On some days, Anthony Jones can’t get to work.
Since he was a teen, the 41-year-old Seattle resident has often struggled with lupus, an autoimmune disease that can cause the body to attack tissue surrounding joints and organs, making everyday tasks like showering, cooking and commuting to his golf course restaurant job impossible.
And due to his preexisting condition, Jones doesn't qualify for private long-term care insurance to help manage his disease when he is older and needs more assistance.
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Lawmakers had cases like his in mind when they passed a new program called WA Cares. Beginning July 1, Washington will be the first state to deduct money from workers’ paychecks to finance long-term care benefits for residents who can't live independently due to illness, injury or aging-related conditions such as dementia.
"There have been times I’ve been unable to work," Jones said. "It’s very hard for me to live, walk my dog, cook for myself. Sometimes it gets so bad showering can be a challenge — normal, everyday activities that people often take for granted and don’t understand that we are all a medical issue away from something happening."
The push to find a long-term care solution comes as Washington and other states prepare to face a doubling of the 85-and-older population over the next 15 years — a crisis that will challenge the ability of states to meet long-term care needs already promised through Medicaid.
Washington's payroll deduction approach to long-term care funding is getting the attention of policymakers around the country, including California and New York, which are developing programs similar to WA Cares.
An estimated 7 million to 8 million Americans have private long-term care insurance, which can be costly and generally requires applicants to pass a health screening. Many assume Medicare covers long-term care, but that’s not the case except for limited care for skilled nursing or rehabilitation. Medicaid requires applicants to be low-income and spend down all life savings to $2,000 or less to qualify.
"Social insurance is a smarter way to do this, because you’re paying from your first paycheck when you’re 15 in the summer job until your last paycheck, but then as soon as you retire you don’t owe anything," said WA Cares Fund Director Ben Veghte. "You pay a little bit over your whole career instead of paying a lot at a time when you can least afford to."
Washington workers will start paying into the WA Cares Fund at the start of July, at which point .58% of total pay per paycheck will be deducted. That means an employee making $50,000 will pay $290 per year.
Benefits become available in 2026 to those who qualify — people who need help with bathing, dressing or administration of medication — to pay for things such as in-home care, home modifications such as wheelchair ramps, or transportation to the doctor. The fund covers home-delivered meals and reimbursement to family caregivers. The lifetime maximum benefit is $36,500, with annual increases based on inflation.
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Although advocates say the benefit will provide a financial lifeline for workers who otherwise could not afford care, opponents are concerned that the payroll deduction will amount to a pay cut for those who contribute to the fund but never need the benefits at a time when downward pressures on wages — including inflation, gas prices and layoffs in certain sectors — are already stretching paychecks thin.
State Rep. Jim Walsh, R-Aberdeen, contends that the program will only cover a fraction of costs that will far surpass the benefit’s maximum payout.
"The lifetime maximum benefit under WA Cares Act is not very much money," Walsh said. "Anybody who has a family member in a nursing home knows that’s about two or three months of nursing home care at current prices. However you slice it, the $36,000 lifetime benefit is just not really long-term long-term care."
The average cost of in-home care services in Seattle is $3,600 a month, according to AARP. For long-term care at a private nursing home, that cost averages $12,000 per month.
About a third of residents in the U.S. who need long-term care, according to Veghte, will need it for three years or more. Ideally, he said, the WA Cares Fund will help through the first year, allowing time to plan next steps. What happens when the benefit dries up, however, is unclear.
"Ultimately that is something we can’t fully address," Veghte said, "but the perfect shouldn’t be the enemy of the good."
Workers will be eligible if they have paid the tax while working at least 500 hours per year in three of the previous six years, or if they've paid it for a total of 10 years without an interruption of five years or more.
The benefit, however, is not portable; people who pay into the program but later move out of state will not be able to access it, though lawmakers could address that in the future. WA Cares also only covers the taxpayer, not a spouse or dependent.
"The leaders of the program are aware of the portability problem," Veghte said, "and are working on solutions."
