Title: WISH Act
Policy area: Social Welfare

Summary:
Well-Being Insurance for Seniors to be at Home Act or the WISH Act
This bill provides initial funding to establish a federal long-term care insurance benefit and puts in place a new payroll tax to finance the benefit in the future. The initial funding for the benefit and related outreach must be repaid to the Department of the Treasury within 10 years.


[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4289 Introduced in House (IH)]

<DOC>






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 Representatives 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 attendance by another 
        person, averaging $298,000 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 number 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 combination 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 supports (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 households if they faced that need. HHS 
        projections show that older adults who need LTSS for more than 
        5 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 methods for 
        ordinary Americans to be able to take responsibility for 
        planning for the risk of a substantial period of disability 
        during retirement years.
            (9) Those methods must also responsibly support 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 support themselves in their communities during 
periods of serious 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 disability (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 determined 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 
individual no longer has a continual serious functional disability (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 Secretary of 
        Health and Human Services in consultation 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 number 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 period.
            ``(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.
    ``(d) Definition of Continual Serious Functional 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 individual (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 average indexed monthly 
                earnings for long-term care equal to or less than the 
                dollar amount representing the 40th percentile in the 
                table established 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 earnings 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 indexed 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 indexed 
                        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 indexed monthly 
                earnings for long-term care.--For purposes of this 
                subsection, the average indexed monthly earnings for 
                long-term care of an individual shall be determined 
                under section 215(b) 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 number of 
                        benefit computation years for which no wages 
                        were paid in and no self-employment income 
                        credited.'; and
                            ``(ii) in paragraph (2)(B)(ii), by striking 
                        `1950' and inserting `2021'.
            ``(3) Time of calculation.--The time described 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 primary 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 application for long-
                term care insurance benefits under this section.
    ``(f) Provision of Information Relating to Obtaining Long-Term 
Care.--The Commissioner of Social 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 information with respect to an 
individual's application for long-term care insurance benefits, an 
annual statement described 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 
recipient'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 entitled to a long-
        term care insurance benefit for a month during a calendar year 
        shall submit a statement 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 serious 
                        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 described in the 
                preceding paragraphs of this subsection; or
                    ``(B) beginning after the fifth consecutive year 
                with respect to which the individual has reported, in 
                the annual statement required under paragraph (2), a 
                country of residence other 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 section.
    (b) Appropriation.--
            (1) In general.--There is appropriated to the Federal Long-
        Term Care Insurance Trust Fund out of moneys in the Treasury 
        not otherwise appropriated--
                    (A) for each of fiscal years 2022, 2023, and 2024, 
                $12,000,000 for the initial establishment of the Long-
                Term Care Insurance program and payment of benefits 
                during such fiscal years;
                    (B) $50,000,000 for public education relating to 
                the Long-Term Care Insurance program 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) reported to the Secretary of the Treasury 
                pursuant 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 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 
                applicable rate of tax under such sections to such 
                compensation, that relate to the taxes imposed with 
                respect to wages described in subparagraph (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 subparagraph.
            (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 
        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 Managing 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 securities.
    (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 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 
recommendations 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 subsection 
                (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 individual a tax equal to 
        the applicable percentage of the wages (as defined in section 
        3121(a)) received by the 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.''.
            (3) Tax on self-employment income.--Section 1401 of such 
        Code is amended--
                    (A) by redesignating subsection (c) as subsection 
                (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 income in any taxable year after 
        2021.''.
            (4) Application of long-term care insurance tax to federal, 
        state, and local employment.--Section 3121(u) of such Code is 
        amended--
                    (A) in the heading, by striking ``hospital 
                insurance tax'' and inserting ``hospital insurance tax 
                and long-term care insurance tax'';
                    (B) by striking ``sections 3101(b) and 3111(b)'' 
                each place it appears and inserting ``subsections (b) 
                and (c) of section 3101 and subsections (b) and (c) of 
                section 3111''; and
                    (C) in paragraph (2)(C), in the matter preceding 
                clause (i), by inserting ``(except for purposes 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 ``subsections (a) and (b)'' and inserting 
        ``subsections (a), (b), and (c)''.
            (2) Employee representative contribution.--Section 3211(a) 
        of such Code is amended by striking ``subsections (a) and (b)'' 
        each place it appears and inserting ``subsections (a), (b), and 
        (c)''.
            (3) Employer contribution.--Section 3221(a) of such Code is 
        amended by striking ``subsections (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 amended--
                    (A) in the heading, by inserting ``and long-term 
                care insurance taxes'' after ``Hospital insurance 
                taxes'',
                    (B) in subclause (I), by striking ``the rate of tax 
                in effect under section 3101(b)'' and inserting ``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 inserting 
                ``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 Retirement 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 period 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 sections of the Internal 
Revenue Code of 1986 are amended as follows:
            (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 ``sections 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 beginning 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 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 earnings for 
                long-term care that would be calculated 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 average indexed monthly 
                earnings for long-term care (as determined under such 
                paragraph (2)(B)) of each individual whose average 
                indexed 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 defined 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--
                            (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 attained 
                age 35, by making such notice available on the 
                individual's account on the website of the Social 
                Security Administration, to be updated annually.
            (3) Eligible individual.--In this subsection, the term 
        ``eligible individual'' means an individual--
                    (A) who has a social security account number; and
                    (B)(i) who has wages or net earnings from self-
                employment; or
                    (ii) with respect to whom the Commissioner has 
                information that the pattern of wages or self-
                employment income indicate a likelihood of noncovered 
                employment.

SEC. 7. GAO REPORT ON PERFORMANCE OF THE WISH PROGRAM.

    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 manipulation of 
        eligibility criteria by beneficiaries or beneficiary advisors 
        and recommendations as to the merits 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 connected and 
        recommendations as to the merits of possible remedies, 
        including the merits of imposing a financial 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 consumer 
        understanding of long-term insurance offerings and 
        recommendations as to the merits of possible remedies, 
        including the merits of standardizing insurance offerings to 
        improve consumer understanding.

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 Administrator 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 supports needed 
        by individuals who are not eligible for benefits under section 
        235 of the Social Security Act, including individuals disabled 
        in childhood, individuals 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.
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