LTC Bullet:  What Have You Done for Me Lately?

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 our “Membership 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 Zone.”

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 Reform.

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 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, 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 awhile.

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.

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 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:

 “LTC Bullet:  The LTC Problem and Solutions:  Thousand Bullets Retrospective

LTC Bullet:  Reality Check: The Facts on LTCI:  Thousand Bullets Retrospective

LTC Bullet #1,000:  Medicaid Planning:  Thousand Bullets Retrospective

LTC 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:

January So What If the Government Pays for Most LTC?, 2011 Data Update
February Bipartisan Congressional Blast at New York Medicaid
March National LTC Commission Disbanded:  Did this April Fool’s report by spokesman “Tungan Sheek” catch you off guard?)
April:  SCAN the LTC Possibilities
May Let’s Play LTC Jeopardy
June The Role of Estate Recoveries in LTC Financing
July Medicaid Spend Down that Isn’t and Why it Matters
August Do the Rich Benefit from Medicaid?
September:  The Tarnished Name of Assisted Living
October Why Don’t Children Buy LTCI for Parents?
November Annuity Blues
December:  A twofer:  Government LTC is Getting Old announced publication of our Georgia report and 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.

LTC E-Alerts

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 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 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 day.


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 (archived here.)

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 Reform (archived here.)

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 scored.

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 outcomes.

Season’s Greetings

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.