Updated April 14, 2025
This update is intended for our community of LTC planning advocates and insurance practitioners to stay up-to-date on the latest legislative news regarding any proposed long-term care state payroll tax that we are following at BuddyIns. This is not a comprehensive assessment, so please email us with any news from your neck of the woods.
Also see our California Proposes Payroll Tax page.
State Legislation
Currently, seven states are actively considering legislation to address the high cost of long-term care potentially through a long-term care state payroll tax, with two of the most populous states, California and New York, among them. The reason these states are important:
- Both are actively moving toward a legislative solution
- The cost of care in these states is higher than average
- We don’t expect that either state will be able to provide a substantial benefit to pay for long-term care services, which speaks to the greatest challenge in trying to legislate a long-term care benefit: overall cost.
This update seeks to clarify the current progress made in each state that has legislation pending and whether there will be an exemption to any payroll tax if a resident owns qualified long term care insurance. Product types available in each state are also included. There are other states that appear on several watch lists. We could not find any information on legislative drafts or anything pending in these states: AK, CO, IL, MI, MO, NC, OR, UT. If you have any information on proposed legislation, please contact marc@buddyins.com.
BuddyIns recommends employers who are interested in offering LTC insurance and employees interested in purchasing coverage for the value of the product, begin the process earlier. If an exemption or incentive is allowed in a state to encourage private purchase, waiting may result in a rush to purchase products and limited capacity. In addition, we advise consumers to opt for more meaningful coverage rather than try to meet an exemption threshold. If you are looking for basic consumer education regarding long term care and long term care insurance, please visit our Long Term Care Insurance Guide page.
Washington
Washington voters have rejected Initiative 2124, which would have allowed residents to opt out of the state's WA Cares long-term care insurance program. The initiative was defeated with about 55.5% of voters opposing it. Supporters of the initiative argued that it would save residents money and provide more flexibility, while opponents feared it would undermine the program and leave many without a safety net for long-term care. The rejection of the initiative is seen as a significant victory for those advocating for the preservation of the WA Cares program. Read more here.
Known as the Washington Cares Fund, this legislation, signed into law in 2019, provides access to a lifetime benefit amount that can be used on a wide range of long-term services and supports. The payroll tax for W-2 workers began July 1, 2023. The first benefits are available beginning July 2026.
January 2024 Commission Recommendations Summary:
Important Updates (please refer to the linked summary for additional information).
- Supplemental Private Long-Term Care Insurance – establishes a framework for a private long-term care insurance market that supplements WA Cares.
- Allow Individuals to Rescind Private Long-Term Care Insurance Exemptions – provide a one-time limited opportunity to permanently join WA Cares until June 30, 2028, five years after the premiums start.
- Managing Costs of Portability - The Commission recommended six options for managing the cost of portability, ultimately settling on a set of measures to offset the cost of portability.
- Changes to Benefit Eligibility - includes adopting a Medicaid-style benefit threshold, and incorporating a 90-day forward certification of need. May eliminate the ability for beneficiaries to use their benefit for short-term car needs. Also recommended was the adoption of a HIPAA-style benefit threshold for out-of-state residents.
How the Program Works
- Contributions: Washington workers pay $0.58 per $100 of earnings. Most employees will contribute, and employers are responsible for collecting the tax and remitting to the Washington Cares Fund.
- Benefits: Starting in July 2026, each person who is eligible to receive the benefit can access care costing up to $36,500 (adjusted annually for inflation) over their lifetime.
- Eligibility: To be eligible to receive the benefit, you must meet contribution requirements and need help with at least three activities of daily living.
- State is considering a recertification process for those who chose to opt-out through the purchase of long term care insurance.
- Benefit portability (qualifying for the benefit if an employee moved out of state) is still an outstanding issue.
- Benefit qualifications may change from what was originally adopted.
Insurance Market Update:
- Approximately 480,000 out of the 3,800,000 employees (13%) opted out of the Washington Cares Fund through the purchase of group or individual LTC Insurance or Life Insurance with LTC riders. This was despite most carriers being overwhelmed by demand over a short period of time and exiting the marketplace. These carriers have since returned to the market.
- BuddyIns estimates that more policies were purchased through group solutions, but more premium was purchased from individual products.
- Despite only a limited time to purchase coverage and only in one state, the sales in Washington increased the LTC Insurance marketplace in the entire country by at least 200%. Premiums increased more modestly given the lower average premium per policy.
California
Key Points Updated 10/10/2024
Work has not progressed from the actuarial report by the firm of Oliver Wyman, commissioned by the legislature, which was released on December 15, 2023, along with updated FAQs. There has been no movement from the governor, legislature, or DOI.
- Expect significant turnover in the state legislature
- New legislature will be sworn in on December 2, 2024
- Committee leadership and legislative priorities will likely shift
Key takeaways of the Actuarial Report:
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- CA Payroll Tax pricing looks very similar to WA Cares Fund for the lowest benefit level at 0.6% of income
- There is a proposed cap unlike WA at $400,000 of income
- The tax could be as much as 3% of income at the highest plan design
- Shared tax cost between employers and employees
- The task force has recommended a private insurance opt-out. Actuarial cost of the private insurance opt-out did not seem as high as expected
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It's prudent to offer a group or individual solution that is either traditional or hybrid with LTC rider
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As we experienced with WA, carrier capacity may be limited, so best to enroll sooner instead of waiting if planning to offer LTC, whether or not the payroll tax is implemented
California continues its push towards a payroll tax model similar to Washington that would fund a minimum long-term care benefit. The California Long Term Care Insurance Task Force provided recommendations regarding the legislation. See the Insurance Market Update below.
The Task Force recommended options for establishing a statewide long-term care insurance program. A presentation of the draft feasibility report was released on December 15, 2022, and is now in actuarial review. The deadline for the actuarial review is the end of 2023.
Early indications are that a proposed tax would be on earned income for W-2 employees. It is unclear yet how an exemption would work if someone owns a qualifying long-term care insurance policy.
Insurance Market Update:
Per the California Long-Term Care Insurance Task Force:
- May split the cost of the payroll tax between employer and employee
- May also allow an opt-out provision if the employee has a private LTCi policy but there are no firm details on how the California payroll tax exemption will be structured or when it would apply
- IMPORTANT: The state may assess the financial impact of changing the deadline for the purchase of opt-out eligible private insurance policies from the Program effective date to the beginning of the year preceding the Program effective date. (Final Draft Feasibility Report, page 15)
Additional Information - See our CA Update for the most current information and important links.
- There are approximately 16,500,000 employees in California or more than 4 times the number in Washington state.
- It's important for employees to obtain meaningful LTCi coverage and to start the process before any final state announcements are made. This will help avoid the rush for long-term care insurance coverage that we saw in Washington.
- There are slightly fewer group and individual products and carriers in California than in Washington mostly because product approvals from the state take longer. Carriers may accelerate new solutions to market depending on the results of the feasibility report
- BuddyIns expects the capacity of individual products in California to be limited, but group products with streamlined underwriting may have more availability
Hawaii
NEW Hawaii's House Bill 2224 (H2224) is focused on long-term care and aims to address the growing needs of the state's aging population. The bill acknowledges that Hawaii has the highest life expectancy in the U.S., leading to an increasing number of seniors requiring long-term care services. It highlights concerns about rising institutional care costs, the strain on Medicaid, and the financial burden on families.
The legislation emphasizes the importance of aging in place, supporting community-based services, and exploring public-private funding options to make long-term care more accessible and sustainable. The bill is part of broader efforts to ensure seniors receive quality care while preventing excessive costs for the state.
New York
Updated 1/13/2025
Long term care bill introduced for 2025 legislative session. Both the Senate and Assembly must pass a bill before the Governor can consider it for signature (approval) or veto (rejection). This new bill (S1179) is an identical version of A1499 in the Senate. A bill with a “same as” in the alternate house is an important early sign that a bill could pass both the Senate and Assembly. It indicates that individual lawmakers in each house are supportive of the bill.
According to the state, the committee may amend the bill to satisfy the concerns of committee members, leave it as is, or refer it to another committee for further deliberation. The bill may be reported to the full Senate chamber for consideration if a majority share of the committee members support it.
The New York legislature is considering once again funding a modest amount of state-provided long-term care (LTC) coverage financed through a payroll tax on most workers in the state. There are still many questions about the details of the full legislation and administration should this bill be passed. However, the nation’s fourth most populous state has taken legislative steps to explore the possibility of offering a public long-term care benefit.
New York State considered this possibility with draft legislation as recently as 2022, which did not pass the legislature. This 2023 bill is very similar to the 2022 legislation with an attempt to develop an LTC payroll tax, public benefit amount, and private long term care exemption with direct references to the Washington State LTC payroll tax.
Insurance Market Update:
- There are approximately 8,700,000 employees in New York or more than twice the number in Washington state.
- There are significantly fewer group and individual products and carriers in New York than in Washington.
- BuddyIns expects capacity of individual products in New York to be extremely limited, but group products with streamlined underwriting may have more availability.
See our New York-specific page for more information.
Maryland
NEW Maryland's legislature has been working on Senate Bill 631, which focuses on studying public and private options for long-term care insurance. Here’s what’s happening:
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The bill requires the Department of Aging to contract with an independent consultant to conduct an insurance study on how to help individuals prepare for long-term care services.
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The study will include actuarial modeling to analyze different approaches, including a public, time-limited long-term care insurance benefit funded through payroll deductions, and a public-private risk-sharing option to support insurers.
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The study will involve input from multiple state agencies, including the Maryland Department of Health, Department of Disabilities, Maryland Insurance Administration, and Department of Labor.
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The interim report summarizing the study’s progress is due by December 31, 2024, and the final report with results is expected by December 31, 2025.
This initiative could shape the future of long-term care financing in Maryland.
On January 17, 2024, the Maryland legislature agreed to require the Department of Aging to contract with an independent consultant to conduct a study on "public and private options for leveraging resources to help individuals prepare for long-term care services and supports needs." An interim report is expected by December 31, 2024.
Massachusetts
NEW Massachusetts has been actively working on its Long-Term Care (LTC) Study Commission. Here’s the latest:
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The Massachusetts Executive Office of Health and Human Services (EOHHS) selected Milliman to conduct a feasibility study for a potential statewide LTC insurance program.
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The study includes stakeholder engagement and actuarial analysis and is expected to take six months.
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House Bill 652, which aims to establish a special commission to study and recommend a statewide LTC insurance program, was referred to the Committee on Elder Affairs.
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Governor Maura Healey signed a $56.2 billion FY2024 budget bill, which includes funding for an actuarial study on LTC insurance.
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There’s a timeline conflict regarding the delivery of the actuarial report—one deadline suggests May 1, 2024, while another projects September 1, 2025.
The commission is still in the study phase, but Massachusetts is clearly making moves toward long-term care reform.
Minnesota
NOTE: We're aware of rumors circulating among key contacts who work with the MN legislature that there are discussions about passing a bill. We are working to verify that information.
This state's approach seems to be to encourage affordable long term care funding solutions. A draft of a bill that is similar to the Washington State legislation was introduced in 2021. There has been no known update. As drafted, the bill provides 365 Benefit Units of $100 each to eligible beneficiaries payable to qualified providers. This benefit is funded by a long-term care state payroll tax and there is no known exemption. There was also recent momentum on legislation allowing for certain Hybrids that combine term life insurance and long-term care insurance as a lifestyle plan, so it seems that many things are still on the table in the land of 10,000 lakes. A link to the draft legislation can be found here.
Insurance Market Update:
- There are approximately 2,700,000 employees in Minnesota.
- There is similar product availability in Minnesota as in Washington, so BuddyIns expects capacity of individual products in Minnesota to be similar to Washington.
Pennsylvania
NEW This bill was referred to the Aging and Older Adult Services Committee on August 22, 2022, and there have been no recorded votes or further legislative action since then.
The bill is similar to the WA Cares Act. Please read the bill for yourself but remember that educating PA consumers about meaningful LTCi coverage is an important conversation that should happen regardless of this legislation.
Highlights of the Pennsylvania House Bill 2779 include:
- Self-employed will be able to opt-in
- Funded through a payroll tax of 0.58%
- Benefit is $100/day up to a $36,500 maximum lifetime benefits
- To qualify for the benefit, the person must be at least 18 years of age and have worked a minimum of 500 hours per year in the state, irrespective of resident state
- Similar to WA, requires residency to receive benefits
- Benefit disbursements could begin on January 1, 2026
- Claim qualification is based on three activities of daily living (ADLs)
There may be an exemption to the long-term care state payroll tax but there are few details on what that might look like. It's important to have a conversation about meaningful coverage regardless of any state payroll tax or exemption
In addition to the state updates above, we are often asked if there is any pending federal legislation. Please read the update below for information on what we were able to find while doing our research.
Federal Long-Term Care Legislation
Long-Term Care Affordability Act
NEW Senator Pat Toomey reintroduced the Long-Term Care Affordability Act to make long-term care insurance more accessible. The bill proposes allowing individuals to use up to $2,500 annually from their 401(k), 403(b), or IRA accounts to pay for long-term care insurance premiums without facing tax penalties. This bill would allow the payment of long-term health care insurance to be paid using tax-exempt retirement plan distributions. Specifically, it would exclude such distributions from the gross income of an insured person up to $2,500 per individual in a taxable year. The bill also requires a description of long-term care insurance arrangements and establishes reporting requirements.
The legislation has gained support from organizations like the Alzheimer’s Association and America’s Health Insurance Plans, but it’s still awaiting further action in Congress.
WISH Act
NEW The Well-Being Insurance for Seniors to be at Home (WISH) Act is making waves again! Congressman Tom Suozzi (D-NY) has reintroduced the bill alongside Rep. John Moolenaar (R-MI) to tackle the growing long-term care crisis in the U.S. Suozzi first introduced the bill in 2021, but it didn’t gain much traction. Now, he’s pushing for a national conference in spring 2025 to bring together experts, advocates, and policymakers to discuss how a public-private partnership can help Americans afford long-term care.
Well-Being Insurance for Seniors to be at Home (WISH) Act would amend Title II of the Social Security Act to provide long-term care insurance benefits. Individuals who have attained retirement age, have filed an application for long-term care insurance benefits, are insured for long-term care insurance benefits, and have a continual serious functional disability would be entitled to a long-term care insurance benefit for each month beginning with the first month in which the individual meets the criteria.
21st Century Long-Term Care Caucus
NEW The 21st Century Long-Term Care Caucus is actively working to address challenges in the long-term care sector. Here’s what’s happening:
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The caucus, co-chaired by Rep. Bryan Steil (R-WI) and Rep. Ann Kuster (D-NH), focuses on workforce shortages, industry regulations, and innovative care solutions.
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Lawmakers are pushing for bipartisan solutions to improve care quality and affordability, especially in response to the COVID-19 pandemic’s impact on long-term care facilities
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The caucus is engaging with stakeholders and provider groups to explore financing reforms, including potential public-private partnerships.
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LeadingAge, a major aging services organization, has urged the caucus to support the Well-Being Insurance for Seniors to be at Home (WISH) Act, which would create a federal long-term care insurance program.
The bipartisan 21st Century Long-Term Care Caucus will address the long-term care needs and financial concerns of American families. The caucus will bring together members from both parties to identify and address long-term health care in the United States and implement solutions to ensure care recipients and their families have the support they need.
