China Standardizes Long-Term Care Insurance Payment Rules
China’s National Healthcare Security Administration (NHSA) has issued new regulations governing long-term care insurance payment management, standardizing payment scope, methods, and criteria across all regions as the country moves toward nationwide implementation of its “sixth social insurance.” The Guiding Opinions, released on August 26, aim to ensure equitable access to care services for elderly and disabled citizens while safeguarding the financial sustainability of the insurance fund, according to Xinhua News.
Background: From Pilot to National Program
China launched its first long-term care insurance pilots in 15 cities in 2016, followed by a second batch in 2020 that expanded coverage to 49 national-level pilot regions. The program is widely described as the country’s “sixth social insurance,” joining pension, medical, unemployment, work injury, and maternity insurance as a pooled-risk mechanism for care services.
In March 2026, the General Office of the CPC Central Committee and the State Council issued the “Opinions on Accelerating the Establishment of the Long-term Care Insurance System,” formally transitioning the program from pilot to nationwide implementation. The framework set a unified contribution rate of approximately 0.3% and called for basic full national coverage by the end of 2028, as Beijing News reported.
The new payment management guidelines represent the next step in this transition, addressing inconsistencies that emerged as different pilot regions developed their own payment mechanisms.
What the New Guidelines Establish
The Guiding Opinions, issued as document 医保发〔2026〕19号, clarify three core elements of long-term care insurance payment management, as detailed in the NHSA official document.
Payment scope: Insurance funds can now reimburse disability assessment fees from designated assessment institutions, long-term care service fees from designated providers, and management fees for third-party organizations involved in insurance administration. Payments are based on the National Long-term Care Insurance Service Item Catalog, first issued in September 2025, which includes 36 service items spanning daily living care and basic medical nursing. The guidelines explicitly prohibit duplicate reimbursement between basic medical insurance and long-term care insurance for the same services.
Payment methods: Assessment services will primarily be paid per person, while nursing services will primarily be paid based on service duration. Home care is billed hourly, institutional care is billed per bed-day, and community care uses flexible payment units tailored to specific services. The framework also leaves room for future quota-based or per-item payments for intelligent services and assistive devices.
Payment standards: The annual maximum payment per insured person from the long-term care insurance fund shall not exceed 50% of the previous year’s per capita disposable income of urban and rural residents in the coordinating region. Standards will be dynamically adjusted based on regional economic development, average wages, industry fee levels, and caregiver skill levels. Provincial coordination is encouraged to reduce disparities between regions, with incentives favoring home and community care over institutional care.
According to the NHSA policy interpretation, the guidelines were developed “based on summarizing pilot experiences across regions, and after consultation with the Ministry of Finance,” to “further leverage the strategic purchasing role of the long-term care insurance fund to genuinely protect the basic care needs of insured persons.”
Scale of the Program
As of September 2026, more than 320 million people are enrolled in long-term care insurance across 121 coordinating regions, with cumulative fund expenditure exceeding 114.2 billion yuan (approximately $16 billion). Over 4.6 million disabled persons have received nursing services through the program, according to statistics released at a State Council Information Office press conference on September 4 and reported by China Daily.
NHSA Deputy Director Wang Wenjun announced at the same press conference that the system should achieve basic full national coverage by the end of 2028, with 247 coordinating regions expected to have established the system by the end of 2026. The program has also stimulated significant private sector investment, attracting nearly 70 billion yuan to related care industries, with 13,000 designated care service institutions now operating—ten times the number at pilot inception.
Fund Supervision and Quality Control
The guidelines introduce robust fund management and oversight mechanisms. They require scientific annual budget preparation, budget performance management, and the establishment of fund operation monitoring and risk prevention systems. Long-term care insurance fund payments shall not be managed or disbursed by third-party social organizations.
Penalties are specified for violations: funds can be deducted or withheld for improper assessment services with abnormally high or low pass rates, nursing services that fail to follow care plans or meet service catalog requirements, and third-party organizations that do not manage according to regulations. The guidelines also call for integrating long-term care insurance fund usage into routine supervision frameworks, including flight inspections, daily monitoring, social oversight, and intelligent surveillance systems.
A Historic Step in Aging Response
The timing of these regulations is significant. China’s population aged 60 and above surpassed 323 million in 2025, and the number of disabled elderly is projected to reach 41.51 million by 2035, placing unprecedented strain on the country’s care infrastructure.
Wang Zongfan, a researcher at the China Academy of Labor and Social Security Sciences, described the shift as transformative: “From families bearing responsibility alone to society sharing risks collectively, this transformation marks a historic step in China’s response to the challenge of population aging,” as quoted in Time Weekly’s coverage of the Medical Security Law.
The Medical Security Law, passed by the Standing Committee of the 14th National People’s Congress on August 28 and effective January 1, 2027, formally incorporates long-term care insurance into China’s legal framework, providing statutory backing for nationwide implementation.
Commentary in the Beijing Youth Daily captured the broader significance: “Long-term care insurance protects the dignity of disabled persons, solves the care challenges of families, and adds momentum to social development.”
What to Watch For
Existing pilot areas are required to use approximately three years to gradually transition to the new standards, ensuring stable continuation of benefits for insured persons. By the end of 2028, the long-term care insurance system is expected to achieve basic full national coverage, with coverage expanding from employees to urban and rural residents.
Key developments to monitor include the rollout of provincial implementation plans—22 provinces have already issued theirs—and the continued growth of the long-term care workforce, which currently includes approximately 400,000 nursing service personnel and more than 70,000 certified long-term care workers. As the system matures, the standardization of payment management will be critical to ensuring that China’s rapidly aging population receives consistent, quality care regardless of where they live.