LTC Bullet: New State X Project: Own this LTC Research Project

Tuesday, February 16, 2010


LTC Comment: Learn how to save a state millions, improve LTC, expand LTCI, and own a piece of the action, after the ***news.***

*** FEARLESS CAREGIVER. Steve Moses will speak at the Nashville, Tennessee "Fearless Caregiver" conference on March 10, 2010. We'll provide full details on the program soon in an LTC E-Alert. In the meantime, check out with its exceptional resources for family caregivers. To register for the "Fearless Caregiver" program at the Radisson Opryland Hotel in Nashville, go here. ***

*** NEW JH WEBSITE. John Hancock has launched a new interactive microsite,, to help brokers and consultants explore and establish LTC insurance plans for businesses with up to 1,000 employees. The site includes information and tools to help brokers and consultants, whether familiar with LTC insurance or not, navigate through the employer-sponsored LTC insurance benefits planning process. Get the details here. ***

*** NEW MMMI WEBSITE. The MetLife Mature Market Institute has launched a new website here ( You'll find MMMI's research, information and consumer publications easier to access, navigate and retrieve. The site features a new Topic Index for easy access to information on Baby Boomers, caregiving, advocacy, health, housing, long-term care, finances, family and work. Other improvements include a research home page, a media room, downloadable charts, key study findings and methodologies, a publications listing and an area to sign up for their free e-newsletter, QuickFACTS. ***

*** JOBS IN LTC. The unemployed need jobs and the LTC insurance industry needs producers. A perfect match. So: "An alliance of leading long-term care insurance organizations has launched the national 'Jobs To Protect America's Future' campaign. The effort intends to recruit, train and support up to 2,000 unemployed Americans who will help educate Americans about the need to plan for the potential risk of needing long-term care." Get the details from the American Association for Long-Term Care Insurance here. ***



LTC Comment: Last year, we proposed a "State X" project to study LTC financing problems in one key state and propose solutions. Center for Long-Term Care Reform members and supporters responded with targeted contributions. Your financial help primed the pump, attracted outside foundation support, and we got the job done. Read our report, titled "Doing LTC RIght," here.

Rhode Island was a unique opportunity because of its "global Medicaid waiver." But every state faces similar problems and challenges. So we propose to take our analytical model and our recommendations for doing LTC right to the rest of the country. Here's what we have in mind and how you can participate, own part of the program, and receive the same published recognition our original "State X" project donors did.


I can't think of anything more important for the future of long-term care than achieving these three goals:

(1) Wake up the public to the risk and cost of LTC,

(2) Prepare more people to pay privately for long-term care, and thereby,

(3) Save the Medicaid safety net for people in need by unleashing the markets for LTC insurance and home equity conversion.

But it does not look like any of these outcomes will occur without a nudge. So, we've come up with the following proposal to help matters along. The Center for Long-Term Care Reform will perform the proposed project in state after state for as long as it takes to achieve the objectives listed above.

For each project in each state, if our recommendations are implemented, the state will save millions of dollars, more of its citizens will have access to higher quality long-term care, and the reverse mortgage and LTC insurance markets will expand. The Center needs $25,000 per state to make it happen. Here's how you can participate:

Purchase up to 100 shares in a project at $250 per share. Once a full project is sold out (100 shares sold), share-holders will vote on which state to target with one vote per share. Combine your shares with others to choose the state or buy 100 shares in a project (full ownership) to guarantee your choice. Or persuade your company, carrier, or organization to sponsor a project. We'll seek supplemental foundation support too, but we need your help to prime that pump. The state must agree to participate, of course, but in the condition they're in financially now, we don't see many states turning away free help.

If you think you may like to participate, contact Steve Moses at or 206-283-7036, give us the state you'd prefer to target and we'll fill in the blanks in the following "generic" proposal for you and your state.

Bottom line, we estimate conservatively that states which implement our recommendations will save 10 percent of their annual Medicaid nursing home expenditures within five years by reducing Medicaid LTC dependency, increasing estate recoveries, and maximizing private LTC financing through home equity conversion and LTC insurance.

Here's the basic proposal. Again, we can fill in the blanks for any state quickly. While no contribution is too small, shares are in $250 increments and we strongly encourage full project ownership.


How to Reduce Medicaid Expenditures and Improve Long-Term Care
a proposal by the
Center for Long-Term Care Reform
submitted to [Name of Organization]
on [Date]

I. The National Problem

Medicaid is a means-tested public assistance program, i.e. welfare. Yet Medicaid is the principal funding source for long-term care (LTC) throughout the United States, not only for the poor, but for most Americans. Although LTC users are only seven percent of the Medicaid population, they account for more than half of the program's costs nationally. The only way Medicaid can survive as a long-term care safety net for the poor is if more prosperous people plan responsibly and pay privately for their own long-term care. But Medicaid crowds out most private LTC financing alternatives such as home equity conversion and insurance. The trend toward greater and greater dependency on welfare-financed nursing home care is reversible. It will be reversed by responsible public policy or by default as costs skyrocket and public resources dwindle with the aging of the baby boom.

II. The State Problem

[State] spent [$$$] on Medicaid in 2007 of which [$$$] or [%%%] were LTC expenditures for older people and adults with physical disabilities, an increase of [%%%] since 2002. [State's] age 85 plus population, the cohort most likely to require LTC, was [thousands] or [%%%] in 2007, but is expected to be [thousands] and [%%%] in 2030, a [%%%] increase. Medicaid is the primary payer for [%%%] of the state's nursing home residents. Another [%%%] rely primarily on Medicare. Medicaid and Medicare also pay for most home health care, 75% nationally. Our best estimate is that only [%%%] of [State's] 50+ citizens own LTC insurance. Very few use home equity to fund LTC. Thus, financing Medicaid LTC is a large and growing strain on [State's] budget. Private LTC financing is minimal and shows few signs of increasing. Demographic and fiscal pressures will exacerbate these problems. Yet federal law and regulations inhibit some effective corrective actions [State] might take--such as tightening loose eligibility rules--and encourage other initiatives--such as "rebalancing" from institutional to home care--which may increase utilization and costs.

III. Substantive Proposal

[State] can reduce its annual Medicaid budget by an amount equal to 10% of current nursing home expenditures for aged and disabled recipients or [$$$ ] per year within five years. We propose to conduct a study of LTC financing in [State] that shows why such savings are possible and how to achieve them while improving access to quality LTC for everyone in the state. Toward that end, we will . . .

  • Research and document federal and state Medicaid LTC eligibility laws and regulations that encourage public assistance dependency for LTC.
  • Interview state staff who make, interpret, and implement LTC eligibility policy to identify eligibility "loopholes" that circumvent spend-down rules.
  • Measure the level of Medicaid estate planning, i.e. artificial impoverishment to qualify for Medicaid LTC, in [State] with a literature search and interviews.
  • Analyze how much revenue [State] receives from federally mandated estate or lien recoveries and how much more could be recovered using best practices.
  • Examine the reverse mortgage market and interview lenders and loan representatives to identify ways home equity could offset Medicaid LTC costs.
  • Examine the LTC insurance (LTCI) market and interview carriers, brokers, agents and regulators to identify ways LTCI could offset Medicaid LTC costs.
  • Meet key state legislators and executive branch officials to discuss why Medicaid LTC expenditures are so high and how they could be reduced progressively.
  • Meet LTC providers (nursing home, assisted living and home health) to get their perspective and gauge their support for measures to increase private LTC revenue.
  • Meet senior advocates to get their perspective and gauge their support for measures to increase overall public and private LTC resources.

We propose to work with a representative of [the sponsoring organization and/or the State Medicaid program] to identify interviewees and schedule appointments. We will visit [State] for one week to conduct the onsite research and interviews. We will conduct other necessary research online.

IV. Business Proposal

Deliverables, within six weeks of project approval, will include (1) a comprehensive report (approx. 25 pages) that explains the problem of LTC financing and recommends solutions to achieve savings of at least [10% of State's Medicaid nursing home budget] per annum; (2) one or more newspaper op-eds, and (3) an article suitable for publication in [the sponsoring organization's] journal.

Stephen Moses (professional bio attached) will conduct all of the research and interviews for this project. He has conducted many similar studies over the years. Examples of his project reports are at

Total cost: $25,000 including travel expenses and distribution of electronic reports to all interviewees and respondents. Payable: $10,000 upon signing; $5,000 upon successful progress report; and $10,000 upon submission of acceptable deliverables.

Respectfully submitted [date]

Stephen A. Moses