Directs the department of health to contract with a qualified entity for a feasibility study and actuarial analysis of long-term services and supports financing and services options.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9121
SPONSOR: Kelles TITLE OF BILL:
An act directing the department of health to contract with a qualified
entity for a feasibility study and actuarial analysis of long-term
services and supports financing and services options
PURPOSE OR GENERAL IDEA OF BILL::
To direct the Department of Health to conduct an analysis of current
public and private long term care financing options in New York State,
to explore the feasibility of creating a public long-term care insurance
option, and to prepare a report with findings and recommendations for
the Governor and Legislature.
SUMMARY OF PROVISIONS::
Section 1 authorizes and directs the Department of Health to contract
with a qualified entity to conduct a feasibility study and actuarial
analysis of long-term services and supports financing and service
options.
Section 2 sets out the parameters for the feasibility study and actuari-
al analysis including but not limited to:
*Analysis of public and private long term care financing options and any
gaps that exist in New York State
*Modeling three public long-term care program options to be funded
through a payroll deduction
*Modeling the impact of tax alternatives and other incentives for
purchase of private long term care insurance
Section 3 requires that the Department of Health prepare a report to be
submitted to the Governor and Legislature within one year of the effec-
tive date, containing findings and recommendations.
Section 4 establishes the effective date.
JUSTIFICATION:
The New York State Department of Health estimates that by 2030, more
than 5.3 million New Yorkers will be over the age of 60.1 Many will need
long term care services and supports at some point in their later
years.2
Contrary to what many believe, the federal Medicare program does not pay
for long term care; it provides for time-limited rehabilitative care
only.3 To qualify for long term care through the Medicaid program, New
Yorkers must deplete income or assets and may be left with very little
to get by on.
Private long term care insurance is not an option for many given the
cost, as policies have become increasingly unaffordable.4 Rate increases
are frequent and, in many cases, staggeringly large. The New York State
Department of Financial Services has reported that as of December 2022,
the number of New Yorkers with long term care insurance policies was
only 386,686,5 well below the 50% of New Yorkers over 65 who are
expected to need long term care services in the future.6
The result is a lack of help for those requiring financial assistance to
meet long term care needs. Too many are forced to spend down income and
assets to become eligible for Medicaid, to pay out-of-pocket for care-
givers for themselves or loved ones,, or to directly take on care
responsibilities for family members. This impacts not only the individ-
uals needing care, but families as well. For those providing care to
family members, the sacrifices (such as loss of income and career oppor-
tunities) are many.?
The struggle to pay for long term care is an issue that touches almost
every family in New York State - 50% of us will need long term care at
some point in our .lives, and yet we do not have a system in place to
address the high costs of such care. It is long past time to change
that.
In the absence of progress on the federal level, several states have
taken the lead in addressing this pressing issue for their residents.
In 2023 Washington State established the nation's first public long term
care insurance program, WA Cares, which guarantees long term care insur-
ance coverage for every worker in the state.8 In April 2025; Massachu-
setts released its "Long-Term Services and Supports Feasibility Study,"
funded by the Massachusetts legislature in its FY 2024 state budget.1~
Other states, including California, Michigan, Hawaii, Minnesota, Maine,
and Vermont, are exploring solutions. Many have taken the initial step
of funding a study to explore public insurance options.11
The recently released NYS Master Plan for Aging includes a recommenda-
tion to "consider a new financing system to pay for LTSS in the State,
focusing on a long-term care social insurance model. This new program
would supplement the existing Medicaid, the Expanded In-home Services
for the Elderly Program (EISEP), and private long-term care insurance
markets after conducting an actuarial study on LTSS financing model
feasibility. This would consider the types of benefits, who should qual-
ify, how it should be funded and other variables and concurrent study of
LTSS benefit design which includes cash-only, services-only, and an
option between the two. It also covers all LTSS services, including
examination of anticipated costs for funding of public education and
workforce investments."
Enactment of this legislation will take the first step to put New York
on the path towards a viable solution to the long-term care crisis by
funding the study called for in the Master Plan for Aging and to explore
public long term care insurance options.
PRIOR LEGISLATIVE HISTORY::
New bill
FISCAL IMPLICATIONS::
To be determined.
EFFECTIVE DATE::
The act shall take effect immediately.
1 NYS Department of Health, Long Term Care Planning Project, available
at https://www.health.ny.gov/facilities/long_term_care/planning_project/
2 Richard Johnson, What Is the Lifetime Risk of Needing and'Receiving
Long-Term Services and Supports?, U.S. Department of Health and Human
Services (April 3, 2019), available at
https://aspe.hhs.gov/reports/what-lifetime-risk-needing-receiving-long
term-services-supports-0
3 Priya Chidambaram and Alice Burns, 10 Things About Long-Term Services
and Supports, available at
https://www.kff.org/medicaid/issue-brief/10-things-about-long- termser-
vices-and-supports-ltss/
4 Jordan Rau & Reed Abelson, Financial Ruin is Baked into the System, NY
Times (Dec. 15, 2023), available at
https://www.nytimes.com/2023/12/15/health/readers-long-termcare.html
5 Adrienne A. Harris, Superintendent, NYS Department of Taxation and
Finance, Report to the Governor and Legislature on Long Term Care Health
Insurance Plans (Dec. 2022), available at
https://www.dfs.ny.gov/system/files/documents/2023/12/2023_1tc_biennialr
eport_2023122 2.pdf; NYS Department of Taxation and Finance, Long Term
Care Insurance: Looking Back and Thinking Ahead (June 7, 2023), at 1,
available at
https://www.dfs.ny.gov/system/files/documents/2023/06/dfs_ltc_report_202
30607.pdf
6 NYS Senate Committees on Aging, Health, and Labor, Addressing the
Crisis in the Longterm Care Workforce (July 27, 2021) at 4, available at
https://www.nysenate.gov/sites/default/files/article/attachment/longterm
_care_workforce_hearing_report_2021.pdf
7 Id at 8 (As many as 10% of family caregivers leave the workforce in
order to provide care at some point in their careers. An AARP report
estimated that in 2017 there were 2.5 million unpaid caregivers in the
state.)
8 See https://wacaresfund.wa.gov/
9 https://www.mass.gov/doc/long-term-services-and-supports-feasibility-
studycommissioned-by-eohhs/download
10 MA Gen. Laws ch. 28 of 2023, § 2, line 4000-0300,
https://malegislature.gov/Laws/SessionLaws/Acts/2023/Chapter28
11 MIT CoLab, State by State Long-Term Care Progress, Transforming Long-
Term Care, https://www.transformlongtermcare.com/progress-by-state
STATE OF NEW YORK
________________________________________________________________________
9121
2025-2026 Regular Sessions
IN ASSEMBLY
September 26, 2025
___________
Introduced by M. of A. KELLES -- read once and referred to the Committee
on Health
AN ACT directing the department of health to contract with a qualified
entity for a feasibility study and actuarial analysis of long-term
services and supports financing and services options
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The department of health is hereby authorized and directed
2 to contract with a qualified entity for a feasibility study and actuari-
3 al analysis of long-term services and supports financing and services
4 options. The study and analysis shall be developed in consultation with
5 stakeholders and provide projected cost estimates of alternative financ-
6 ing and service options as well as possible impacts to existing state-
7 funded programs and services, including, but not limited to, Medicaid-
8 funded home-based care and hospice programs as well as residential
9 long-term care programs.
10 § 2. Such study shall include but not be limited to:
11 (a) an analysis of public and private long-term care financing
12 programs that exist in the state, the participation rates for those
13 programs and any clear gaps that exist including, but not limited to,
14 gaps in coverage, affordability, participation and any factors relevant
15 to the design of a public program;
16 (b) modeling of three public long-term care insurance program options
17 funded through a payroll deduction, including a front-end, limited dura-
18 tion program, a limited duration, back-end catastrophic program, and an
19 unlimited duration program; provided further, that key modeling outputs
20 shall include estimated program participation rates, program costs, the
21 distribution of program benefits, the impact on Medicaid expenditures
22 and any financial and legal risks to the state; provided further, that
23 sensitivity analysis on key program parameters shall be completed and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13577-01-5
A. 9121 2
1 include daily benefit amounts, coverage duration, benefit increase
2 options, form of benefit and premium levels; and
3 (c) modeling the impact of tax alternatives and other incentives for
4 the purchase of private long-term care insurance on take-up rates in the
5 state; provided further, that key outputs shall include the impact on
6 insurance take-up rates, the sociodemographic profile of individuals
7 projected to purchase long-term care insurance, program costs and the
8 impact on Medicaid expenditures.
9 § 3. The department of health shall prepare a report which shall be
10 submitted to the governor and to the legislature within one year of the
11 effective date of this act, containing findings and recommendations.
12 § 4. This act shall take effect immediately.
