The Commonwealth Fund has released a timely issue brief detailing ways to enhance Medicare’s support for family caregivers. These proposed short- and long-term policies fall into four main areas: coverage for in-home services, financial support, improved access to information, and increased research on family caregiving.

Medicare Beneficiaries

Millions of Medicare beneficiaries require long-term services and supports (LTSS) for daily activities like bathing, dressing, medical care, prescription management, housekeeping, and transportation to live safely and independently. However, Medicare typically does not cover these services, forcing many beneficiaries to pay out of pocket or rely on family and unpaid caregivers. Additionally, Medicare lacks coverage for most caregiver support services, leaving families struggling to afford necessary care. While Medicaid provides some financial and structural assistance—often including payment for family caregivers—its LTSS coverage, particularly for Home and Community-Based Services (HCBS), can be limited and challenging to navigate.

The implications are significant. Without adequate community-based care, Medicare-only beneficiaries may have to deplete their resources to qualify for Medicaid assistance. Unfortunately, due to underfunding, Medicaid HCBS often falls short, leading beneficiaries to leave their homes for nursing facilities.

Family Caregivers

Family caregivers are essential in preventing these outcomes. Research indicates that 92% of individuals needing LTSS who live outside institutions receive unpaid assistance from family and friends. This caregiving workforce, comprising about 38 million people, provides services with an estimated economic value exceeding $600 billion annually. However, this support comes at a cost: nearly 80% of family caregivers report spending about a quarter of their income on caregiving expenses, with Black and Latinx families facing even higher financial burdens—34% and 47% of their income, respectively. Many caregivers also encounter employment challenges, with six in ten reporting negative impacts on their work situations.

Eliminating the “Homebound” Requirement?

The Commonwealth issue brief outlines several recommendations for improving Medicare to better support families managing in-home care needs. For instance, it suggests eliminating the “homebound” requirement for home health benefits, which currently confuses both beneficiaries and providers, and ensuring those with complex needs have adequate access to home health services.

Additionally, the brief explores how Medicare could help cover caregiver services, aligning more closely with Medicaid’s payment options. Other proposals include modernizing Medicare benefits, reimbursing families for out-of-pocket caregiving expenses, and improving data collection to better understand caregivers’ burdens. Some of these policy ideas have already emerged in proposed rules from the Biden-Harris administration, such as encouraging Medicare Advantage plans to educate enrollees about supplemental benefits.

Summary

Throughout the brief, the Commonwealth Fund highlights areas where Medicare falls short in meeting beneficiaries’ needs, often leaving them without the assistance they require.