Dedicated to ensuring quality long-term care for all Americans

How to Fix Long-Term Care 

Briefing Paper #1:  The History of Long-Term Care Financing or How We Got Into This Mess -- (PDF for print)


How did the USA come to have a welfare-financed, institutionally biased LTC system in the wealthiest country in the world where no one wants to go to a nursing home?  We answer this question first or we risk treating symptoms instead of causes and making problems worse instead of better. 

Briefing Paper #2:  Medicaid Long-Term Care Eligibility -- (PDF for print)

Despite the conventional wisdom that people must spend down into impoverishment before qualifying for Medicaid LTC benefits, the truth is that income and asset eligibility rules are so generous that most people qualify easily without spending down significant wealth.  This brief explains how and why.

Briefing Paper #3:  Medicaid Planning for Long-Term Care -- (PDF for print)

Even people who are too affluent to qualify for Medicaid LTC benefits under the generous basic eligibility rules can qualify easily with the help of simple or sophisticated legal techniques marketed by "Medicaid planners."  This brief explains how.

Briefing Paper #4:  Rebalancing Long-Term Care -- (PDF for print)

Despite the high hopes of many analysts and policymakers, rebalancing Medicaid LTC services from nursing home care to home care without simultaneously tightening eligibility will not save money and will increase costs interminably.  This brief explains why.

Briefing Paper #5:  Dual Eligibles and Long-Term Care:  How to Save Medicaid LTC $30 Billion Per Year and Pay for the "Doc Fix" -- (PDF for print)

Medicaid recipients also eligible for Medicare are the program's most expensive.  Better public policy could delay or prevent Medicaid dependency for millions who would otherwise become dual eligibles.  This brief explains precisely what needs to be done to achieve that goal.

Briefing Paper #6:  Private Long-Term Care Financing Alternatives -- (PDF for print)

Medicaid does not have to bear the brunt of most LTC financing if policy makers unleash the potential of the four major private financing alternatives that currently go mostly untapped.  This brief explains what those sources are and what needs to be done to maximize their potential.

Briefing Paper #7:  Overview:  How to Fix Long-Term Care

This series of seven Briefing Papers explains why LTC service delivery and financing are the way they are in the United States.  It points the way toward solutions that will reduce Medicaid's LTC financial exposure, enhance care access and quality, and encourage private sector solutions and employment. 

For more information, contact Steve Moses, president of the Center for Long-Term Care Reform ( at or


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