LTC Bullet: Open Letter to Policy Makers

Friday November 2, 2001


On October 22, 2001, the Center for Long-Term Care Financing sent the following letter to all U.S. Governors; Lt. Governors; State Medicaid Directors; American Health Care Association (AHCA) State Executives, American Association of Homes and Services for the Aging (AAHSA) State Executives, Assisted Living Federation of America (ALFA) State Executives; and to approximately 100 Centers for Medicare and Medicaid Services (CMS) officials.

We believe this letter makes some critical points about America's long-term care service delivery and financing system. Please read it and underscore its message with the aforementioned officials in your state. If you've read the Center's public policy papers and our LTC Bullets, you know the Center for Long-Term Care Financing has an important message to convey regarding the diagnosis and treatment of long-term care's current malaise. Help us get this message to the powers-that-be.

Now, here's the letter:

Dear ,

What goes around comes around! And the long-term care financing crisis has come around again. Here's one way to tackle it.

In the early 1990s, the American economy dragged. State and federal tax receipts plummeted. Medicaid nursing home costs skyrocketed. Congress and President Clinton took action to stanch the hemorrhage in long-term care expenditures. They closed some eligibility loopholes and mandated Medicaid estate recovery in the Omnibus Budget Reconciliation Act of 1993. When OBRA '93 had little effect, they passed the Health Insurance Portability and Accountability Act of 1996, which contained the so-called "throw granny in jail [for transferring assets] law." When that blew up in their faces, they passed the Balanced Budget Act of 1997, which contained the provision dubbed "throw granny's lawyer in jail [for recommending that granny transfer assets]." That legislation proved to be unenforceable. Now we're all back to square one, trying to control the abuse of Medicaid nursing home benefits without the statutory tools to do so.

For the past few years, no one worried very much about this problem. In the late 1990s, America's economy boomed. State and federal tax receipts exploded. Medicaid expenditures leveled out. The politically sensitive issue of targeting Medicaid to the genuinely needy became easier to avoid than to confront. Then all of a sudden came the crash, new economic doldrums, sinking tax revenues, rising Medicaid costs, alarming nursing home bankruptcies, and persistent demands for expensive new services like home care and assisted living. We're now a decade closer to the Age Wave crisis, but further away than ever from a workable long-term care service delivery and financing system. We've come full circle. We have a narrow window of opportunity in which to prepare for the aging of the baby boomers and to build a comprehensive long-term care infrastructure. Now is the time to act.

That's where the Center for Long-Term Care Financing comes in. We are a 501(c)(3) charitable, nonprofit think tank and public policy group. We advocate targeting scarce public LTC resources to the genuinely needy and encouraging everyone else to plan early to save, invest or insure against the risk of long-term care. Our principals--Stephen Moses, President and David Rosenfeld, Executive Director--have many years of experience analyzing state and federal long-term care financing programs and recommending solutions. Mr. Moses is widely recognized as an expert and innovator in the field of long-term care. He publishes, speaks and testifies on long-term care financing throughout the United States. Mr. Rosenfeld is an attorney and MSW with a growing reputation as a long-term care analyst and commentator. The Center publishes an online newsletter called "LTC Bullets" and maintains an informative website at with major reports and speeches created to help public policy makers confront the LTC financing challenge.

The Center for Long-Term Care Financing would like to offer our services to help your state improve access to and quality of long-term care services for all citizens-- rich, poor, and in between. Our principals have conducted a series of statewide "Magic Bullet" studies designed to help states target their Medicaid long-term care resources more effectively and attract more private financing for long-term care. In these studies, we interview all stakeholders in the long-term care issue; we review all state and federal statutes and regulations; we present a logical and fully documented state-specific analysis of the problem; and we produce a comprehensive report with specific recommendations. Samples of our reports from Illinois, Maryland, Florida and several other states are available upon request. States can save upwards of 20 percent of their Medicaid nursing home budgets (or raise reimbursement levels or expand services to more eligible people) by following our study recommendations comprehensively. If we cannot convince you that our work will save the state at least ten times the cost, then don't give us the job. Actual results should be many hundreds of times the cost. Please give us the opportunity to present a proposal with no obligation.

Biographical profiles for the Center for Long-Term Care Financing's principals are enclosed. Check out the Center's bona fides and samples of our work products at If you have any questions or comments, please contact Stephen Moses or David Rosenfeld at 425-467-6840, extensions 2 and 3 respectively. Thank you for your consideration.


Stephen A. Moses, President

David M. Rosenfeld, Executive Director