LTC Bullet: LTC News Update and Free Almanac Access

Tuesday, January 5, 2010


LTC Comment: Keep up on all the LTC reports and data after the ***news.***

*** Today's LTC Bullet is sponsored by LTCA, Inc. LTCA has created a first-of-its-kind "hybrid" agency platform enabling high-producing PPGA's to remain contracted, compensated and vested directly with each carrier, while still receiving risk-free lead generation and full-service back-end support traditionally provided only to "captive" agents. If you're not getting the most from your marketing organization call 1-800-742-9444 to learn more, or visit our website to apply. ***

*** FREE ACCESS. Click here, use "free" and "access" for your user name and password, and get 24 hours of The Zone and the "Almanac of Long-Term Care" at no charge, thanks to LTCA, today's LTC Bullet sponsor. If you're a paid-up member of the Center, of course, you get all our publications and free access full time, all the time to The Zone, the LTC Almanac and many other features. But if you're not a member, join now here or contact ***

*** LTC-TV. Our LTC embed reporter Damon Moses asked LTC experts their opinions of the CLASS Act at the LTCI Producers Summit Conference in Kansas City last November. Now you can watch and hear their answers. Get LTC actuary and expert Claude Thau's opinion here (Part One, 8 minutes) and here (Part Two, 3 minutes). Check out Marsh Senior VP Anthony Stratidis here (1.5 minutes) and LTC Partnership Managing Partner Michael Fitzpatrick here (1.5 minutes). For the rest of the interviews, including conference keynoter and nationally syndicated financial columnist Terry Savage and conference organizer Jim Glickman and others, go to our LTC-TV channel here. ***

*** 2008 HEALTH OUTLAYS published. U.S. health care spending grew by 4.4 percent in 2008, the lowest rate in 50 years but still 4.3 percent above the overall inflation rate. We'll have more analysis soon in our annual "LTC Bullet: So What if the Government Pays for Most Long-Term Care," but in the meantime read about the latest health expenditure data in today's New York Times here and in the Wall Street Journal here or on p. A-4 of the WSJ print edition. ***



LTC Comment: The "Almanac of Long-Term Care" is a special feature in The Zone, our password-protected website for LTC specialists. We update it periodically to reflect the latest reports and published articles from think tanks, government agencies, and LTC experts of all kinds. The LTC Almanac is where I go when I need to find the latest statistical updates and published analysis related to long-term care.

The Almanac contains 11 "chapters" including Aging Demographics; International; Unfunded Liabilities--Social Security, Medicare, and Budgets; Long-Term Care; Caregiving; Long-Term Care Financing; Long-Term Care Insurance; Reverse Mortgages; Long-Term Care Providers; Medicaid; and Medicaid Planning. Use this resource whenever you need to get the latest and best information quickly.

Most of the time, the Almanac of Long-Term Care is available only to Center members. But thanks to the sponsor of today's LTC Bullet, we're making an exception: 24 hours of free access to the LTC Almanac and everything else in The Zone. Check it out here using "free" and "access" for your user name and password. Please thank today's LTC Bullet sponsor for this "sneak peek" at The Zone. Then join the Center and get all our resources at your fingertips 24/7/365.

Now, to give you the flavor of what you'll find in the LTC Almanac, here are our latest updates, uploaded to The Zone today:


Chapter: Long-Term Care

Long-Term Care Awareness

MetLife Mature Market Institute, "MetLife Long-Term Care IQ: Removing Myths, Reinforcing Realities," September 2009, pps. 5-6, LINK

Key Findings

* More than eight in 10 respondents (85%) understand that long-term care could be the result of a variety of causes such as Alzheimer's disease, an accident, or a chronic or disabling condition.

* Just over one-third know that most longterm care services are received in one's home. While the number of respondents (37%) who do know this has increased since the 2004 survey (18%), there continues to be a very low overall awareness level.

* Over four in 10 (43%) are able to correctly identify the national average monthly cost for assisted living.

* Two-thirds (66%) are unable to identify which programs or insurance policies pay for long-term care services.

* Only 18% know long-term care insurance rates are primarily based on age, but almost nine in 10 (87%) are aware a comprehensive policy covers care at home, in an assisted living facility, and in a nursing home.

* Less than one-half (45%) can correctly identify how many households are caring for an adult family member or loved one.

* Over six in 10 (64%) are aware that transferring financial assets to your family would not allow you to qualify immediately for Medicaid payment of long-term care.

* Fewer than four in 10 (36%) know that 60%-70% of 65-year-olds will require long-term care services at some point in their lives.

See for analysis: LTC E-Alert #9-112: LTC Ignorance or Stupidity?, Thursday, October 1, 2009,

Home and Community-Based Services

Terence Ng, Charlene Harrington, and Molly O'Malley, "Issue Brief: Medicaid Home and Community-Based Service Programs: Data Update," Kaiser Commission on Medicaid and the Uninsured, Washington, DC, November 2009,

EXECUTIVE SUMMARY Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007. The recent financial crisis could impact the ability of many states to provide Medicaid services to the growing number of people who rely on the program for health and long-term care services. The ongoing debate about health care reform could also affect Medicaid eligibility and services provided in home and community-based settings. This report presents a summary of the main trends to emerge from the latest (2006) expenditures and participant data for the three main Medicaid HCBS programs: (1) optional 1915(c) HCBS waivers, (2) the mandatory home health benefit, and (3) the optional state plan personal care services benefit. It also presents findings on eligibility criteria, provider, service and waiting lists for all three programs, as well as provider reimbursement rates for the home health benefit and the personal care services benefit in 2008. (p. 1)


Chapter: Caregiving


National Alliance for Caregiving in collaboration with AARP, "Caregiving in the U.S. Executive Summary," November 2009, Excerpts:

"The purpose of this study is to present a portrait of family caregivers today, and to compare it to a portrait of caregivers in the past. A national profile of caregivers first emerged from the 1997 Caregiving in the U.S. study. A related study was conducted in 2004, and now, in 2009, we are presenting the results of the third wave of this important study. Each of the three studies has inquired about certain core elements of caregiving situations, while also exploring new areas." (p. 1)

"In the past 12 months, an estimated 65.7 million people in the U.S. have served as unpaid family caregivers to an adult or a child. About 28.5% of the respondents surveyed reported being caregivers. The percentage of people who are caregivers does not appear to have changed significantly since 2004." (p. 4)

"More than three in ten U.S. households (31.2%) report that at least one person has served as an unpaid family caregiver within the last twelve months, leading to an estimate of 36.5 million households with a caregiver present." (p. 4)


Chapter: Long-Term Care Insurance

State and Federal Tax Incentives

David Baer and Ellen O'Brien, "Federal and State Income Tax Incentives for Private Long-Term Care Insurance," AARP Public Policy Institute, Washington, DC, November 2009, p. 9,

"[I]n 35 states and the District of Columbia, people with long-term care insurance may qualify for a state subsidy (including the federal itemized deduction that is carried from the federal return). In 15 states, people who purchase long-term care insurance receive no state subsidy. In 9 of those 15 states, there is no broad-based income tax; in the other 6 states there is no state subsidy because the states neither carry through the federal itemized deduction nor offer any unique state tax benefits (see figure 3)."

Financial Planners Liability for Not Recommending LTCI

"Scary Story," Registered Rep, April 1, 2006,

Scary story re no LTCI 0406 URL:

"A registered rep in Utah did everything right by his elderly clients. He even recommended long-term care insurance as an asset-preservation tool but they had turned him down. Later, when their son sued him after both parents tragically suffered from dementia and began ringing up incredible medical bills, the advisor assumed he was covered by his errors-and-omissions insurance. He was so confident, in fact, that he didn't keep a record of his advice, which would have likely helped him immensely in the suit.

"Unfortunately, his confidence was misplaced. While his actions routinely covered him from a suit by his clients, it did not protect him from their son acting on their behalf. His ignorance of the fine print cost him dearly: He had to pay $600,000, plus any legal fees incurred, to the son."


Chapter: Reverse Mortgages


MetLife Mature Market Institute, "The Essentials: Reverse Mortgages," December 2009, LINK

Fundamentals of reverse mortgages in a quick question and answer read.


Chapter: Medicaid

Medicaid Financing

Dennis G. Smith and Edmund F. Haislmaier, "Medicaid Meltdown: Dropping Medicaid Could Save States $1 Trillion," WebMemo No. 2712, The Heritage Foundation, Washington, DC, December 1, 2009,

"The health care legislation currently in Congress not only imposes new costs on states through expansion of the Medicaid program; it also preempts state authority in management of the program. Faced with becoming merely an agent of the federal government, states will likely take the rational and reasoned approach of simply ending the state– federal partnership known as Medicaid."

Medicaid Services

LTC Comment: Medicaid planning not only results in LTC eligibility without significant spend down, it also makes people eligible for a wide range of services Medicaid covers that Medicare doesn't, thereby adding to the benefit of qualifying. The Medicaid benefit package is often as good as or better than health care plans available in the private market through employers or independently.

Updated Online 50-State Database Provides Comprehensive Source on Medicaid Benefits, The Kaiser Family Foundation's Commission on Medicaid and the Uninsured has updated its online database of Medicaid benefits to include data from October 2008, the most recent available. The comprehensive database houses information on Medicaid acute and long-term care benefits in the 50 states, the District of Columbia and the U.S. territories. It includes data about 46 services, including whether the benefit is covered, the populations that are eligible to receive various benefits, and the limitations, co-payments and payment rules that apply to the benefits for each state or jurisdiction. The database is searchable by Medicaid benefit as well as by state, and includes information from 2003, 2004, 2006 and 2008. You can compare specific benefits across states and in regional groupings of states. Additionally, you can print, e-mail or save your search results. The database can be accessed at