In early October, the Harris campaign revealed a new senior care proposal that, if implemented, could change the way that America cares for its senior citizens. The plan, dubbed “Medicare at Home,” could expand Medicare — the insurance program available to Americans aged 65 and older — to finally cover in-home care for seniors.
“Currently, Medicare does not cover most in-home care,” says Arnulfo De La Cruz, president of the California union SEIU 2015, largest long-term care union in the U.S. and the largest local union in Service Employees International Union (SEIU). Seniors requiring more extensive care are often required to spend down their pensions or savings to qualify for Medicaid, a separate government insurance program. The Harris plan exemplifies the type of bold solutions needed to address the senior care crisis in this country, De La Cruz adds. “Under Vice President Harris’ plan, Medicare will cover home care for the first time ever for all of our nation’s seniors and those with disabilities who need it.”
The proposal also seeks to address a growing issue in this country — the burden placed on what is called the sandwich generation, the nearly quarter of Americans who care for both their own children as well as aging or disabled relatives.
Ahead, learn more about Harris’ proposed plans to improve Medicare, what senior care and policy experts have to say about the suggested changes and who could benefit most.
“For the first time, Medicare would cover home care costs for any senior or disabled person who needs it and is struggling to pay for it.”
—Brandon Blakeley, co-founder of Mirador Living
What is the Harris Medicare proposal?
There are some key differences between current Medicare policy and the Harris proposal, which seeks to meet more of the needs of today’s seniors. “For the first time, Medicare would cover home care costs for any senior or disabled person who needs it and is struggling to pay for it,” says Brandon Blakeley, the co-founder of Mirador Living, a platform that helps families find long-term care for seniors.
“Currently, Medicare only pays for in-home care for people who meet certain requirements, and usually only for a limited amount of time,” says Dr. Howard Degenholtz, a professor in the Department of Health Policy and Management at the University of Pittsburgh. “It is best understood as a short-term ‘rehabilitative’ care benefit and must be authorized every 30 or 60 days.”
Many Americans are confused by the differences between existing Medicare and Medicaid programs. For example, about half of adults ages 50 and older think that Medicare already covers in-home care, according to a 2022 survey conducted by AARP. But that’s not the case, according to health policy experts.
Here’s a quick look at the differences between Medicare and Medicaid in 2024:
Medicare vs. Medicaid
| Requirement | Medicare | Medicaid |
| Income based? | No. | Yes. |
| Age requirement? | Yes, participants must be 65+. | No, Medicaid is available to Americans of any age. |
| Disability determination? | No. | Yes, for those who do not qualify by income, disability can determine eligibility. |
| Covers facility care? | Limited; short-term stay following a hospitalization, typically under 100 days. | Yes, with doctor approval and income or disability eligibility. |
| Covers in-home care? | Limited; part-time or intermittent home care with medical requirements. No 24-hour home care provided. | Yes, with doctor approval and income or disability eligibility. |
Degenholtz says that seniors who need help with daily living tasks or have memory impairment like dementia or Alzheimer’s typically are not eligible for Medicare Home Health Care benefits. The percentage of Americans who fall in this gap is significant, says Wendell Potter, the president of the Center for Health and Democracy. However, “Vice President Harris’ proposal offers a better option for the nearly 20% of seniors who require assistance with daily activities.”
“Importantly, this would allow people to receive long-term care in their homes where they feel safest and healthiest.”
—Wendell Potter, president of the Center for Health and Democracy
Potter adds that funding long-term care options for all Medicare beneficiaries is a crucial step in this country. Some individuals could have all of their care covered, while those in a higher income bracket could receive support for some of the cost. “Importantly, this would allow people to receive long-term care in their homes where they feel safest and healthiest.”
Harris cites her own experience caring for her mother, who died in 2009 after a battle with colon cancer, as part of the impetus behind this monumental proposal. “Vice President Harris cared for her aging mother and knows that when families cannot find affordable care for their elderly parents or children, it is not just a big financial strain, but also a source of severe emotional stress that takes a big toll on families,” the campaign states in a press release.
How would the Harris proposal change senior care in America?
While it may sound simple — allowing an insurance program to fund in-home care — the Harris proposal could have far-reaching benefits and implications for seniors, their families and caregivers. This proposal would be the largest expansion of Medicare since the Medicare Modernization Act in 2003, which added prescription drug coverage to Medicare plans, Blakely says. Additionally, he cites several other key changes:
Expands access to in-home care benefits
Since this plan is a proposed expansion of Medicare, rather than a change to Medicaid, it would be accessible to more senior Americans. Medicare recipients could be eligible for in-home care when they are unable to perform daily living tasks or have dementia or Alzheimer’s — something that does not currently qualify seniors for Medicaid if they have any pension or assets.
This is significant, as a 2021 survey by the AARP found that 77% of adults over 50 would prefer to age at home — a choice many do not have under current Medicare limitations.
Ends the practice of estate recovery
In addition to Medicare expansion, the proposal includes a plan to work with Congress to end estate recovery, the current practice of seizing the assets of deceased Medicaid beneficiaries in an effort to recoup long-term care costs. If successful, many who rely on Medicaid to cover care costs could be protected from having their families lose assets to the state or even lose a home that has been in the family for generations.
Includes additional benefits for seniors
The Harris campaign also plans to further increase protections for seniors, expanding on work done under the Biden administration. This includes:
- Tax credit enhancements that could save Americans $800 per year on healthcare premiums.
- Extending the $35 cap on insulin and other common drugs.
- Limiting out-of-pocket drug costs to $2000 per year, per senior.
- Continued negotiations with pharmaceutical companies to lower the cost of more prescription drugs.
“The group that will benefit the most is the middle class — people who have enough pension or retirement savings that they do not qualify for Medicaid, but do not have enough income or savings to pay for the care they need.”
—Dr. Howard Degenholtz, professor of health policy and management, University of Pittsburgh
Who could be most impacted?
The Harris Medicare plan is aimed at helping several groups of Americans who often fall through the cracks of the current system, including:
Middle-class seniors
Degenholtz says this proposal would target the seniors who most often struggle to afford care. “Home care is covered by Medicaid for people who are financially eligible,” he says, which is a plus for low-income seniors but often excludes other groups who struggle to pay.
Some wealthy families can afford the out-of-pocket cost of home care, which can be as high as $70,000 per year. That leaves out the middle, though. “The group that will benefit the most is the middle class — people who have enough pension or retirement savings that they do not qualify for Medicaid, but do not have enough income or savings to pay for the care they need,” says Degenholtz.
Jill McNamara, the general manager of Senior Care for Care.com, calls the proposal significant and believes it could be more cost-effective than the current system. “The majority of individuals prefer to age at home, but cost remains a major barrier,” she says. “At the same time, institutional care can be incredibly expensive, with the cost of a shared room in a nursing home in the US averaging over $100,000. When that cost shifts from a family to Medicaid, it still remains quite costly for the government. Government-funded in-home care could not only be more cost-effective but also better aligned with aging preferences.”
Family caregivers
This plan could also impact family members caring for aging loved ones. A September poll by AARP found that 78% of women over age 50 who care for an aging family member report feeling financial stress. By allowing Medicare to fund in-home care, those women can re-enter the workforce to alleviate that burden.
Professional senior care workers
For senior care workers, De La Cruz says this proposal could provide much needed reform and improve work conditions overall. “For too long and too often, home care providers, who are primarily women, women of color and immigrants, have been disrespected and undervalued,” he says.
Home care is one of the nation’s fastest growing job sectors as the senior population soars, but much of that care is unregulated and underpaid. “Vice President Harris’ plan will expand the home care workforce and will mobilize qualified home health aides, personal care attendants or direct care workers recognized by their state,” says De La Cruz.
Is the Harris Medicare proposal viable?
While the details of this proposal address crucial gaps in senior care in this country, some voters wonder if the Harris proposal could actually work. A few key considerations include:
Cost
Being cared for at home may be what most families want, but how will the United States pay for it? The Harris proposal cites a Brookings Institution study that estimates the cost of their plan to be about $40 billion annually, which experts say is not unreasonable.
The Congressional Budget Office estimates that the Biden Harris Administration’s Medicaid prescription drug cost negotiations are already expected to save $31 million per year by 2031. Harris is pushing for Congress to continue to negotiate drug prices for even more savings — keeping money with hard-working citizens instead of pharmaceutical companies.
Policy implementation and legislative concerns
While the Harris Medicare proposal seems to address many key concerns affecting today’s aging Americans and their families, these changes would require modifications to existing federal programming — something that is not always easy to accomplish in a highly divided government.
According to Allison Hoffman, professor of law and professor of medical ethics and health policy at the University of Pennsylvania Carey Law School, some of the challenges to implementing this policy could include:
- Designing benefits to include home-based, long-term care. Shifting the responsibility for at-home care from Medicaid to Medicare is complicated policy work.
- Meeting the demand for in-home care staff. Currently, many positions offer low pay for demanding work. Medicare funding could change that, but it will take time.
- Bipartisan support. Passing this policy will take a lot of support in the House and Senate, which will depend on the 2024 election cycle. Historically, Republicans have not supported expansions of Medicare or Medicaid.
Hoffman says that Congress has had the chance to amend Medicare’s policy in regard to at-home care several times in recent years without success. She cites two reasons for the failure:
- The cost of expanding Medicare.
- The fact that family members often step up to fill gaps in care.
“That gives Congress the ability to neglect dealing with long-term care — because family averts a crisis of unmet need,” she says.
“From a policy perspective, it’s the right thing… Medicare is our social insurance program for older people and people with disabilities, and one of this population’s greatest needs is caregiving.”
—Allison Hoffman, professor of law, medical ethics and health policy, University of Pennsylvania
That said, this policy is both feasible and necessary, according to Hoffman. “Medicaid pays for some of it [in-home care services] now through what are called Home and Community-Based Services, and Medicare could cover these benefits in more equitable and comprehensive ways.”
The bottom line
The Medicare at Home policy outlined by the Harris campaign could target a growing need in this country. It could allow seniors to age at home, which most prefer. It could also relieve the burden on their family members — many of whom also work and care for young children at the same time. But, while the Harris campaign has outlined strategic ways to fund this plan, policy experts say that it could be difficult to pass without congressional support in what may, once again, be a very divided Congress.
Ultimately, the proposal is just one possible way to address the growing needs of seniors and their families, and it should inspire additional, much-needed conversations about the gaps aging adults face when seeking care. “From a policy perspective, it’s the right thing,” concludes Hoffman. “…Medicare is our social insurance program for older people and people with disabilities, and one of this population’s greatest needs is caregiving.”
