‘Medicare for All’ Plan Would Expand Coverage for LTC — But Nursing Homes Stay Under Medicaid

Sen. Bernie Sanders this week introduced a bill to create a single-payer health care system for the U.S., a plan that includes long-term care in its scope — but keeps coverage for institutional nursing home care under Medicaid.

The legislation would ensure that the so-called “Medicare for All” plan would include benefits for at-home long-term care for people with chronic illnesses or disabilities, a major expansion of previous efforts along similar lines, multiple outlets reported.

Medicare currently does not cover long-term care, and under Sanders’s bill, nursing facility and other institutional coverage would be still covered under Medicaid.


Any attempt at nationalizing health care coverage in the United States will be met with staunch opposition from Republicans and other conservatives, though support for Medicare for All could become a litmus test for more progressive candidates seeking to unseat President Trump next fall.

Provider groups took a cautious view of the legislation, which was also introduced by Democratic Sens. Kamala Harris, Cory Booker, Elizabeth Warren, and Kirsten Gillibrand. Like Sanders, all of them are running for president in 2020; while an officially an independent, Sanders caucuses with Democrats and is also seeking the party’s nomination.

“We are delighted that Congress is paying attention to long-term services and supports,” Marsha Greenfield, LeadingAge’s vice president of health legislation, said in comments emailed to Skilled Nursing News. “This particular bill is interesting and we are reviewing it to better understand it.”


The proposal to keep SNFs and other forms of institutional care under the auspices of Medicaid comes amid multiple reports of Medicaid reimbursement falling short of the cost of nursing home care.

Massachusetts, Texas, Wisconsin, South Dakota, Washington state, Montana, and New Mexico are among the many varied states that have reported issues with Medicaid reimbursement for nursing home care in the past year. Providers in several states have turned to various programs designed to bolster their Medicaid rates and stave off the pressures of razor-thin operating margins that are worsened by Medicaid’s shortfall in coverage.

The American Health Care Association (AHCA) zeroed in on this aspect of Sanders’s bill as a cause for concern, in addition to questions about the viability and sustainability of the proposal.

“More than half of long term care in the country is covered by Medicaid, which does not fully fund the cost of care,” Clif Porter, senior vice president of government relations at AHCA, said in a statement provided to SNN. “This contributes to the increasing number of nursing home closures, particularly in rural areas. The Medicaid program was founded to provide for our nation’s vulnerable populations, including the frail and elderly, and we need to ensure that any proposals do just that.”

Companies featured in this article: