LTC Bullet: HIAA's New LTCP Books, Course and Designation Evaluated

Tuesday, February 4, 2003


LTC Comment: Read our evaluation of the new HIAA long-term care insurance professional designation (the LTCP) after the *news*.

*** The Center for Long-Term Care Financing invites your financial support. Center President Steve Moses says "I would ask our readers to consider that thousands of lawyers make six-figure incomes and seven-figure firm revenues qualifying affluent people for Medicaid LTC benefits by means of artificial impoverishment. The Medicaid planners' trade association has over 4,000 members and a budget exceeding $1,000,000. On the other hand, the Center for Long-Term Care Financing is the only organization in America fighting for rational public policy to discourage Medicaid planning and save Medicaid for the poor, whom the program is supposed to protect. We advocate state and federal policy to target scarce Medicaid resources to the genuinely needy while creating strong incentives, such as tax deductibility, for everyone else to insure privately for long-term care." Won't you help the Center carry on this mission? Support the Center for Long-Term Care Financing with a check mailed to 2212 Queen Anne Avenue North, #110, Seattle, Washington 98109 or contribute online at . Donor-zone access accrues to all individual donors of $150 (tax deductible). Corporate contributions gain organizational access based on negotiated rates. Contact Amy McDougall at 425-377-9500 to set up a conference call to discuss corporate contributions. Thank you for helping the Center save Medicaid and encourage private long-term care financing. ***

*** For a glimpse of what we're up against in the fight against Medicaid planning abuse, read this impassioned consumer outcry published recently in Newsweek magazine: "My Turn: Cheating Uncle Sam for Mom and Dad," by Diana Conway. "Jan. 27 issue - Once my parents reached their 80s, I started getting an unwanted education in just how expensive end-of-life care can be. I began to discover, too, that there are clever ways for people with money to avoid paying their fair share of nursing-home costs." For the rest of the story, go to . Our thanks to the many LTC Bullets subscribers who brought this article to our attention. ***

*** Have you wanted to attend one of the Center for Long-Term Care Financing's highly acclaimed "LTC Graduate Seminars?" We're no longer scheduling them except when sponsored. Here are some dates and locations that are available. If you would like to attend the LTC Graduate Seminar at one of these locations and dates, let Amy McDougall know ( or 425-377-9500). With ten or more pre-registrations ($225 prepaid), we will schedule a program. If you would like to sponsor a seminar and you can provide a venue, the Center will compensate your organization with some free admissions. This is a great way for LTCI carriers or brokers to make contact with highly qualified independent producers. We encourage LTC providers (nursing homes, assisted living facilities and their state associations) to sponsor The LTC Graduate Seminar also. For details, including syllabus, instructor's credentials, and extensive testimonials, go to .

Denver, Colorado on February 18, 2003
Milwaukee, Wisconsin or Chicago, Illinois on March 13, 2003
New York City (Manhattan) on March 25, 2003
Other dates and locations available by request. ***

*** Donor zone content now goes daily by email to all paid subscribers. Our LTC E-Alerts, LTC Data Base and LTC Reader publications are designed to keep LTC insurance producers and other LTC experts at the forefront of knowledge and professionalism. We track the electronic, trade and academic literature in all LTC-related fields; we choose the reports and articles we think you will find most useful; we distill the information into a quick read (five minutes or less); we add a brief analysis to indicate why we think the information should matter to you; we email you the publication daily; and we archive it all at so you can find back issues when you need them. Our latest donor-only zone content sent during the past few days includes:

LTC E-Alert #3-009--LTC Liability Crisis
LTC E-Alert #3-010--Don't Count on Veteran's Health or LTC Benefits
LTC Data Base #3-002--State Level LTC Data You Can Use
LTC Reader #3-004--AARP Says "What, Me Worry?" About Baby Boomers

If you already qualify for The Zone, you can click the following link, enter your user name and password, and go directly to the latest donor zone content and the archives: . To Zone In, mail your tax-deductible contribution of $150 or more to the Center for Long-Term Care Financing, 2212 Queen Anne Avenue North, #110, Seattle, WA 98109. Then email your preferred user name and password (up to 10 characters each). You can also contribute online by credit card or direct withdrawal at . ***


The long-awaited, much-anticipated, new long-term care insurance designation sponsored by the Health Insurance Association of America (LTCP, for "Long-Term Care Professional") has arrived. It's a self-study program comprised of four parts, each with a charge of $115 for members and $165 for non-members. HIAA's brochure says: "Developed in conjunction with the American Association for Long-Term Care Insurance (AALTCI), this curriculum offers a convenient and comprehensive way to get the information you need about long-term care, why it is an increasingly important issue in America, how to pay for LTC services, what the LTC insurance product does, and much, much more." A classroom alternative or supplement to the self-study program is also available with prices ranging from $825 to $1200 for a two-day "review course" and a one-half day test. Price depends on whether the student is a member of HIAA or AALTCI, a "marketing sponsor," or an individual non-member. You can get all the details at 1-800-828-0111 or or from AALTCI at

In today's Bullet, we'll take a closer look at the four-volume course books for this program. Each of the books has multiple contributors and reviewers, all well known in the long-term care insurance field. Only Volumes 3 and 4 have authors cited, Jason Goetze and Eileen Tell/Jocelyn Gordon, respectively. It's hard to imagine more comprehensive coverage of every imaginable aspect of long-term care insurance.

Volume 1, "Long-Term Care: Understanding Needs and Options," "provides an overview of growing long-term care needs and the role of long-term care insurance in satisfying those needs. Topics include the benefits and limitations of Medicare, Medicaid, and private health insurance. The text covers the long-term care marketing continuum, from seminar selling, analysis of individual needs, and policy delivery, to post-sales service and the claims process."

Volume 2, "Financing Long-Term Care Needs: Exploring Options and Reaching Solutions," "examines in detail the various ways that people finance long-term care. It covers a variety of financing options, including personal savings, reliance on family members, government programs, mortgage, annuities, and long-term care insurance. It also looks at the role of long-term care insurance in estate and business planning."

Volume 3, "The Long-Term Care Insurance Product: Policy Design, Pricing, and Regulation," "explores the history of long-term care insurance and the specific provisions that long-term care policies often contain. It covers the ramifications for the insured of such provisions as inflation protection, renewal privileges, restoration of benefit, contingent nonforfeiture, and others."

Volume 4, "Long-Term Care Insurance: Administration, Claims, and the Impact of HIPAA," "describes the process of claims administration for long-term care insurance (LTCI). It also focuses on the impact of HIPAA on LTCI claims." Additionally, Volume 4 contains question and answer review sections covering all four books.

At the Center for Long-Term Care Financing, we're naturally most interested in how authors and courses handle the complicated and sensitive issues regarding who pays for long-term care and how. So let's take a closer look at Volume 2 on "Financing Long-Term Care Needs." Weighing in at 392 pages, this book has chapters on Medicare, Medicaid, Reverse Mortgages, Commercial and Private Annuities, Life Insurance, LTC Insurance, LTCI Policy Design, Employer-Sponsored LTCI, Estate Planning, and Ethical Market Conduct. Appendices include the NAIC Long-Term Care Insurance Model Act and the NAIC Long-Term Care Insurance Model Regulation. Be forewarned, this is not what you'd call scintillating prose. It reads like a training manual, but, hey, that's what it is. At least the information is clear and well-organized with frequent review tests to wake you up and make sure you're absorbing the content.

Where we find most books and courses on long-term care fail miserably is in their sections on Medicaid. So, naturally, that's where we look first for problems. If they get Medicaid right, there is a very good chance everything else will pass muster too. "Financing Long-Term Care Needs" contains a 21-page chapter on "The Medicaid Program." We found only one thing dead flat wrong in this section. Contrary to what the book says, nearly everywhere a home remains exempt if the Medicaid recipient expresses an INTENT to return, whether or not there is any reasonable expectation medically that he or she will be able to return to the home. Of course, the book also says "to be eligible for Medicaid benefits, one must be poor" which is misleading, because Medicaid (for LTC) only requires a cash-flow problem. You need to be poor, but only AFTER you spend your income, no matter how large, for medical and long-term care. Exempt assets, such as a home, business and many others can be kept without any limit. But this book makes this complexity clearer than most books do. It also has sections on the pitfalls of relying on Medicaid whether one qualifies by spending down or by means of Medicaid estate planning, perhaps the most critical subject to explore.

All things considered, the HIAA course books for the LTCP designation do a yeoman's job of covering an extremely broad range of topics that every long-term care insurance professional should understand in some detail. Of course, you will search fruitlessly through these 1400 plus pages for any coverage of or answers to the really interesting questions about long-term care insurance. For example: If the demographics of aging are so scary and people need LTCI so badly, why don't more consumers buy it? Why does America's long-term care service delivery system remain institution-based and welfare financed when no-one wants to go to a nursing home and we're the wealthiest nation in the world? Why are so many nursing homes bankrupt and assisted living facilities unprofitable? Why is debt and equity capital almost nonexistent to build and operate new long-term care facilities? Why are tort liability settlements exploding and liability insurance premiums skyrocketing for long-term care providers? Why are attorneys allowed to make huge incomes artificially impoverishing well-to-do clients to qualify them for welfare-financed nursing home care? Why do we have a dire shortage of nurses and nurses aides to provide long-term care? Why won't Congress and the President pass above the line tax deductibility for LTC insurance when it's such a slam-dunk, obvious measure?

Such a list of questions and puzzles could go on endlessly. But if you want answers to them, you'll have to tune in to the Center for Long-Term Care Financing's LTC Bullets, donor-only zone, and our LTC Graduate Seminar. No course on long-term care insurance can answer the really challenging questions facing the industry without also taking into account the economic and political context in which the product struggles to survive and prosper. That's what we do at the Center for Long-Term Care Financing.