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LTC Bullet: Wisconsin LTC Reform Misguided

Thursday October 8, 1998


The Milwaukee Journal Sentinel reported this week that Wisconsin is planning a "sweeping new reform of long-term care" to be unveiled in Gov. Thompson's upcoming state budget early next year.

The central theme of the proposed "Family Care" program is to give seniors a choice of care settings including home and community-based care. By reducing the number of older and disabled people in nursing homes, Wisconsin officials predict they can virtually pay for the program.

Fredi-Ellem Bove, the state's budget chief for the Dept. of Health and Family Services predicts that "once they have a choice, most elderly and disabled people will choose to stay at home or in community settings rather than in nursing homes, substantially reducing their costs."

According to Bove, Wisconsin currently spends $2,200 a month in Medicaid on elderly people living in nursing homes, and $4,100 on disabled people, not including the amount those patients pay as their share of the cost. Bove predicted it would cost only $1,200 a month for elderly and $1,900 a month for disabled people who elect to stay at home or in the community.

Beware! Wisconsin is pursuing the right ends by the wrong means. One sure way to derail the privatization of long-term care financing and destroy its promise is to make publicly-financed long-term care even more attractive to consumers than it already is.

The damage done by easily accessible Medicaid nursing-home benefits has been mitigated by the fact that most people do not want to go to nursing homes. Expanded public financing for more desirable kinds of care will not merely exacerbate the "woodwork factor" of induced demand as other writers have warned, it will make Medicaid estate planning more attractive to consumers and more lucrative to elder law practitioners. It will inhibit the market for privately-financed chore services, home care, assisted living, and geriatric care management. And it will decimate demand for private long-term care insurance.

Public benefits have always been and will always remain starved for financing. Our only hope to achieve a fully financed, universally available, comprehensive long-term care service delivery system is to draw as heavily as possible on private financing and depend on public resources only to cover the interstices of need left unfilled by the private market.

A road map for achieving universal access to top-quality long-term care across the whole continuum of care settings may be found in the Center for Long-Term Care Financing's white paper "LTC Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle."
Contact the Center for more information or to order a copy. ph: (206)447-1340; e-mail:; web site:

Source: Fran Bauer, "Long-Term Care Reform May Cost Little," Milwaukee Journal Sentinel, October 5, 1998.