LTC Bullet:  LTC Compact Study Proposal 

Thursday, April 19, 2007 


LTC Comment:  Would a plan promoted by elder lawyers in New York relieve the LTC financing crisis or undermine both Medicaid and private insurance?  How to find the answer, after the ***news.*** 

*** BOOMER CENTURY.  We've learned that this excellent PBS documentary hosted by Age Wave expert Ken Dychtwald will re-broadcast in Denver in April.  Check here for future air dates in your area: *** 

*** CERTIFIED FINANCIAL PLANNERS take an interest in LTC.  Check out James Geary, "Try a Little LTC:  A Guide to Long-Term Care Insurance," CFP Board eNewsletter, April 2007:  Excerpt:  "LTC insurance is still relatively rare. 'You should be thinking about LTC insurance when you're in your forties, and you should own it by the time you're fifty,' says Stephen A. Moses, president of the Center for Long-Term Care Reform. 'If you're older than fifty, you should do it now.' For a variety of reasons, though, most people do not purchase LTC insurance. 'It's an uncomfortable thought to consider being dependent on others for care,' says Moses. 'But then it's uncomfortable to think about dying, too, but most people still buy life insurance.'" *** 

*** CONGRATS TO JOSHUA WIENER.  Press release:  "RTI International has won the contract to conduct a comprehensive review and analysis of research on issues related to the projections of long-term care financing, as announced today by the National Investment Center for the Seniors Housing & Care Industry (NIC). This undertaking is the first of its kind on this subject."  Dr. Wiener, formally of Brookings, the Urban Institute, HCFA, CBO and a widely published author on long-term care issues, will direct the project.  For details, see  Although a staunch advocate of publicly financed long-term care, Josh Wiener does high quality research, gives opposing views (like mine) thoughtful consideration, and assures me that this project "is not analyzing policy options. *** 



LTC Comment:  Recently, a member of the professional staff of the germane committee for Medicaid (Energy and Commerce) in the U.S. House of Representatives asked me:  "What do you think of this Long-Term Care Compact plan under consideration in New York?  Is this an idea we should explore at the national level?" 

That query convinced me that the time is right, or maybe already a little late, to take a close look at the LTC Compact.  Someone needs to analyze its likely impact on the long-term care financing system and provide some guidance for legislators and policy-makers who are considering the plan.  LTC insurers and providers who would be heavily impacted for better or worse need to know more precisely how their businesses would be affected. 

Therefore, the Center for Long-Term Care Reform offers the following: 

Long-Term Care Compact Study Proposal 

Presented by: 

Stephen A. Moses, President
Center for Long-Term Care Reform
April 19, 2007 


The "Long-Term Care Compact" is a proposed redesign of New York State's long-term care financing system.  If enacted and implemented, the LTC Compact would obligate state and federal taxpayers to pay the cost of long-term care for participants who have first spent from their own resources and for their own care an amount equal to the lesser of: 

1.  The cost of 36 months in a nursing home, or 

2.  Half their non-housing assets. 

Proponents of the LTC Compact argue that it would clarify citizens' personal responsibility for long-term care costs, replace draconian Medicaid spend-down requirements, reduce public LTC expenditures, and encourage the purchase of private long-term care insurance. 

Opponents of the LTC Compact argue that its eligibility rules would be even easier to evade than Medicaid's, that it would undermine personal responsibility and undercut the market for private long-term care insurance and reverse mortgages, and that it would increase rather than decrease state and federal LTC expenditures. 

Last session, LTC Compact legislation passed the New York State Assembly (lower house of the state legislature).  This year, a new bill has been introduced in the State Senate and another is expected to be introduced in the Assembly. 

A large body of information, both pro and con, has accumulated regarding the LTC Compact.  This includes white papers on both sides of the issue, journal articles, legislative testimony, and extensive correspondence.  

The interests of many citizen and industry groups are at stake.  These include senior advocacy organizations, the elder law bar, long-term care providers, and long-term care insurers among many others. 


I propose to conduct a thorough literature review of the Long-Term Care Compact and to interview in person and/or by phone the major proponents and opponents of the plan.  I will prepare a report that systematically compiles, explains and analyzes the arguments on both sides of the issue.  The report will also offer a judgment on the merits of the LTC Compact and propose a course of action with regard to it. 

As time is of the essence, assuming a contract is signed or sufficient funds collected to support this work before the end of April, I will conduct the field work within one month and deliver the final report within six weeks.  


Under contract with a single sponsor:  $10,000 for the research, interviews and report writing with $2500 due at signing, $2500 due at submission of a mid-project progress report, and $5000 due upon submission of the final report.  Plus travel expenses to include coach air fare, ground transportation or a rental car, food and lodging for one week in New York State, principally in the Albany capital area.  Estimate:  $2000. 

Alternatively, the Center for Long-Term Care Reform will escrow pledges to support this study until sufficient funds have been committed and collected.  We invite single pledges of $1000 or more for this project.  When $12,000 has been pledged and collected, we will begin the work.  To make a pledge for this project, contact Steve Moses at or 206-283-7036. 

CREDENTIALS AND REFERENCES:  Available upon request. 

This proposal respectfully submitted by: 

Stephen A. Moses, President
Center for Long-Term Care Reform, Inc.
2212 Queen Anne Avenue North, #110
Seattle, WA  98109
Office: 206-283-7036
Fax: 206-283-6536
Web site: 

The Center for Long-Term Care Reform, Inc. is a private institute dedicated to ensuring quality long-term care for all Americans.