Harris’s plan for ‘Medicare at Home’ would revolutionize care in America

Vice President Kamala Harris recently unveiled a groundbreaking policy to provide home care services through Medicare, drawing parallels with her own experiences caring for her late mother.

This proposal reinforces one of her longstanding policy priorities — paid family and medical leave. Home care and paid leave are complementary, critically needed care investments that could transform how the U.S. addresses serious health needs, disability and aging.

Harris’s proposal, dubbed “Medicare at Home,” would significantly expand access to home and community-based services, allowing older and disabled people to receive services where they already are. These services empower disabled people to live independently and allow older adults to age at home, as the vast majority of people prefer to do.

Her plan would fill a gap that far too many Americans are falling through. Hundreds of thousands of people are lingering on years-long waitlists for home care. At the same time, people receiving home and community-based services under existing policies are weighed down by administrative burdens that restrict earnings and assets, leaving them with significa n t unmet needs. The combination of a growing disabled population and the Baby Boomer generation reaching retirement age means that Harris’s policy can’t come soon enough.

Compounding this health and aging crisis, the U.S. guarantees no paid leave for health or caregiving, making us an international outlier. As a result, most Americans do not have the paid leave they need to address their own serious health needs or those of a loved one, forcing them to make impossible choices between work and health.

Harris is a longtime leader in the fight for paid leave — she’s made it part of her economic agenda as well as a key campaign message. Her running mate, Gov. Tim Walz (D), signed into law Minnesota’s trailblazing paid leave program in 2023, and he has called for federal paid leave to be the next administration’s first priority.

The Harris-Walz agenda prioritizes home care and paid leave because Americans need both of these supports to balance work, health, care and bills. Taken together, these twin policies create greater flexibility and autonomy for disabled people, those with chronic illnesses and aging people to respond to care needs in the right ways for them and their families. By allowing people to receive the care they need when and where they need it, paid leave and home care hold profound health benefits. Research also shows that paid leave can reduce nursing home usage, reinforcing access to care at home.

At the same time, paid leave and home and community-based services are desperately needed tools to support work, as these programs can reduce barriers to employment for disabled people. Not only do these services provide more flexible access to health care, they can also offer direct employment supports, like job coaching and case management, with strong models in Medicaid for the Harris-Walz program to emulate. Access to formal home care can also increase the ability of family caregivers to work. Similarly, paid leave enables workers to take the time they need for health or care and then return to work, rather than being pushed out of the labor force.

Collectively, these work supports would be boons to both household income and, through greater labor force participation, the American economy.

Writ large, home and community-based services and paid leave mean greater financial security for disabled and older adults and their families. Long-term care costs tens of thousands of dollars per year, making it far too expensive for nearly all Americans to afford out of pocket. Harris’s proposal would pay for new home care services through Medicare, rather than Medicaid, meaning families wouldn’t have to exhaust their own financial resources in order to qualify for support, while preserving existing Medicaid-based services. Paid leave keeps income flowing when serious health needs strike, reducing economic insecurity in the short-term while also bolstering retirement security in the long run.

An escalating need for care or a health need that pulls many people away from work poses a big risk to families, communities and our nation’s economy. But with the game-changing care investments Harris has proposed in home and community-based services and paid leave, the future could look much brighter. Let’s give the American people a firm foundation for health and aging to rely and build upon, with support and dignity — instead of leaving them at perpetual risk of having the rug pulled out from under them.

Mia Ives-Rublee is the senior director of the Disability Justice Initiative at the Center for American Progress. Molly Weston-Williamson is a senior fellow with the Women’s Initiative at the Center for American Progress.