LTC Bullet: LTC Tickler

Wednesday, June 23, 2004

Washington, D.C.--

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.***

*** LAST LTC BULLET UNTIL AUGUST. We'll resume publication of LTC Bullets in early August. Tomorrow and Friday, our donor-only publications will be "LTC Embeds," reports from the front by Steve Moses, in attendance at the 17th Annual Private Long-Term Care Insurance Conference in Washington, DC. The donor-only publications will also resume in early August. If you have a substantive question while we're away, please try the search feature at , to go directly. We use it frequently ourselves to find specific items in the cornucopia of material on the Center's website. Have a wonderful July. ***

*** CLTC MASTER CLASS SCHEDULE. The Center for Long-Term Care Financing does not endorse specific companies or professional designations, but we are acutely aware of the need for education and certification of LTC insurance agents. We've often found that LTCi agents with the "CLTC" certification rank high in professional knowledge and expertise. We also appreciate the support provided to the Center for Long-Term Care Financing by the Corporation for Long-Term Care Certification. As a public service, we will provide each month a schedule of forthcoming CLTC classes with a link to further information. The Corporation for Long-Term Care Certification will offer the "Certified in Long-Term Care" (CLTC) program in a class-room setting referred to as a Master Class on July 8 & 9 in Scottsdale, AZ ; July 14 & 15 in Lake Success, NY; July 15 & 16 in Westminster, CO; July 19 & 20 in Lafayette, LA; July 21 & 22 in Richmond, VA; July 29 & 30 in Altoona, WI; and July 29 & 30 in Concord, NH. For more information, call 877-771-2582 or go to .***

*** 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.

The LTC Reader #4-026--Investments to Capitalize on the Aging of the Baby Boomers (Why not use your expertise in the field of aging to inform your investment choices?)

The LTC Data Update #4-029--Caregiver Stress and the Need for LTCi (New study documents the emotional, financial and legal stressors of LTC caregiving.)

The LTC Reader #4-027--Planning and Making the Most of a Nursing Home Visit (Tips for a successful nursing home or assisted living visit.)

LTC E-Alert #4-033--Vacation in a Nursing Home? (Geriatric "Club Meds" for care recipients to give caregivers respite.)

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: Last March, we announced a new Center for Long-Term Care Financing project to identify and rank states based on how well they do long-term care service delivery and financing: "LTC Bullet: Center Announces Special LTC Project," March 17, 2004, . The results of this study, which was conducted in collaboration with the Council for Affordable Health Insurance and the American Legislative Exchange Council, are in. The draft report is under review. The final report is due for publication in August. Following is a sneak peak at what we found to whet your appetite.

To find out which states do long-term care best, which do it worst, why, and what we need to do about it, stay tuned for the final report.



Most thinking about Medicaid and long-term care is based on a fantasy.

That fantasy is that government can pay for most expensive, formal long-term care for nearly four decades, but people will still, somehow, take personal responsibility and save or insure against this risk.

Reality is that most people will not plan, save, invest or insure for a risk they don't believe they face.

The truth about long-term care is that, starting in 1965, Medicaid and Medicare have paid for the vast majority of all nursing home and home health expenses.

Conventional wisdom that publicly financed care requires impoverishment to the point of destitution is demonstrably false.

The average elderly person in need of long-term care qualifies easily for Medicaid and virtually anyone, almost regardless of income or assets, can qualify quickly without spending down by consulting a Medicaid planner.

With ostensibly good intentions, but perversely counterproductive public policy, government programs have anesthetized the public to the risk of long-term care.

The end result, nearly 40 years after passage of Medicaid and Medicare, is America's severely dysfunctional, welfare-financed, nursing home based long-term care service delivery and financing system.

Long-term care today is plagued by bankruptcies, inadequate revenue, a dearth of capital, staff shortages, access and quality problems, huge tort liability, too few full-pay private payers and too many low-pay Medicaid recipients.

This report explains historically how we got into the current mess, documents the facts enumerated above and below, and proposes some simple, straight-forward solutions.

We take the long-term care system apart, examine it realistically, and put it back together in a way that makes more sense.

We analyze 10 state Medicaid long-term care programs in detail, focusing on five that are headed in the wrong direction and five others that are leaning toward the right course.

Federal law does not allow state Medicaid programs to target program benefits to the genuinely needy or to require more affluent people to pay their own way.

So, we explain how federal law must change.

Few states exercise effectively even the limited control they have over program eligibility and estate recovery.

So, we recommend what states should do to improve Medicaid while containing or reducing costs.

Even as state legislatures are struggling with Medicaid-driven budget crises, their Medicaid programs make welfare financing more attractive by offering desirable home and community-based services (HCBS) in place of nursing home care.

So, we explain what states must do first before Medicaid can hope to fund HCBS adequately.

Common sense suggests that when government pays generously for easily obtained long-term care benefits, people are unlikely to take personal responsibility to pay for their own care.

So, we explain how Medicaid can target its scarce resources to the genuinely needy and save millions at the state level and billions nationally, while improving access to and quality of care for everyone.

Conversely, if eligibility for publicly financed long-term care is tighter and estate recovery is more strongly enforced, it only makes sense that people will be more likely to prepare to pay for their own care.

So, we show how to fix Medicaid to unleash the potential of long-term care insurance and home equity conversion in order to breathe financial oxygen into service providers who currently suffocate financially.

Medicaid was never intended to be "long-term care insurance for the middle class" as it has become. As long as it remains "inheritance insurance" for the baby boom generation, Medicaid will continue to fail in its first responsibility--to provide a long-term care safety net for the disadvantaged.

The good news is that America's long-term care problems are self-inflicted by poor public policy and easy to fix.

If we stop doing what we've always done and start administering the program in more rational ways, the long-term care system will right itself rapidly.

If we stay the course we're on, however, disaster will strike with the aging and senescence of the baby boom generation and possibly long before.