LTC Bullet: Sound Solutions for Long-Term Care
Wednesday, August 24, 2005
LTC Comment: When
it comes to public policy pronouncements from interest groups in Washington, DC,
we seldom see any that get it as right as this one. More after the ***news.***
DON'T MISS THE GREAT DEBATE AND FREE LUNCH.
Vincent Russo (a well-known New York elder law attorney and Medicaid
planner) and Steve Moses (a staunch advocate of private LTC financing
alternatives) will "mix it up" in a debate September 7 at the Cato
Institute in Washington, DC. With
National Health Policy Reporter Ceci Connolly (invited) moderating and Cato's
Health Policy Studies Director Michael Cannon commenting, this is an event you
won't want to miss. Space is
limited (150 seats with some overflow capacity) and filling fast so register
soon at http://www.cato.org/event.php?eventid=2307
. You can also register by e-mailing email@example.com,
faxing (202) 371-0841, or calling (202) 789-5229. Cato Policy
Forums and luncheons are free of charge. If you absolutely, positively can't attend in person, be sure
to watch the webcast of this stimulating debate either live or later in Cato's
archives at http://www.cato.org/realaudio/audiopages.html
STEVE MOSES'S "LTC EMBED" REPORTS from the policy front in Washington,
DC will start again soon. We
occasionally summarize these reports on the "Moses LTC Blog" at www.centerltc.com
, but to get all the nitty gritty details, you must be a member of the Center
for Long-Term Care Reform with a subscription to our daily LTC E-Alerts.
Membership is easy to arrange. Just
call or email Damon at 206-283-7036 or firstname.lastname@example.org
. Tell him you'd like to join and
he'll get you a user name, password, access to our "Members Only"
website zone, and a subscription to the LTC E-Alerts WHILE your check is in the
mail. Alternatively, you can join
online and pay the annual dues of $150 by credit card at http://www.centerltc.com/support/index.htm
. Become part of the solution, join
the Center for Long-Term Care Reform today. ***
LTC BULLET: SOUND
SOLUTIONS FOR LONG-TERM CARE
LTC Comment: Having
spent the better part of the past four months discussing the issue of Medicaid
and long-term care financing with dozens of interested parties in Washington,
DC, we've rarely found so thoughtful an analysis and set of recommendations than
those that follow.
Heavily excerpted in the interest of brevity, these quotes
come from written testimony submitted by Hal Daub, President and CEO of the American Health Care
Association (AHCA) & The National Center for Assisted Living (NCAL), for the
U.S. Senate Special Committee on Aging hearing on July 20 , 2005 titled
"Sound Policy, Smart Solutions: Saving Money in Medicaid." The full text of the testimony can be found at http://www.ahca.org/brief/test050720.htm.
If your organization or association has a carefully
articulated point of view on Medicaid and long-term care financing that you
would like to have evaluated and critiqued by the Center for Long-Term Care
Reform, please send it to email@example.com
. Fair warning, however, we can't
cover every one for publication and our reviews are not always complimentary.
See for example "LTC
Bullet: Alzheimer's Association
Shortsighted on LTC Financing," published Wednesday, July 6, 2005, at http://www.centerltc.com/bullets/archives2005/565.htm
here are selected excerpts from the testimony referenced above before Senate
. . In evaluating the means,
methods, and concepts we can employ to save Medicaid resources - and to use them
in the manner intended for our most vulnerable citizens - we see three primary
areas of opportunity: Medicaid
estate planning, tax incentives to encourage the purchase of long term care
insurance, and home equity conversion concepts.
was never intended to become the nation's primary long term care financing
program and is not sustainable if the baby boom generation uses it as such.
While we must preserve Medicaid as a safety net program, we must also
take steps to encourage people who are able to otherwise fund their own long
is a means-tested public assistance program.
However, the eligibility rules and the statutory prohibition on asset
transfer have not apparently achieved the desired end of care for the truly
eligible for at least two major reasons: first,
the prohibition itself is not adequate; and, second, the apparent proliferation
of Medicaid estate planning techniques that circumvent the prohibition.
situation results in the inappropriate use of state Medicaid funds for
individuals who should not qualify for such public assistance and the
concomitant lack of funds for appropriate reimbursement to providers for care of
the truly needy. Thus, both the
state and Medicaid providers such as nursing facilities are negatively impacted.
. . .
supports additional policy and efforts that both help states retain Medicaid
funds for the truly needy and help providers to receive reimbursement for care
that has been provided. . . .
Incentives to Encourage the Purchase of Long Term Care Insurance
recent congressional sessions, legislative efforts to expand the utilization of
insurance through tax incentives have found growing support.
In addition to tax credits, AHCA/NCAL has supported an 'above-the-line'
deduction to make the deduction available to a maximum number of Americans.
continue to support such measures today but recognize that the cost to the
federal government has been a hurdle for congressional passage of the
legislation. . . .
Such solutions must allow the nation and its citizens' to move beyond
today's pay-as-you-go financing system to one that encourages, supports, and
protects individuals who choose to plan for their own long term care needs
through private insurance and other financial means, while preserving Medicaid
as a safety net program.
Equity Conversion and Other Resources
proposals being advanced involve home equity conversion, long term care
annuities, and inclusion of long term care policies in cafeteria plans.
While encouraging citizens to utilize long term care insurance alone
won't save the Medicaid program from collapse - these and family caregiver
exemptions and credits are all elements that could be combined with the Long
Term Care Partnership Plan into a comprehensive national long term care policy.
equity conversions such as reverse mortgages are particularly intriguing.
According to the National Council on the Aging, 48% of America's 13.2
million households age 62 and older could utilize $72,128 on average from
reverse mortgages. The value is
that these funds are available immediately and could go a long way to pay for
help at home and for retrofitting the home to make it safer and more
comfortable. These funds could also
be used to purchase long term care insurance, or for assisted living or nursing
home care for an ill spouse while the well spouse remained in the family home.
We are aware of the limitations in utilizing reverse mortgages to fund
long term care expenses. Despite
the current limitations, the equity that many seniors possess could help them
tremendously with their needs and their desire to remain in their homes. . . .
realities require a change in policy and a transformation in thinking.
We must fundamentally shift the role of government - from government
simply paying for services to government helping individuals save and plan for
their own long term care needs, while still preserving the Medicaid program as a
safety net for those who truly need it."