LTC Bullet: What Have You Done for
December 20, 2013
LTC Comment: Our annual report on the Center for Long-Term Care Reform’s
year follows the ***news.***
*** MEMBERSHIP BENEFITS. Let’s take a moment to review the benefits of
individual and corporate membership in the Center. For more details, see
Levels and Benefits Schedule.”
In a nutshell, as a regular member of the Center ($150 per year or
$12.50 per month), you’ll get our weekly LTC Bullets and LTC
E-Alerts and a user name and password for access to our “Members-Only
In “The Zone,” you’ll find the “Almanac of Long-Term Care,” our
compendium of LTC news, reports and statistics stretching back more than a
decade with links to critical research materials covering eleven topics
from “Aging Demographics” to “Unfunded Liabilities.”
Other features in The Zone include key Medicaid and Medicare
numbers updated yearly and archived, a transcription of our highly
regarded “Long-Term Care Graduate Seminar,” links to the major current and
past “Long-Term Care Cost Surveys,” a couple dozen reasons why veterans
should not rely on VA benefits for long-term care and much more.
If you’re really serious about a career in long-term care financing, then
join the Center as a “Premium Member” ($250 per year). At that
level, you’ll have all the benefits of regular membership plus email and
phone access to Steve Moses with a 24-hour turnaround and a subscription
to our “Clipping Service,” placing you on the pioneering forefront of
up-to-the moment news, data and analysis in your field.
Premium Elite members ($500 per year) get all of the above plus a
complimentary LTC Bullet or LTC E-Alert sponsorship with a
banner ad, complimentary Center membership for one assistant, and
quickest-turnaround email and phone access to Steve Moses.
Regional Representative members ($500 per year) get all of the
above and, after they meet all the qualifications—including five years
qualified experience and completion of our LTC Graduate Seminar—the status
of Regional Representative of the Center for Long-Term Care Reform.
Every member of the Center gets the “Big Benefit”: the knowledge
and personal satisfaction that you're supporting the indefatigable
research and public policy advocacy of the Center for Long-Term Care
Corporate membership at the Bronze, Silver, Gold and higher levels
is also available. Each level includes the same benefits individual
members receive for increasing numbers of employees or producers plus
additional benefits exclusively for corporate members. ***
LTC BULLET: WHAT HAVE YOU DONE FOR ME LATELY?
LTC Comment: 2013 was a frustrating year for long-term care policy. We
waited month after month for the LTC Commission to be appointed only to
wait longer for them to begin deliberations and finally to produce an
anti-climactic report which fell on deaf ears. It was another fruitless
effort and lost opportunity, despite the valiant efforts and hard work of
a few clear-thinking members.
Then implementation of the Affordable Care Act, alias ObamaCare, stole the
national spotlight. So far, no one has formally identified the third
graders who designed Healthcare.gov, but rumor has it they are being held
back for a year. In fact, the whole Rube Goldberg scheme to hijack health
care is failing fast. Now we worry, was that their goal in the first
place—to pave the way for a single-payer system? Will they snuff out the
last embers of a free market in health care or will a better system rise
like a Phoenix from the ashes, sloughing off both ObamaCare and the crony
capitalist mixed system that preceded it?
In the meantime, the only viable alternative to welfare-financed long-term
care is less than healthy. More long-term care insurance carriers left
the business or raised premiums and regulators threaten to make life even
more difficult for the brave companies and souls who remain. The Federal
Reserve plans to keep interest rates near zero for at least another year
propping up government’s deficit spending and Medicaid expansion while
devastating the private insurance industry’s financial reserves and
destroying its customers’ ability to afford its products.
Nor is home equity conversion yet a viable financing source for long-term
care. Starting January 1, 2014, Medicaid’s home equity exemption
increases from a minimum of $543,000 in most states to a maximum of
$814,000 in 13 states. That travesty is only exceeded by the widespread
abuse of Medicaid-compliant annuities, which were granted a longer lease
on life by three major court cases this year. The wealthy can easily
divest unlimited amounts of money, qualify for Medicaid LTC overnight, and
crowd out poor people from the best long-term care by paying privately for
How bad is this situation? That’s exactly the question we set out to
answer with the “Index of Long-Term Care Vulnerability” which figures
prominently in the Center’s 2013 publications discussed below. It’s
probably too late now to avoid a catastrophic financial meltdown, so
what’s important next year is to understand the risk and do whatever we
can do to mitigate the damage. That will remain the Center for Long-Term
Care Reform’s focus in 2014.
Nevertheless, we expect 2014 to begin a turnaround. Disenchantment with
Medicaid expansion on the acute and long-term care sides will grow.
Political support for ever-more-deficit spending with borrowed funds will
decline. Disillusionment with entitlement programs and increasing
evidence of their unfunded liabilities will compel thoughtful citizens to
reassess their retirement risks and take more personal responsibility.
The more of them who do so the less disastrous the inevitable collision
with financial reality will be when it occurs.
On that happy note, let’s turn to the Center for Long-Term Care Reform’s
year in brief.
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 1025 Bullets (so far), by date
here and by topic
here. These 1000 plus articles are a valuable historical resource.
Make use of them.
In 2013, to celebrate the Center’s 15th anniversary (April 1,
2013) and our thousandth LTC Bullet (published May 25, 2013), we
began a retrospective series highlighting the most interesting and
dramatic LTC Bullets that we’ve published since the Center’s
founding in 1998. We’ve completed four of our seven main topical areas.
Check them out as compiled, edited and published by Damon:
Bullet: The LTC Problem and Solutions: Thousand Bullets Retrospective”
Bullet: Reality Check: The Facts on LTCI: Thousand Bullets Retrospective”
Bullet #1,000: Medicaid Planning: Thousand Bullets Retrospective”
Bullet: LTC Services: Thousand Bullets Retrospective”
In 2014, we’ll bring you the remainder of our retrospective series
covering these topical areas: “Politics and Legislation”; “Demographics
and Other Data”; and “CLTCR News.” Stay tuned.
Highlights of our 2013 LTC Bullets include:
So What If the Government Pays for Most LTC?, 2011 Data Update
Bipartisan Congressional Blast at New York Medicaid
National LTC Commission Disbanded: Did this April Fool’s report by
spokesman “Tungan Sheek” catch you off guard?)
SCAN the LTC Possibilities
Let’s Play LTC Jeopardy
The Role of Estate Recoveries in LTC Financing
Medicaid Spend Down that Isn’t and Why it Matters
Do the Rich Benefit from Medicaid?
The Tarnished Name of Assisted Living
Why Don’t Children Buy LTCI for Parents?
December: A twofer:
Government LTC is Getting Old
announced publication of our Georgia
The Index of Long-Term Care Vulnerability: A Case Study in Virginia.
The Center for Long-Term Care Reform published a total of 43 LTC
Bullets in 2013.
Our LTC E-Alerts serve a different purpose than the Bullets.
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
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 38 LTC
E-Alerts in 2013.
LTC Clipping Service
2013 was our second year offering a clipping service in real time. In
addition to getting a summary of the news and key professional
developments once a week, we send our clipping service subscribers an
average of three items per work day. Reading them on the go keeps your
professional knowledge at a peak minute-by-minute. They make 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 explained all the details and pricing for the LTC Clipping Service in
LTC Bullet: New LTC Clipping Service. Check it out. If you’d like
to subscribe, contact Damon at 206-283-7036 or
The Center for Long-Term Care Reform published a total of 742 LTC
Clippings so far in 2013 or roughly 2.1 per calendar day and 3.0 per work
The Center for Long-Term Care Reform published three major reports in
2013. One more is pending and we hope to report its publication before
the end of this year. Check them out at these links:
Maximizing NonTax Revenue from MaineCare Estate Recoveries, Center
for Long-Term Care Reform, Seattle, Washington, May 15, 2013.
The Index of Long-Term Care Vulnerability: A Case Study in Virginia,
published simultaneously on November 26, 2013 by the
Thomas Jefferson Institute and the Center for Long-Term Care Reform
The Index of Long-Term Care Vulnerability: A Case Study in Georgia,
published simultaneously December 3, 2013 by the
Georgia Public Policy Foundation and the Center for Long-Term Care
Pending publication: The Index of Long-Term Care Vulnerability: A
Case Study in New Jersey.
Our three most recent study reports all carry the title “The Index of
Long-Term Care Vulnerability.” The Index is a seven-part analytical tool
with numerous subparts designed to help legislators and policy-makers
measure the sustainability of their states’ Medicaid and long-term care
financing systems. Its objective and empirical metrics facilitate
analysis of Aging Demographics, Morbidity, Medicaid viability, Federal
financing, State financing, Private financing, and Entitlement mentality
as these factors will impact long-term care in the future. In each of our
“Index” reports, you will find a version of the Index filled out by Steve
Moses and another blank version which you are invited to fill out based on
your own opinion of how each of the key factors should be weighted and
Other publications by the Center this year included:
“States Decry Medicaid LTC Loopholes,” Long Term Care News, Issue
Number 34, June 2013, pps. 20-23.
“Government Role in Long-Term Care: It's Getting Old,” op-ed posted on
December 6, 2013 by the Georgia Public Policy Foundation:
“Government's role in long-term care is getting old,” The Columbia
County News-Times, December 11, 2013,
Steve Moses addressed 125 LTCFP partners at their annual all-partners
meeting in San Diego on January 12, 2013; 15 dinner guests of the Maine
Heritage Policy Center in Bangor, Maine on May 22, 2013 regarding
MaineCare’s long-term care program, our studies, and the importance of
estate recovery; 60 luncheon guests of the Maine Heritage Policy Center in
Portland, Maine on May 23, 2013 on the same topic; 40 attendees and a
live C-SPAN 2 audience at the American Enterprise Institute on
May 31, 2013 for a program titled “Long-term
care: Markets or mandates?” Video here:
70 agents on an AIM webinar on July 30, 2013 titled "Long Term Care Update
-- Congressional Committee Status"; 40 MBA and other students at the
Wharton Business School by Skype video on September 18, 2013; 40 state
attorneys at the 46th Annual Conference of the American
Association of Public Welfare Attorneys in Newport, Rhode Island on
November 12, 2013 and 28 attendees at the Virginia Health Care Round Table
on December 12, 2013 sponsored by the
Thomas Jefferson Institute for Public Policy.
Plans for 2014
We’re still formulating our strategy for the coming year. A likely target
of our efforts is the egregious abuse of Medicaid-compliant annuities
which we documented this year in two of our reports. We have in mind a
research project to review the loophole in federal law that enables the
practice and to document more cases like the $450,000 and $900,000
examples we discovered this year. If we can get the support for such a
study and conduct it, we’ll produce the evidence and argument to convince
Congress to end this Medicaid planning gimmick.
Further plans involve refining the Index of Long-Term Care Vulnerability,
applying it in more states, and bringing the results to the attention of
the powers-that-be who can adjust course and improve likely future
All in all, 2013 was a challenging year for long-term care financing and
for your Center. We look forward to a better 2014 as the ground becomes
more fertile for public policy research and advocacy. The pendulum has
begun to swing back, away from expansion of government dependency and
toward more fiscal responsibility.
We wish our many friends and members a Merry Christmas and Happy New Year.
The Center’s Clipping Service will continue without interruption, but for
everything else, we’ll see you next year.