German long-term care insurance faces 22.5 billion euro deficit by 2029, Health Minister Warken says

German statutory long-term care insurance faces a financing gap of up to 22.5 billion euros by 2029, Health Minister Nina Warken (CDU) said, a figure larger than previously projected.

For 2027, Warken projects a shortfall of 7.5 billion euros, up from an earlier estimate of 6 billion euros. For 2028, the deficit is expected to exceed 15 billion euros, according to reports in the Frankfurter Allgemeine Zeitung and Rheinische Post, which cited Warken's presentation to state health ministers on the planned Care Insurance Reorganization Act (PNOG).

"The current spending trend already threatens the solvency of care funds this year," Warken told the Rheinische Post. She attributed the widening gap to a surge in the number of people classified as needing care. The number of people entitled to care benefits has doubled since the introduction of a new definition of care needs in 2017, she said, reaching more than 6 million people — "far higher than was forecast at the time."

Warken stated that groups such as children and adolescents with ADHD are now included in care statistics, a development she said was not anticipated when the 2017 reform was passed. She said she will present reform proposals by mid-May.

Warken ruled out eliminating any care grades but said the criteria for grades 1 to 3 must be tightened based on scientific recommendations. "No, we will not eliminate any care grade. But we will have to return to the scientific recommendation that was developed before their introduction when it comes to classification into care grades 1 to 3," she said. At the introduction of the five care grades in 2017, she explained, the eligibility requirements were set significantly lower and benefits were made "more comfortable." "We simply can no longer afford this today, ten years later," Warken added.

Warken also plans to introduce a right to professional care guidance to support family caregivers, while stressing that the insurance is a "partial coverage" system and cannot cover all costs of care.

Eugen Brysch, chairman of the German Foundation for Patient Protection, accused the federal government of fueling the crisis by not repaying care fund expenditures from the pandemic. "The federal government itself is fueling the financial crisis of long-term care insurance," Brysch told dpa. He called for shifting pension insurance contributions for family caregivers and training costs to tax revenue, which he said would relieve the care fund by 9 billion euros. "Together, that would immediately relieve the care insurance by 9 billion euros," he said.

Florian Reuther, director of the Association of Private Health Insurance (PKV), said the expansion of the care needs definition in 2017 made it impossible to keep spending growth in line with revenue. "The structural deficit of the pay-as-you-go financing can no longer be denied," Reuther said. "The expansion of the concept of care needs since 2017 has made this impossible."

Left party parliamentary group leader Sören Pellmann accused Warken of planning cuts for the weakest and called for a comprehensive care insurance system funded by all income groups. "Instead of tackling the truly necessary fundamental reforms, Warken wants to cut the weakest," Pellmann told AFP. He said children make up only 2% of the 6 million people in need of care. "To blame them for the deficit is hard to beat in terms of shabbiness," Pellmann said. He predicted that any plan to make higher earners contribute more would be "cosmetic," while stricter care-grade classifications and reduced subsidies for nursing home places were the real measures planned.