Bullet: Medicaid Commission Update
Wednesday, May 31, 2006
LTC Comment: Will
the Medicaid Commission fix long-term care financing or make huge problems even
worse? Our best guess after the
TODAY'S LTC BULLET is sponsored by Ron Hagelman and the Republic Marketing
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. To sponsor an LTC Bullet
yourself, contact Damon at 206-283-7036 or firstname.lastname@example.org.
THE BRAVE NEW WORLD OF LONG-TERM CARE. The
Deficit Reduction Act of 2005 changed the ground rules for LTC financing.
Medicaid will no longer be a tax-payer financed fall-back for affluent
people who fail to save, invest or insure for long-term care.
That means the public should plan and prepare for LTC as they never have
before. But nothing will change
unless states implement the DRA, the feds enforce it, the media publicize it and
the private sector sells alternatives to Medicaid like insurance and reverse
mortgages. How well do you and your
producers understand this critical law and the new marketing opportunities it
opens? Bring in Center President
Steve Moses to present his exciting educational/motivational program on the DRA:
what is it, what does it mean, and how should you present it to maximize
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Center for Long-Term Care Reform usually charges a flat fee of $5,000 for
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producers or consumers for only $1,000 plus expenses. Here's where Steve is scheduled to be in the next few months:
Seattle: most of the time
Dallas: last week of June
New Mexico: late August
Phoenix: late September
San Antonio: second week of October
San Diego: third week of October
Florida: fourth week of October
Austin, TX: second week of November
Steve at 206-283-7036 or email@example.com
to schedule a program. ***
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LTC BULLET: MEDICAID
Medicaid Commission Update
Stephen A. Moses
Probably no social program or problem has been the subject
of more studies, task forces and commissions than Medicaid and long-term care.
Yet the program continues to slip toward insolvency and the problem gets
worse every year. By all
appearances, after a good start, the "Medicaid Commission" appointed
by Health and Human Services Secretary Michael Leavitt last year, is now likely
to damage Medicaid further and exacerbate the long-term care financing problem
even more. Here's the story.
Secretary Leavitt established the Medicaid Commission in
May 2005 under Public Law 92-463, the Federal Advisory Committee Act, to advise
him on "ways to modernize the Medicaid program so that it can provide
high-quality health care to its beneficiaries in a financially sustainable
way." At the time, states
struggled with deficient revenues and bloated budgets.
Medicaid was a big part of the problem.
It had recently exceeded Medicare in cost and topped primary and
secondary education as the biggest item in state budgets.
The National Governors Association (NGA) called for strong measures to
rein in Medicaid's cost explosion.
Long-term care and other services for the aged, blind and
disabled account for the lion's share of Medicaid's cost problem.
While only one-fourth of Medicaid recipients are aged, blind and
disabled, they account for two-thirds of the program's costs.
Poor women and children are three-fourths of Medicaid's enrollment, but
they account for only one-third of its cost.
Therefore, the NGA proposed measures to target Medicaid long-term care
eligibility to people truly in need in order to stanch the financial hemorrhage.
The Medicaid Commission took heed. Its first mandate was by September 1, 2005 "to provide
recommendations on options to achieve $10 billion in scorable Medicaid savings
over five years while at the same time make progress toward meaningful
longer-term program changes to better serve beneficiaries."
It met that deadline and several of its recommendations--including
critical measures to discourage Medicaid planning (artificial
self-impoverishment) abuses--became part of the Deficit Reduction Act signed by
President Bush on February 8, 2006.
But further developments do not bode so well.
After completing its first report under severe deadline pressure last
Fall, the Medicaid Commission turned to its bigger responsibility:
"By December 31, 2006, the Commission is tasked with making
longer-term recommendations on the future of the Medicaid program that ensure
the long-term sustainability of the program."
In its four meetings since starting on this larger challenge, the
Medicaid Commission has heard a barrage of biased testimony favoring expansions
of Medicaid and a dearth of ideas on how to preserve the program as a long-term
care safety net for the poor.
At the Commission's May 17-18, 2006 meeting in Dallas, for
example, a long line of witnesses advocated an even longer list of measures
intended to make Medicaid-financed long-term care more available and attractive
to American consumers. The people
and groups with the most access to the Medicaid Commission--well endowed
foundations and think tanks, avid advocacy groups, and highly profitable private
companies that service Medicaid in various ways--want things we all want such as
more home and community-based care, less nursing home institutionalization,
better care coordination, consumer-directed care funded by more rational revenue
streams and governed by more sensible regulations.
These voices should be heard.
But there are other ideas and arguments that need to be
heard which the Medicaid Commission has failed to entertain.
For example, the Commission should give more consideration to Medicaid
long-term care eligibility, financing and history.
Eligibility and financing are critical because unless and until they
control easy access to subsidized nursing home care funded by Medicaid, making
home and community-based services more readily available will swamp Medicaid
financially, encourage more Medicaid planning abuse, and impede the market for
LTC insurance and home equity conversion, which are the system's only hope of
Understanding the history of long-term care financing is
essential. To focus as the Medicaid
Commission is doing on the crazy-quilt status quo of long-term care without
examining how it came to be leaves the Commission at risk of addressing symptoms
instead of causes. Why does America
have a welfare-financed, institution-based long-term care system in the
wealthiest country in the world where no one wants to go to a nursing home?
Until the Medicaid Commission addresses and answers that question, it is
in danger of attempting to solve a problem caused by excessive government
financing by adding even more government financing.
That's like trying to put out a fire by dousing it with gasoline.
In the end, the Medicaid Commission will likely make
Medicaid's problems worse instead of better if it continues to ignore how
government intervention in the long-term care marketplace--however
well-intentioned--caused Medicaid's problems of access, quality, reimbursement,
discrimination and institutional bias in the first place.
As of now, the Medicaid Commission is midway on a slippery
slope toward contributing to Medicaid's collapse as a long-term care safety net
for the needy. Instead of saving
Medicaid by targeting it more wisely and encouraging private financing
alternatives like insurance and reverse mortgages, the Commission is moving in
the direction of feel-good reforms that could make matters much worse than they
A public policy tragedy may be in the making.