国家医疗保障局于2026年8月26日发布《关于做好长期护理保险支付管理工作的指导意见》，从支付范围、支付方式、支付标准、基金监管和服务质量评价五个维度对长期护理保险支付管理进行统一规范1。新规设置年度最高支付限额不超过统筹地区上年度城乡居民人均可支配收入50%的底线规则1，同时强化失能评估管理以防止骗保1。对评估通过率畸高畸低的机构，按比例扣付直至拒付1。
截至2025年9月，长期护理保险制度已覆盖1.9亿人，支出超过850亿元1。新规的出台背景之一是防范基金风险。2026年5月上海发生的一起骗保案件凸显了这一必要性：护理机构与评估中心勾结，234名老人评估等级被人为降低，144人因此不再享受待遇，两家机构累计违规套取基金200余万元，5名犯罪嫌疑人被抓获1。
医疗保障法于2026年8月28日表决通过，第五十五条明确"国家建立健全长期护理保险制度"1，将长期护理保险正式写入法律。
The National Healthcare Security Administration released the "Guidance Opinion on Strengthening Long-Term Care Insurance Payment Management" on August 26, 2026, establishing unified standards across five dimensions: payment scope, payment methods, payment standards, fund supervision, and service quality evaluation 1. The new regulations set an annual maximum payment limit not exceeding 50% of the previous year's per capita disposable income of urban and rural residents in the coordinated region 1.
The framework strengthens fraud prevention through enhanced assessment management 1. In May 2026, a significant case in Shanghai revealed coordination between a care facility and an assessment center that improperly reduced the care grades of 234 elderly individuals, resulting in 144 people losing eligibility for benefits and enabling the two institutions to illegally claim over 2 million yuan from the fund; five criminal suspects were arrested in connection with the case 1. To address such abuses, the new rules require proportional deductions from or complete suspension of payments to institutions showing abnormally high or low assessment approval rates 1. As of September 2025, the long-term care insurance system covered 1.9 billion people with total expenditures exceeding 850 million yuan 1. The institutional framework received legislative backing when the Medical Security Law passed on August 28, 2026, incorporating long-term care insurance into law with Article 55 explicitly stating that "the state shall establish and improve the long-term care insurance system" 1.
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