LTC Bullet:  “The Index of Long-Term Care Vulnerability:  A Case Study in Virginia” Published

Friday, December 6, 2013


LTC Comment:  Can the Commonwealth of Virginia’s Medicaid-based long-term care system survive?  Hard questions asked, analyzed and answered after the ***news***

*** SEND STEVE TO HEALTH CARE ROUNDTABLE in Richmond, VA.  The Thomas Jefferson Institute for Public Policy (TJI) published our major report titled “The Index of Long-Term Care Vulnerability:  A Case Study in Virginia.”  This study introduces the public policy world to our new “Index of Long-Term Care Vulnerability” which enables analysts to answer objectively the question:  can LTC financing survive in its current and tending form?  TJI is sponsoring an important “Health Care Roundtable” on December 12.  Steve Moses will present our report’s findings and join the discussion with some of the top health care policy analysts in the country, including Grace-Marie Turner of the Galen Institute, Michael Tanner of the Cato Institute and Bob Helms of the American Enterprise Institute. 

The Center for Long-Term Care Reform seeks to raise funds to support Steve’s trip to give this presentation and contribute to this important health policy conversation. 

Special deal:

Pledge any amount $25 or above to support this important project and we’ll comp you for a year of the Center’s clipping service (usually $120 minimum; valid for new clipping service subscribers only) at no extra charge. 

Pledge $50 or more and we’ll upgrade your Center membership to the next higher individual level, e.g. Regular membership ($150 per year) goes to Premium Membership (usually $250 per year); Premium goes to Premium Elite or Regional Representative ($500 per year, for those who qualify).  Check out our “Membership Levels and Benefits” for details on all membership levels. 

If you can help, let Damon know at or 206-283-7036.  He’ll subscribe you to the Clippings or upgrade your membership immediately, even while your check is in the mail. 

We’ll gladly make similarly attractive special offers to corporate donors willing to pony up somewhat larger amounts.  Just email Steve at or call him at 425-891-3640 to discuss and negotiate a bonus benefit most attractive to you and your company.

How to contribute:  Make your check out to Center for Long-Term Care Reform and send to: 2212 Queen Anne Avenue North, #110 / Seattle, WA  98109  --  Or contribute online here.

Our goal is to raise $1,500 to support this trip and opportunity.  Thanks in advance for your consideration and support. ***

*** IF YOU’RE NEAR RICHMOND, VA ON 12/12/13, YOU CAN ATTEND THE SAME EVENT and join Steve’s cheering section (free registration required, see below):  Leadership Roundtable On Health Care Reform — Register today for the next Leadership Roundtable hosted by the Thomas Jefferson Institute for Public Policy!  This Roundtable, on Health Care Reform, is sponsored by Verizon-Virginia and will take place on Thursday morning, December 12 in the Shenandoah Room of the SunTrust Building, (919 East Main Street in Richmond), from 8:30 am until noon.  The first half of the session will cover an update on Obamacare and possible reforms; the second half will discuss reforming or expanding Medicaid in Virginia.   Among the expert speakers confirmed –

  • Grace Marie Turner, President of the Galen Institute
  • Michael Tanner, Healthcare expert for the Cato Institute
  • Kevin Kuhlman, Manager of Legislative Affairs for the NFIB National Office
  • Robert B. Helms, Resident Scholar, American Enterprise Institute, and
  • Stephen Moses, Center for Long Term Care Reform (and author of a new Jefferson Institute study here)

Registration for this Leadership Roundtable is Free, but there is limited space available.  To register at no charge, please click here. ***

*** PUBLICATION ANNOUNCEMENT:  “The Index of Long-Term Care Vulnerability: A Case Study in Virginia — Virginia is faced with a serious problem as are all states:  The aging population requires us to determine how to handle the additional costs this will bring to government and personal budgets.  Long Term Care is one of the more important problems facing all parents, as parents, siblings, aunts and uncles live longer and longer.  What are the costs today?  What are the projections for these costs in the future?  And how should we consider restructuring this need for Long Term Care?  These are the questions and concerns examined by this new study on Long-term care funded by Medicaid. Read It Here!” ***

*** KEY NUMBERS UPDATED:  The Centers for Medicare and Medicaid Services (CMS) has updated the critical Medicare and Medicaid numbers for 2014.  For example, the home equity exemption for Medicaid increases from a minimum of $543,000 ($500,000 in 2010) to a maximum of $814,000 ($750,000 in 2010).  For all the new numbers, including the Community Spouse Resource Allowance (CSRA) and the Minimum Monthly Maintenance Needs Allowance (MMMNA) see our updated chart here.  It shows the year-by-year increases in all the key numbers as adjusted annually for inflation going back two decades.  You’ll need your Center Member’s-Only User Name and Password.  Need a reminder?  Or want to join the Center, receive our weekly publications and get access to The Zone?  Contact Damon at 206-283-7036 or ***



LTC Comment:  As ObamaCare doubles down on Medicaid for national acute-health-care policy, the beleaguered welfare program continues to undermine long-term care throughout the country.

After three decades of analyzing America’s long-term care financing system and proposing policy solutions in dozens of national and state-level studies here, we realized it may be too late to avoid a catastrophic meltdown of the system.

So we decided to ask a different question in three studies this year.  Instead of “What’s wrong and how can we fix it?,” we asked “What is the probability today’s LTC system can survive the challenges it faces?” 

Step one was to ask:  What are the main challenges our long-term care financing system(s) face?  We broke them into seven key questions:

1. How many older people are coming in the next few decades?  (The “Age Wave”)
2. How sick will they be?  (Morbidity)
3. How viable is Medicaid as a long-term care payer?
4. How reliable is federal revenue on which Medicaid mostly depends?
5. How reliable is state revenue on which Medicaid secondarily depends?
6. How much private-pay revenue is available to relieve LTC financing pressure on Medicaid?
7. How strong is dependency on public programs (i.e., the entitlement mentality)?

To measure those challenges, we developed an “Index of Long-Term Care Vulnerability.”  The Index enables a user to assign percentage weights of importance to each of the challenges and then to score and rank the national and state levels of achievement on each of several sub-issues within each challenge using objective metrics.

Not quite sure what we mean by that?  Then take this opportunity to read our first of three forthcoming reports that apply the Index of Long-Term Care Vulnerability to specific state Medicaid and long-term care financing systems.  You’ll find a full explanation of our methodology, a sample “Index” filled out by the author for Virginia, and an Index worksheet you can use to assign your own weights, ranks and scores to your own state.

The Thomas Jefferson Institute for Public Policy and the Center for Long-Term Care Reform published “The Index of Long-Term Care Vulnerability:  A Case Study in Virginia” last week.  You can read it at TJI’s website or the Center’s.

To whet your appetite for the full report, what follows is the “Foreword,” written by Michael Thompson, president of the Thomas Jefferson.  You can also read two media articles about our study here and here.


Michael W. Thompson

Virginia is faced with a serious problem as are all states: the aging population requires us all to figure out how to handle the “costs” that this is going to bring to government and personal budgets.

Long Term Care is one of the more important problems facing all families as parents, brothers and sisters and aunts and uncles live longer and longer.  What are the costs today, what the projections for these costs in the future, and how should we consider restructuring this need for Long Term Care in order for those who need it receive it, and that the burden on government – on the taxpayers – is kept within reasonable bounds?

It is these questions and concerns that prompted the Thomas Jefferson Institute to ask Stephen Moses of the Center for Long Term Care Reform to look into our program and, with his expertise from doing similar work in other states, to suggest what we ought to do here to prepare for this growing need within our society.  Four concerns popped out to me in this study that need to be opening and frankly discussed. They are:

1) Long-term care is expensive, funded mostly by Medicaid (considered part of our nation’s welfare program), heavily dependent on already strained state and federal revenue, and facing an on-coming wave of aging boomers who will test the adequacy of scarce public resources.

2) Virginia is one of only seven states in which the age 85 plus population, the cohort most likely to need LTC, is projected to more than quadruple between 2012 and 2050, up 307%! So financing long-term care in Virginia will become a huge problem.

3) The Commonwealth has doubled down on its Medicaid-financed LTC system by implementing major new programs to (a) “rebalance” services from nursing home care to home care (making Medicaid more desirable) and (b) to “manage” care by turning it over to large managed care organizations (making Medicaid recipients more vulnerable to cost cutting and quality problems).

4) While ramping up Medicaid for long-term care, Virginia has not done enough to encourage private sources of LTC financing that could relieve financial pressure on the tax-financed program. Asset spend down, estate recovery, home equity conversion and private long-term care insurance could and should contribute far more to financing quality LTC services.

This study, “The Index of Long-Term Care Vulnerability: A Case Study in Virginia,” focuses on this problem and offers some policy alternatives. At the end (in the Appendix) there is worksheet/an index process that policy makers, policy influencers and others can use to determine long term care needs depending on the variables outlined in this report. This is a serious problem that needs to be confronted sooner than later.

Michael W. Thompson, President, Thomas Jefferson Institute for Public Policy November 2013