LTC Bullet:  LTC Blues in the Empire State 

Thursday, October 5, 2006 


LTC Comment:  New York State is a model of what not to do about long-term care financing.  We can learn as much from negative role models as positive ones.  Read and hear Steve Moses's remarks on LTC in NY after the ***news.*** 

*** PODCASTS.  We've added a new feature to the Center's Members-Only website, AKA "The Zone."  Nowadays, most folks have "MP3" players.  Great for music, but these little electronic gems are also a godsend for using down time to keep up with great ideas of all varieties:  sales, inspiration, news, and analysis to name a few.  Our first podcast is an interview by Steve Moses with Aegis Living's CEO Dwayne Clark at the National Investment Center's ( conference in Chicago last week.  Clark's senior living company was ranked the fastest growing small company in the country by Inc. magazine three years ago.  You'll know why when you listen to this interview.  Check it out at .  We'll add new podcasts periodically and let you know when we do in this space.  *** 

*** ZONED OUT?  No worries, Zone In easily.  Just contact Damon at or 206-283-7036 and join the Center.  Annual individual memberships are $150.  Corporate and organizational memberships covering everyone on your team are negotiable.  As soon as you say "the check's in the mail," Damon will assign your user name and password and you'll be in The Zone with access to its many features including the new podcast.  You'll also receive our LTC Bullets online newsletter and/or our daily LTC E-Alerts:  as much or as little as you choose to receive.  What's more, you'll be part of our fight for rational long-term care public policy.  Join the team.  Join the Center today. *** 

***  METLIFE MARKET SURVEY OF NURSING HOME & HOME CARE COSTS.  No doubt you've already seen this news elsewhere.  Just a heads up therefore that we keep a link to these annual surveys in The Zone so you can find each year's report quickly and easily after time passes and they're no longer in the news.  Center members check it out at  Non-members:  JOIN! 

The average daily cost of a private room in a nursing home rose from $203 to $206 per day last year. The average annual cost increased by 1.5 percent to $75,190.  Average semi-private room rates rose 3.9 percent from $176 to $183 per day. Find the MetLife Market Survey of Nursing Home & Home Care Costs at: *** 



The Manhattan Institute's Empire Center for New York State Policy conducted a forum on Medicaid reform September 26, 2006 in Albany, NY.  

Hear Steve Moses's presentation on long-term care financing in New York at  (If this audio file won't start by clicking on it, cut and paste it into your media player.) 

Read a Times Union article about the program at  

Check out the details about all speakers and their presentations on the Empire Center's website at  

Following are some excerpts from Steve's speech outline to give you the gist of his presentation. 


"New York and Long-Term Care Financing" by Stephen A. Moses presented to the Empire Center for New York State Policy's conference on "Health Policy Issues and Options for New York:  What Can We Learn from Other States?" in Albany, New York on September 26, 2006. 

New York is a LTC Basket Case 

Distinctive Facts re NY (most from AARP "Across the States" report) 

o  Between 2002 and 2020, NY's % of population 85 plus will grow from 1.7% to 2.3% 

o  New York is Number 1 on these categories: 

            -  Total Medicaid Spending:  $38.5 billion (2003)
-  LTC Spending Per Capita:  $815; US ave.:  $288
-  HCBS Spending Per Capita:  $317; US ave.:  $95 

o  Medicaid nursing home reimbursement rate:  $172 (2002)
Private-pay "          "                "             "  :  $260 (2003)
Medicaid pays only 66% of the private-pay rate

o  Medicaid as Primary Payer (%), 2003:            73.7 vs. 66.3 US
Medicare as Primary Payer (%), 2003:            11.9 vs. 11.3 US
“Other” as Primary Payer (%), 2003:            14.4 vs. 22.4 US 

o  Very low estate recoveries:  .27% of LTC costs; rank 37
Very low LTCi market penetration:  1% to 5%

o  Spousal refusal 

o  No TOA for home care 

o  LTC Compact - $330K or half assets pledged; lock in heavy government financing; unsupportable for long-term 

o  Worst fact:  I have to pay half the cost as a federal taxpayer! 

Following this set up, Steve analyzed the problem and presented these recommendations: 

o  The State of New York should conduct a top-to-bottom review of Medicaid long-term care eligibility, coverage, services, and estate recoveries.   

o  The county-administered system in New York creates problems and complications that need to be monitored more closely, documented thoroughly, and corrected where possible.   

o  The state should put an end to the "Spousal Refusal" eligibility dodge by pursuing its subrogated right to litigate on its and the Medicaid recipient's behalf in all such cases.   

o  New York should study and document the practice of Medicaid estate planning, develop hard-dollar estimates of the cost to state and federal taxpayers (who each pay half the cost of Medicaid), and close eligibility "loopholes" that can be controlled at the state level.   

o  New York should aggressively implement the new DRA statutory authorities to help the state control its Medicaid long-term care eligibility hemorrhage.  Also, apply TOA rules to home care. 

o  The state should mount a public relations campaign to educate the public that long-term care is a personal responsibility for which public financing will become less and less available as time goes on. 

o  New York should encourage the purchase of private LTC insurance and the use of home equity conversion (e.g. reverse mortgages) to pay for long-term care.