LTC Bullet:  The New York Long-Term Care Compact Proposal 

Wednesday, July 18, 2007 


LTC Comment:  New York is considering a proposal that would revolutionize long-term care financing.  Our analysis, draft report, and a late-breaking update after the ***news.*** 

*** TODAY'S LTC BULLET is sponsored by Gerald Dock, CEO of Greenhaven Marketing Corporation in Anoka, MN.  We thank Jerry for supporting our coverage of the forthcoming LTC Partnership Summit and for his creative idea that "frequent flyer miles could be a method to increase members' support of the Center in a fashion less costly to us and beneficial to the Center."  If you have frequent flyer miles from any airline that you'd like to contribute to support the Center for Long-Term Care Reform's LTC policy work, please contact Damon at 206-283-7036 or  Make a supplemental donation or use miles in lieu of your annual membership dues. *** 

*** SPEAKING OF THE LTC PARTNERSHIP SUMMIT:  Mark Meiners, Professor and Director of the Center for Health Policy, Research & Ethics at George Mason University, has announced the revival of the LTC Education Foundation (which previously put on the original 17-year-running "Private LTC Insurance Conference") for the purpose of sponsoring "The First Annual Partnership Summit:  Charting the Future of Long-Term Care Insurance" to be held August 1-2, 2007 in Arlington, VA.  The meeting begins with a "pre-conference" on July 31.  For all the details and to register, go to and scroll right. *** 

*** REFERRALS.  Thank you for reading the Center for Long-Term Care Reform's latest "LTC Bullets" newsletter.  If you know someone who would be interested in this publication, please recommend us by clicking here  If you have received this edition as a forward, and would like your own subscription, you may subscribe here  Thank you. ***   

*** JOIN "THE ZONE" WITHOUT THE $150 FEE UP-FRONT.  Did you know you can now donate as little as $12.50 per month (automatically on your credit card) and qualify immediately for the Center for Long-Term Care Reform's members-only web zone AND for our one-a-day mental vitamins ("LTC Bullets" and "LTC E-Alerts")?  Please make a new or supplemental contribution now at .  Don't feel limited to the minimum if you can afford and feel moved to contribute more.  Your support is much needed and greatly appreciated.  Please direct any questions regarding our members-only website, AKA "The Zone," or donating online or by check to or call us at 206-283-7036. *** 



LTC Comment:  A description of the New York long-term care compact proposal excerpted from our draft report on the subject follows below.  We invite Center for Long-Term Care Reform members to read the full report in draft at  You will need your user name and password to access this material.  Comments and suggestions are welcome.  Please email them to  The draft was distributed to all study participants on May 31, 2007.  We currently have their feedback under review.  We will publish the final report near the end of July. 

[Not yet a member of the Center, but you'd like to see this report, the "Almanac of Long-Term Care" and the many other content-rich features in The Zone?  No worries.  Contact Damon at 206-283-7036 or  He'll zone you in immediately, give you a user name and password, and start our popular e-letters coming to your email in-box daily.  Individual memberships are $150 per year or $12.50 per month.  Corporate memberships are negotiable.  Support the Center today.] 


I would like to take this opportunity once again to thank Thomas Campbell Jackson, MPH, CEBS, a private philanthropist from New York, NY, for making our LTC Compact study possible.  Mr. Jackson has no economic ties to the long-term care insurance or provider industries.  He responded immediately to our April 19, 2007 request for support for this research:  "LTC Bullet:  LTC Compact Study Proposal,"


Description of the New York LTC Compact Proposal: 

(Following this excerpt from our report, you will find a brief update on the current status of the LTC Compact legislation.) 

The LTC Compact proposes to offer New Yorkers a new option to pay for long-term care.  Under the Compact, a person who is chronically ill and needs long-term care could become a Compact participant by pledging to spend for qualified LTC services an amount equal to half his or her non-housing assets (not counting the first $20,000 for someone with less than $40,000 in total) or the cost of three years in a nursing home (circa $300,000 depending on region of residence), whichever is less.  Upon spending the pledged amount for approved LTC services as satisfactorily documented and verified, the Compact participant would become a Compact beneficiary, eligible for a Compact subsidy.  The Compact subsidy is an amount of payment for future LTC services equal to the Medicaid rate for the same or a similar service.  A Compact beneficiary would be entitled to receive lifetime LTC services funded by the Compact program at the Compact subsidy rate, in accordance with an assessment of need and a plan of care, by paying out of pocket an additional 10% of the Compact subsidy rate plus an annual participation fee not to exceed 25% of personal income. 

The benefits of participation in the LTC Compact would be substantial as compared to circumstances imposed by Medicaid eligibility.  Compact beneficiaries would preserve remaining resources after the Compact pledge amount is satisfied.  They would endure no additional resource or income limitations and no lien or estate recovery requirements as are imposed on Medicaid recipients.  They would have the right to purchase qualified services from any willing provider at the Compact rate (i.e. the Compact subsidy plus the beneficiary's 10% co-payment).  Compact participants could satisfy their required pledge amounts and/or their service co-pays and annual participation fees by means of private insurance policies, if they had the foresight to buy them while they were still insurable.  Such policies would likely cost considerably less than coverage of their full lifetime LTC liability in the absence of the Compact program.  Individuals who were refused long-term care insurance at least twice could contribute, or have contributed on their behalf, up to $10,000 per year into a tax-favored "qualified long term care savings account" for purposes of planning ahead to fund their pledge amount.  Special conditions and protections would apply for married Compact beneficiaries. 

The foregoing description of the LTC Compact proposal is based on provisions in Senate Bill 00116 as "prefiled" January 3, 2007.  That bill specifies that operation of the Compact program would be entirely conditional upon approval and receipt of federal financial participation (i.e. Medicaid money) to help fund it.  It authorizes a "program management entity" to administer the Compact and specifies that such entity shall not be a state agency.  According to the bill, an advisory committee would be appointed consisting of two elder law attorneys, two senior advocates, two LTC providers, and two LTC insurers.  It also provides for an education and outreach campaign in support of  the Compact.  The current bill contains restrictions on asset transfers done within three years of applying for the Compact, except for participants who pledge and satisfy the "maximum" pledge amount.  It contains no cap on protected home equity.  Therefore, it does not reflect changes made by the Deficit Reduction Act of 2005 regarding asset transfers (e.g. five year look back) and exempted home equity (capped at no more than $750,000) under Medicaid. 

LTC Comment:  Center Members:  If you would like to see our analysis and critique of the LTC Compact, proceed now to the draft report in The Zone at


Following is a status report on the New York LTC compact legislation as obtained and edited from information provided by an expert on the scene in Albany, NY.  We requested permission to publish this information with attribution but did not receive a reply. 


The LTC Compact legislation (Senate116-A, Golden) was reported from committee to the Senate calendar, but did not pass the Senate.  It was recommitted to the Senate Rules Committee on the last day of the Regular Legislative Session on June 21, 2007.  (Senator Golden [R-Brooklyn] still Chairs the Senate Aging Committee.) 

The Assembly companion bill, Assembly 8643-A (Englebright), was never reported from the Assembly Aging Committee.  (Please note that Assembly member Steve Englebright (D-Suffolk), who was a major supporter of the LTC compact proposal, is no longer Chair of the Assembly Aging Committee, but is now Chair of the Assembly Tourism, Arts & Sports Development Committee.  The new Chair of the Assembly Aging Committee is Assemblymember Jeffrey Dinowitz [D-Bronx]). 

While the Legislature has technically adjourned for the summer, it will be coming back for several Special Sessions during the remainder of the year.  The first such Special Session is supposed to be on Monday, July 16, 2007.  It's doubtful that this bill will move in a Special Session, unless it becomes a negotiated "leaders item" which is unlikely.