LTC Bullet:  What Have You Done For Me Lately?

Friday, December 14, 2012


LTC Comment:  Our annual report on the Center for Long-Term Care Reform’s year follows the ***news.***

*** 100th BIRTHDAY TODAY of Steve’s mother, Damon’s grandmother, Margaret Moses.  Party this afternoon with family, friends, and a feast of Chinese food, her favorite.  Happy Birthday, Mom!  Relevance to the Center’s mission, you might ask?  Margaret lives in an assisted living facility and her LTC insurance policy offsets the cost of her care significantly.  We don’t just talk the talk; we walk the walk.  Steve bought that AMEX Life policy in 1987 and paid the premiums every year until the waiver of premium took effect this year. ***

*** MEDICARE EXPANSION INTO LTC:  Remember the court settlement that will expand Medicare coverage of skilled nursing, home care and therapy services?  We provided details in LTC Bullet:  Medicare Expansion Could Be Last Straw for Private LTC Financing.  One of the Center’s Regional Representatives forwarded our Bullet to an admissions official at a skilled nursing facility to ask for an opinion.  Here’s the reply he received from that official who asked to remain anonymous: 

“I think that the number of people in our long-term care facility that could qualify for this proposed type of Medicare coverage for ‘maintenance’ would equal about, oh, 100% to 101%?!  Yes, the reimbursement for Medicare is currently about 30%-50% higher than what we bill privately paying residents.

“Given the nature of the current economy, I would be very surprised if our Federal government actually allowed this coverage to start.  Surely, it would increase expenses to the government by Billions and Billions of dollars.

“Given that I'm married to someone with Parkinson's disease, who will qualify for Medicare in exactly 110 days, the effect of this law on my personal life and financial future would be the equivalent of hitting the lottery.  I guess it's safe to say that I would like to learn more.  I hadn't heard anything about it, so thank you for the heads up.” ***

*** MEDICAID PLANNING EXPOSED:  We highlighted the following item in last week’s LTC E-Alert.  Since then many newspapers and other news distributors have picked up the story.  Inasmuch as we do our best to publicize and eliminate the problem of Medicaid planning, we’re pleased to see others picking up the story.

12/6/2012, “Nationwide Financial Warns Against the Financial Pitfalls of ‘Medicaid Planning’,” WSJ MarketWatch

Quote:  "A new Nationwide Financial advisor survey released today found that half of advisors say they have clients asking about giving all their money to their children in order to qualify for government assistance in paying for long term care."

LTC Comment:  Sadly, some things seem never to change.  I cited a similar finding back in 1989:  A survey found that "...a majority of [financial planners] felt that an individual with a catastrophic illness should consider transferring assets to family members in order to qualify for Medicaid."

(Source:  Peter W. Bacon, et al., "Long-Term Catastrophic Care:  A Financial Planning Perspective," The Journal of Risk and Insurance, Vol. LVI, No. 1, March 1989, p. 153)



LTC Comment:  The year 2012 was consumed by hype surrounding the national election.  Based on our years of experience, we’ve concluded that presidential election years are rarely good ones for public policy advocacy.  Public officials and the parties they represent are reluctant to engage regarding anything controversial or politically sensitive.  Long-term care policy, especially as it relates to Medicaid and LTC insurance, certainly falls into those categories.  Not exactly “third rail” level, but dangerous for politicians.  So we kept our powder dry this year, getting ready for a major initiative in 2013, on which, more below. 

We conducted a major study in Maine during 2012, the report of which is titled “The Maine Thing About Long-Term Care Is That Federal Rules Preclude a High-Quality, Cost-Effective Safety Net.”  This study focused on the “maintenance of effort” (MOE) rule in the Affordable Care Act, aka health reform or ObamaCare.  The MOE prohibits states from tightening Medicaid eligibility rules, resulting in their being unable to target scarce public LTC resources to citizens most in need.  In Maine, for example, the MOE restriction meant the state could not reduce its $750,000 home equity exemption—set when the economy was booming—to the lower $536,000 federal minimum (as of 2013) in order to save money and divert wealthier people away from public assistance.

The MOE rule has devastating consequences during bad economic times, preventing state Medicaid programs from making the most of their limited resources.  Policymakers despair when they must divert desperately needed K-12 education funds to finance easy access to Medicaid LTC for affluent seniors and their heirs.  That’s why the Center for Long-Term Care Reform is planning a multi-state series of five studies for Spring through Fall of 2013.  We’ll help five states to identify and achieve savings equal to at least 10% of their Medicaid nursing home expenditures.  The key is to escape the shackles of the maintenance of effort rule, which may be possible for states that do not expand their Medicaid programs under the ACA. 

For our special series of studies in 2013, Center president Steve Moses may recommission the Silver Bullet of Long-Term Care in which he criss-crossed the country for nearly 40,000 miles on our National LTC Consciousness Tour in 2008 and early 2009.  Check out this one-minute slide show about that adventure.  “By living and working in the Silver Bullet on site,” Steve says, “I’ll be able to spend a lot more time with key public officials and program administrators as we conduct our interviews and prepare our reports.”  Stay tuned in the new year for how you can get involved at the local level when these projects begin.

LTC Bullets

The Center for Long-Term Care Reform endeavors every year to keep our members educated and updated about important news and developments bearing on long-term care financing policy.

Once a week, usually on Fridays, we publish our LTC Bullet.  The Bullets are often policy pieces, sort of like op-eds.  You can always find the five latest Bullets here and archives of all 982 Bullets (so far), by date here and by topic here.  These nearly-1000 articles are a valuable historical resource.  Make use of them.  In 2013, in celebration of the thousandth LTC Bullet and the Center’s 15th anniversary, we plan to do a retrospective of the most interesting and dramatic LTC Bullets that we’ve published since the Center’s founding in 1998.  We’ll review them by topic, covering “The LTC Problem and Solutions”; “Reality Check: The Facts on LTCI; Medicaid Planning”; “LTC Services”; “Politics and Legislation”; “Demographics and Other Data”; and “CLTCR News.”

Highlights of 2012 LTC Bullets include: 

January:  So What If the Government Pays for Most LTC?, 2010 Data Update
February:  The History of Long-Term Care Financing or How We Got into This Mess
March:  Dual Eligibles and Long-Term Care: How to Save Medicaid LTC $30 Billion Per Year and Pay for the "Doc Fix"
April:  Boomer Coma
May:  The LTC Graduate Seminar
June:  What the HECM is Happening with Reverse Mortgages?
July:  Why Don’t More People Buy LTC Insurance?
August:  LTC Truth to Power
September:  The Medicaid Long-Term Care Reform Act of 2012
October:  Medicare Expansion Could Be Last Straw for Private LTC Financing
November:  Cut Medicaid to Help the Poor

December:  The Myth of Unaffordability . . . Still!

And don’t miss Damon’s “Memory Lane” series highlighting the best of the best LTC Bullets over the years:

Memory Lane (1998-2001), May 2012
Memory Lane Part Two (2002-2005), May 2012
Memory Lane Part Three (2006-2009), June 2012
Memory Lane Part Four (2010-Present), November 9, 2012

The Center for Long-Term Care Reform published a total of 42 LTC Bullets in 2012.

LTC E-Alerts

Our LTC E-Alerts serve a different purpose.  We scan the print and electronic literature on long-term care services and financing every day.  We identify the articles, speeches and reports that we consider most important for Center members to read, hear or see.  Then we cite them by date, title and author; we provide a representative quote from the source; and we give our “take” on what it means in our “LTC Comment.” 

The main idea behind the LTC E-Alerts is to lift the burden of time-consuming research off the shoulders of LTC professionals whose time is better spent providing financial planning advice to clients, selling long-term care insurance, counseling borrowers on home equity conversion, or supplying any of the many other critical services our members provide.  It’s called “division of labor.”  We have to stay abreast of everything that’s happening in the popular and professional media.  We pore over tons of material so you don’t have to spend nearly as much time doing so.

The Center for Long-Term Care Reform published a total of 37 LTC E-Alerts in 2012.

LTC Clipping Service

New in 2012, we began offering a clipping service in real time.  Instead of, or rather in addition to, getting a summary of the news and key professional developments once a week, we send you an average of three items per work day.  Reading them on the go keeps your professional knowledge at a peak minute-by-minute.  It makes a nice break from other duties.  And you’re probably more likely to read a few items per day than to go through the whole list of publications in the weekly LTC E-Alerts at a sitting.

We announced the LTC Clipping Service in LTC Bullet:  New LTC Clipping Service in January 2012.  Check it out for all the details and pricing.  Want to subscribe?  Contact Damon at 206-283-7036 or

The Center for Long-Term Care Reform has published a total of 812 LTC Clippings so far in 2012 or roughly 2.3 per calendar day or 3.1 per work day.


Here are a few examples of the media coverage the Center for Long-Term Care Reform attracted in 2012:

Thomas G. Donlan, “A Medicaid Mess,” Barron’s, January 14, 2012,  Quotes Steve Moses, references the Center for Long-Term Care Reform, and covers the problem of Medicaid planning.

Rob Nikelewski, “New Mexico’s impending old age crisis: We’ve got the fourth-highest rate of growth 85+,” Capital Report New Mexico; Read the full interview and watch a two-minute video interview here.

Allison Bell, “LTCI Watch:  Maine,” LifeHealthPRO, September 13, 2012,; article about the Center’s project in Maine based on our LTC Bullet titled “The Maine Thing About Long-Term Care.”

Publications (Moses Byline)

Here’s a sampling of Steve Moses’s published articles this year:

"Near-Term Prospects for Long-Term Care Financing Reform:  Final Report to the Milbank Foundation for Rehabilitation,” Center for Long-Term Care Reform, Seattle, Washington, January 27, 2012;

“How to Fix Long-Term Care:  Six Briefing Papers,” Center for Long-Term Care Reform, Seattle, Washington, February 3, 2012;

“Foreword” to “The Completely Understandable LTCI Buyer’s Guide,” by Craig McCormick, LTCI Educational Services, Inc., 2012;

“The Medicaid Long-Term Care Reform Act of 2012,” Insurance Forums, October 9, 2012;

Speeches and Briefings

The Center for Long-Term Care Reform had a good year getting in front of audiences all over the country with our important message.  Here’s a sampling:

On March 19, Steve Moses debated Harley Gordon at the 12th Annual Intercompany Long-Term Care Insurance Conference in Las Vegas in a program titled the “Clash of Titans.”  Read all about it here:  LTC Bullet:  LTC Embed Report from the ILTCI Conference in Las Vegas.

Steve addressed a Rotary Club in Bellevue, Washington; Estate Planning Councils in Erie, Pennsylvania and Baltimore, Maryland; and the Maryland Health Underwriters Association as well as presenting webinars that reached hundreds of LTC professionals electronically.

Season’s Greetings

All in all, 2012 was a good year.  We look forward to an even better 2013 as the ground is more fertile for public policy research and advocacy with the President and Congress beginning new terms.

We wish our many friends and members a Happy Hanukkah, Merry Christmas and Happy New Year.

The Center’s Clipping Service will continue without interruption, but for everything else, see you next year.