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LTC Bullet:

Open Letter to HCFA Administrator

Tuesday July 24, 2000


The Health Care Financing Administration is the U.S. government agency that administers Medicaid and Medicare. An important role of the Center for Long- Term Care Financing is to bring practices that undermine responsible long-term care financing policy to the attention of the media and the government agencies involved. What could be more irresponsible than HCFA's participation in a continuing education seminar for attorneys and accountants on how to artificially impoverish infirm seniors to get them on Medicaid without spending down? The following open letter to the HCFA Administrator in Washington, DC is self- explanatory.


HCFA letter

Dear Administrator Min DeParle,

I am writing to direct your attention to a forthcoming event in Seattle that will dramatically embarrass the Health Care Financing Administration. This event is a continuing education seminar for attorneys and nursing home administrators at which a HCFA Region X (Seattle) health insurance specialist is on the agenda to speak.

The seminar, scheduled for August 17, 2000, is entitled "Washington Medicaid and Medicare Benefits and Eligibility for the Elderly." Two of its five expressed objectives are to train attorneys, paralegals, financial planners, accountants, facility administrators and staff on "new techniques to plan for Medicaid eligibility" and "crucial tax consequences of Medicaid planning techniques." One of the four sections of this seminar is entitled "Medicaid Planning," and its instructor is a member of the National Academy of Elder Law Attorneys (NAELA).

Medicaid planning is the practice of artificially impoverishing an infirm elder to qualify him or her for Medicaid nursing home benefits without spending down. NAELA is a national trade association, which represents Medicaid estate planning attorneys. By putting middle and upper-middle class people on welfare prematurely, Medicaid planners exacerbate Medicaid's serious problems of access, quality, reimbursement, discrimination and institutional bias. How can Medicaid help the poor if its scarce resources are consumed by the well off? Why would prosperous people plan, save and insure for long- term care if they and their heirs can ignore this risk and rely on public assistance?

For the Health Care Financing Administration to lend its credibility to a Medicaid estate planning seminar by providing a U.S. government employee as a speaker at the taxpayers' expense is wrong. The fact that all three of the other speakers at this event are lawyers in private practice who stand to gain financially from HCFA's implied endorsement of Medicaid planning is unconscionable.

For these reasons, I encourage you to investigate the seminar described in the enclosed flyer and terminate HCFA's involvement. More information on the seminar and its sponsor may be found at the sponsor's web site: For more information on the problems associated with Medicaid estate planning, please consult the Center for Long-Term Care Financing's web site at Thank you for considering this request.


Stephen A. Moses, President
Center for Long-Term Care Financing

Tim Westmoreland, HCFA Medicaid Director
Linda Ruiz, HCFA Regional Administrator, Region X, Seattle
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