Berlin – November 05, 2026 -- The Federal Ministry of Health's own cost estimate projects a net deficit of €1.35 billion in 2027 for Germany's social long-term care insurance (SPV), even after the Care Reorganisation Act (PNOG) takes effect. Dr. Carola Reimann, chair of the AOK Federal Association, made the point as the Bundestag held the bill's first reading, and she called the law a stopgap that buys the SPV "a few months" of financial relief at most.
AOK demands a second law once the care commission reports in January
Reimann wants the open financing questions settled in a separate legislative procedure, a "PNOG 2". It would follow the recommendations of the Care Structure Commission (Pflegestrukturkommission), due at the end of January.
Federal and state governments leave key funding gaps open
The AOK says the federal government still does not refinance pandemic-related special burdens or the pension contributions for family caregivers from the budget. The states, in turn, do not cover nursing home investment costs, and training costs in care are not tax-financed. Reimann argues that the last two measures alone could significantly lower co-payments for nursing home residents. In her view, the burden falls on those affected and on contribution payers.
AOK research institute puts assessment savings at half the official figure
The AOK questions whether the ministry has correctly estimated savings and additional revenue. The draft does not transparently show the cost effect of individual measures. Projections from the AOK's scientific institute indicate that the planned adjustment of thresholds in the care-needs assessment system would deliver only half of the stated savings.
The estimate also omits the SPV's financing needs for the rest of 2026 and the start of 2027. Reimann doubts that the further federal loan of €700 million, approved recently, will be sufficient.
Prevention, care guidance and digital cockpit earn praise
The AOK welcomes several structural elements: a stronger focus on prevention and rehabilitation, care guidance (Pflegebegleitung), and the digital Care Cockpit (Pflege-Cockpit), which it says benefit care recipients and their relatives. It also backs the goal of simpler, more understandable benefits, but sees that goal met only in part, for example for respite care (Verhinderungspflege). Flexible use of the community-level budget (Sozialraumbudget) is again made harder.
Reimann concluded that a thorough and sustainable reform of care financing is still outstanding.