LTC Bullet: Center Announces Special LTC Project

Wednesday, March 17, 2004


LTC Comment: Which states do the best job of targeting their scarce Medicaid LTC funds to the genuinely needy? Which states are best at encouraging people to save, invest or insure for long-term care? What are the most effective techniques to save the Medicaid safety net by encouraging private financing of long-term care? More after the ***news.***

*** Today's Bullet is sponsored by LTC, "a third-party, unbiased online resource for the LTC insurance industry which provides an efficient and cost effective delivery method committed to enhancing the information exchange in the long-term care insurance industry." For more information, contact James Dove ( or toll free 888-LTC-3750 x205) or visit LTC at . Thanks so much to LTC for its generous support of the Center and commitment to our common mission of ensuring quality long-term care for all Americans. Won't you help too? Go to to sponsor an LTC Bullet. Find out how you can sponsor other Center activities (e.g., articles, speeches, and LTC Graduate Seminars) by contacting Amy McDougall at 425-377-9500 or***

*** JOIN THE DONOR-ZONE WITHOUT THE $150 FEE UP-FRONT. Did you know you can now donate as little as $12.50 per month (automatically on your credit card) and qualify immediately for the Center for Long-Term Care Financing's donor-only web zone AND for our one-a-day mental vitamins (LTC E-Alerts, LTC Data Updates, and LTC Readers)? Please make a new or supplemental contribution now at . Don't feel limited to the minimum if you can afford and feel moved to contribute more. Your support is much needed, greatly appreciated, and tax deductible. Please direct any questions regarding our Donor-Only Zone or donating online or by check to or call us at 206-283-7036. ***

*** LATEST DONOR-ONLY ZONE CONTENT: Here's the latest Zone content followed by instructions on how to subscribe so you can receive these critical epistles daily by email.

LTC E-Alert #4-016--Special Alert: Big, New CLTCF Project to Help LTCi and Medicaid (The Center announced our new, special LTC project to Donor Zoners.)

The LTC Reader #4-009--How Much Do Medicaid Planners Charge? (A prominent Medicaid planner recommends what to charge for overnight Medicaid eligibility without spending down.)

The LTC Reader #4-010--The Better the Care, The Worse Medicare and Medicaid Pay (Guest editorialist in Nursing Homes magazine says public programs encourage poor long-term care.)

The LTC Data Update #4-012--Latest Poll Data Re Doubts About Social Security (Low confidence in public programs should encourage personal responsibility and private products.)

Don't miss our "virtual visits" to major LTC industry conferences in The Zone. You'll find our comparison of the conferences, session summaries, interviews and pictures at .

Individual donors of $150 or more and corporate donors to the Center for Long-Term Care Financing receive our daily email LTC Bullets, LTC E-Alerts, LTC Readers, and LTC Data Updates for a full year. You'll also get access to the donor-only zone where these publications are archived along with other donor-only features. 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 archives: . If you do not already qualify for The Zone, 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 . ***



LTC Comment: The Council for Affordable Health Insurance (CAHI), a highly respected think tank and public policy organization in Washington, DC, solicited and accepted the following project proposal from the Center for Long-Term Care Financing. The Center will rank and critique states on their LTCi market penetration, their ability to control Medicaid LTC eligibility, and their success in Medicaid estate recovery, as well as other related issues. The timing and potential for this project are great because of the Medicaid-LTC driven fiscal crisis in the states. We hope to awaken legislators and policy-makers to the enormous potential of controlling Medicaid expenditures and preserving Medicaid for the needy by diverting more people to LTCi and home equity conversion. CAHI and the American Legislative Exchange Council (ALEC) will produce our report, distribute it to key state legislators and the media, and promote the findings.

Please read the following project prospectus. Send us comments or suggestions, including your recommendations about which states are strong or weak in the various areas of the project. If possible, help us close the final gap in financing this project by making a targeted contribution and by encouraging your company to contribute as well. Thanks for your support.


PURPOSE: Identify and publish a list, by state, of prioritized interventions to reduce Medicaid expenditures and increase private LTC financing sources while improving access to and quality of long-term care for all citizens: rich, poor and in between.

BACKGROUND: Medicaid is a means-tested public assistance program, i.e. welfare, but it has become the single biggest payor of long-term care in the country for middle and upper-middle class people, as well as the indigent. Medicaid long-term care costs are already straining state budgets and will grow out of control with the aging of the baby boomers unless constrained. States desperately need politically sensitive means to control Medicaid LTC expenditures while encouraging private financing alternatives, such as insurance and home equity conversion.

PROBLEM: Federally mandated Medicaid LTC eligibility rules allow people with incomes that are high, but insufficient to fund their long-term care and other medical expenditures, to qualify. Retainable assets are unlimited if held in exempt form, such as a home, business, auto, prepaid burial, etc. Sophisticated legal techniques, such as trusts, annuities, life care contracts, etc., expand these elastic eligibility rules much further. Consequently, easy access to publicly financed LTC has anesthetized the public to this risk and left most Americans in need of care dependent on underfinanced Medicaid nursing home care, which is declining in quality and exploding in cost. Private LTC financing through insurance or home equity conversion is very limited and could be much greater.

PROPOSED INTERVENTION: The Center for Long-Term Care Financing proposes to conduct a study of state Medicaid program eligibility and estate recovery policies with the purpose of publishing a state-by-state guide. This guide will list measures each state can take to control Medicaid LTC expenditures (1) by establishing the moral high ground of and increasing the recovery from Medicaid estate recovery, (2) by targeting the Medicaid program's benefits more effectively to the genuinely needy, and (3) by increasing the demand for and financing from private long-term care financing sources such as long-term care insurance and home equity conversion.

WORK PLAN AND DELIVERABLE: Stephen Moses will personally call each state, interview responsible officials, compare eligibility and estate recovery policies, and prepare state-level proposals for statutory and/or administrative changes to achieve the objectives listed above. He will prepare a guide to include as many states as possible, but no less than the top ten, prioritized by potential for Medicaid savings and maximization of private financing alternatives. The guide will describe what each state should do to achieve the objectives. Draft deliverable by April 30, 2004; final report no later than May 31, 2004.

COST: $45,000. (The Council for Affordable Health Insurance and the American Legislative Exchange Council have each pledged $7,500 toward this project. The Center for Long-Term Care Financing has raised an additional $20,000 from various sources. That leaves $10,000 we need to raise to fully fund the project.

HOW TO CONTRIBUTE: This project promises to help Medicaid and private LTC insurance finance more and better long-term care for all Americans. Please help if you can and encourage others to contribute.

By check: indicate "Special LTC Project" on your check and mail it to the Center for Long-Term Care Financing, 2212 Queen Anne Avenue North, #110, Seattle, Washington, 98109.

By credit card: Go to, click on the "Donate Now" button, fill out the form and put "Special LTC Project" in the "gift information" box.