(B) of 
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— 
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(A) by mail— 
(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. 
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SEC. 6. 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. 
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SEC. 7. 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 
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