LTC Bullet:  LTC Debate Preview and Guide 

Tuesday, September 6, 2005 

Washington, DC-- 

LTC Comment:  Tomorrow's webcast debate, "Medicaid and the Long-Term Care Crisis:  Who Should Pay?," will be much more interesting if you know who the discussants are and what to expect them to say.  More after the ***news.*** 

*** GREAT DEBATE on Medicaid and long-term care.  Limited seating is filling fast for Steve Moses's debate with Vincent Russo, a major New York Medicaid planner and former president of the National Academy of Elder Law Attorneys.  The debate will take place at the Cato Institute (1000 Mass. Ave., NW in Wash., DC) on Wednesday, September 7 at noon.  Free lunch is included.  Details and a registration form (required) are available online at  Marilyn Werber Serafini of the National Journal will moderate the debate and Cato's Michael Cannon, whose book on health policy will be released September 19, will offer comments.  *** 

*** IF YOU CAN'T BE THERE IN PERSON, be sure to catch the webcast live at or in the Cato media archives at *** 

*** CAPITOL HILL BRIEFING on Medicaid and long-term care financing.  On Friday, September 9 at noon (free lunch to follow), Steve Moses will give a briefing titled "The Trouble with Medicaid" in Room B-354 of the Rayburn House Office Building.  Details, an online registration form and special instructions for news media may be found at  Cato's Jagadeesh Gokhale, Senior Fellow and Michael Cannon, Director of Health Policy Studies will also speak at this event, which is open to the public. *** 



LTC Comment:  According to the old saying, "You can't follow the game without a program."  So, following is some information about tomorrow's debate and the participants, including a preview of what to expect. 

TITLE OF THE DEBATE:  "Medicaid and the Long-Term Care Crisis:  Who Should Pay?" 

TIME:  Wednesday, September 7, 2005 at Noon. 

LOCATION:  The Cato Institute at 1000 Massachusetts Avenue, N.W. in Washington, DC.  Pre-registration at is required. 

WEBCAST:   Catch the debate live at or watch it later in the Cato Institute's video archives at 

DESCRIPTION OF THE DEBATE:  "Medicaid, the joint federal-state health care program created in 1965 for the poor, is imposing a growing burden on taxpayers.  It has grown larger than Medicare, the federal health care program for the elderly, and already accounts for a larger share of state expenditures than elementary and secondary education.  Part of that growth is due to many middle-income seniors using Medicaid to pay for nursing home expenses and other long-term care.  Those seniors own assets that could cover such expenses for a period of time, either directly or by purchasing long-term care insurance.  Should their assets be used to help Congress cut projected Medicaid expenditures?  Please join us for a debate that could profoundly affect the future of Medicaid and long-term care."  


INTRODUCTION:  Michael F. Cannon, Director of Health Policy Studies, Cato Institute, author of the recent Cato policy analysis "Medicaid's Unforeseen Costs" and of a new book on health policy forthcoming September 19, 2005. 

MODERATOR:  Marilyn Werber Serafini, the distinguished health care correspondent for the highly regarded National Journal, an indispensable publication for public policy makers, lobbyists, and analysts. 

DEBATERS:  The two discussants for this debate: 

Stephen Moses is president of the Center for Long-Term Care Reform, an outspoken critic of Medicaid estate planning and a strong advocate of private long-term care financing alternatives.  For details, see

Vincent Russo is managing shareholder of Vincent Russo & Associates, P.C., an elder law firm with five offices on Long Island, New York.  Russo is a Medicaid planner and a former president of the National Academy of Elder Law Attorneys.  For details, see  

STRUCTURE:  Michael Cannon will introduce the subject.  Marilyn Werber Serafini will introduce the discussants.  Then, Moses and Russo will present their answers to the question "Who Should Pay for Long-Term Care?"  Each will have exactly ten minutes to make the best case for his position. 

Following the presentations, the discussants will ask two questions of each other in turn.  Russo will have one minute to ask the first question.  Moses will have two minutes to reply.  And Russo will have one minute for an optional rebuttal.  Then Moses will ask the second question, followed by Russo's reply, and Moses's rebuttal.  And so on. 

After two rounds of questions and answers between the discussants, the remaining time will be given over to questions from the audience. 

WHAT TO EXPECT:  Steve Moses will critique America's publicly financed long-term care service delivery and financing system, recommend modifications to Medicaid (some of which have already been recommended by the National Governors Association and the Medicaid Commission), and propose a heavier reliance in the future on private long-term care financing alternatives such as insurance and home equity conversion.

We anticipate that Mr. Russo will emphasize the personal financial and emotional burden of long-term care on families, advocate for more public financing of long-term care through Medicaid and Medicare, defend Medicaid estate planning, critique private financing alternatives like long-term care insurance and reverse mortgages, and oppose most measures to contain public expenditures for long-term care. 

HEADS UP:  Below are some of the ways Medicaid planners commonly defend artificial impoverishment of their clients followed by our rebuttals of each of these excuses.  When you watch and listen to the debate, see if any of these arguments are used. 


EXCUSE:  Our clients are not rich.
FACT:  Average Medicaid planning client is among the upper 10 or 20 percent of seniors in income and assets:  $25,000 to $30,000 in income; home owned free and clear worth $250,000 to $400,000 plus $150,000 to $200,000 in additional assets. 

EXCUSE:  Don't get the wrong illness:  heart attack victims get Medicare; Alzheimer's victims get impoverished.
FACT:  We'll lose Medicare long before we'll get social insurance for LTC. 

EXCUSE:  If Congress didn't want the wealthy on welfare, they wouldn't put loopholes in the law.
FACT:  Ten Congresses and four Presidents have struggled to stop Medicaid planning, even going so far as to criminalize the practice, albeit unsuccessfully.  For example:  TEFRA '82, OBRA '85, MCCA '88, OBRA '93, HIPAA '96, BBA '97. 

EXCUSE:  There is no difference between Medicaid care and private pay care.
FACT:  Medicaid pays for very little HCBS or assisted living.
FACT:  Medicaid is already on its last legs fiscally and threatens to drive nursing homes into bankruptcy throughout the U.S.  What will it be in five or ten years?
FACT:  Medicaid eligibility rules can change as happened in OBRA '85; you may lose your eligibility after you've lost your money.
FACT:  The best nursing homes are not Medicaid-certified, but are 100% private pay.  Go to three nursing homes:  all private pay, all Medicaid, and in between.  Then decide.
FACT:  Medicaid pays for "low cost care of uncertain quality" and Medicaid planners' clients crowd out the poor from the best Medicaid beds.
FACT:  When economic times are tough, like now, Medicaid planning clients can lose their beds in good nursing homes when "bed reserve days" are cut. 

EXCUSE:  You paid your taxes; you have a right to free nursing home care.
FACT:  Medicaid is welfare, not social insurance like Medicare and Social Security.  You are entitled to nothing unless you legitimately meet income and asset limits. 

EXCUSE:  Medicaid planning is only one small part of what elder law attorneys do.
FACT:  Medicaid planning is the "cash cow" of most elder law practices generating the vast majority of all revenue.

EXCUSE:  Medicaid planning is as ethical as tax planning.
FACT:  Tax planning does not cause a vulnerable elder who could have afforded quality private home care or assisted living to lose his or her life savings and become dependent on a bankrupt welfare program for underfinanced nursing home care. 

EXCUSE:  Our clients are the seniors, not the "greedy heirs."
FACT:  The driving force behind Medicaid planning is the adult heirs who make both financial and health care decisions for their cognitively impaired parents and therefore have a conflict of interest. 

EXCUSE:  Medicaid planning is crucial because most people are either too young or too old, too rich or too poor for LTC insurance.
FACT:  Nonsense.  Most Americans can afford private LTCI at some point in their lives and would buy it except for perverse incentives in public policy that reward Medicaid planning and punish responsibility. 

EXCUSE:  We recommend LTC insurance for anyone who qualifies financially and medically.
FACT:  Medicaid planners give lip-service to LTC insurance, but are rarely sources of qualified referrals.  Every insured senior is one less Medicaid planning client. 

EXCUSE:  It's just not right for hard-working, tax-paying responsible people to get nothing while the irresponsible get Medicaid.
FACT:  Welcome to welfare.  That's what it is.  It rewards irresponsibility and punishes responsibility.  Same with social insurance.  Only private insurance prices risk and charges irresponsible poor risks more than it charges responsible people who are good risks. 

EXCUSE:  Medicaid planning and LTCI go together:  buy a three-year policy and then transfer assets.
FACT:  This is terrible advice that results in coordinating benefits between private insurance that buys quality care at the most appropriate level and a bankrupt welfare program that pays inadequately only for nursing home care.