LTC Bullet:  The Index of Long-Term Care Vulnerability:  A Case Study in New Jersey

Friday, January 17, 2014


LTC Comment:  The Center for Long-Term Care Reform and the Common Sense Institute of New Jersey have published “The Index of Long-Term Care Vulnerability:  A Case Study in New Jersey.”  Details after the ***news.***

***  "FRESH THINKING ON LONG-TERM CARE FINANCING:  THE AMERICAN LONG-TERM CARE INSURANCE PROGRAM" by Federal Long-Term Care Insurance Program CEO Paul Forte is a thoughtful, well-documented Contingencies article well worth a careful reading.  Unfortunately, his proposal leaves little room for LTCI producers and it does not solve the problem of easy Medicaid LTC access after the insurable event occurs.  Quote:  "Many U.S. policymakers believe that there's no way a voluntary long-term care (LTC) insurance program can attract a critical mass of enrollees. Given the 2011 severing of the optional federal Community Living Assistance Services and Supports Act from the Affordable Care Act (ACA) and a continuing exodus of private insurers from the LTC market, this isn't surprising. But arguing that any LTC program must be mandatory ignores both the federal budget deficit and ongoing political resistance to mandatory provisions in the ACA." ***

*** THE FOURTEENTH ANNUAL INTERCOMPANY LONG TERM CARE INSURANCE CONFERENCE will be held March 16-19, 2013 at the Rosen Centre, in Orlando, FL.  Find details and registration at the conference website here:  If you have questions, please contact Jim Glickman at 818-867-2223.  Check out the closing conference session on “The Future of the Industry Session” here.  Genworth's CEO Thomas J. McInerney will complete the panel previously announced.  Conference highlights also include keynoter Chris Gardner, whose life story The Pursuit of Happyness became a best-selling book and movie. ***

***  THE INSTITUTE FOR THE AGES has announced that National Public Radio (NPR) correspondent Ina Jaffe will headline the dinner keynote presentation at the Seventh Annual International Conference on Positive Aging on February 11, 2014 at the Hyatt Regency in Sarasota, Florida.  For more information about the Conference program, travel and hotel arrangements, and other details, visit  Tickets may be purchased online at  Sponsorship opportunities are still available.  Please email inquiries to or contact Michelle Bauer at 727-510-2524. ***



LTC Comment:  Last summer, the Center for Long-Term Care Reform conducted research on Medicaid and long-term care financing in three states:  Virginia, Georgia and New Jersey.  Last month, we published our reports on the first two states in “The Index of Long-Term Care Vulnerability:  A Case Study in Virginia” and “The Index of Long-Term Care Vulnerability:  A Case Study in Georgia.”  On Wednesday, January 15, 2014, we released the third and last report in the current series titled “The Index of Long-Term Care Vulnerability:  A Case Study in New Jersey.” 

Today we bring you the Executive Summary of the New Jersey report and encourage you to read any or all of the three studies.  Each report features a new tool, called the “Index of Long-Term Care Vulnerability.”  The purpose of the Index is to help legislators, policy makers and analysts assess the future sustainability of their states’ long-term care financing systems.  

Try your hand at filling out the “Index” for your state.  You’ll find two links to the Index tool at the end of each report.  One link goes to a sample version I filled out as an example.  The other link goes to a blank version you can use to evaluate the state of your choice.  See the body of each report for links to the sources you’ll need to find the data for your state.

Soon, we will publish a comparative analysis of Medicaid and long-term care financing in the three states comparing them to each other and to the USA as a whole.  This year, we plan to apply The Index of Long-Term Care Vulnerability to more states and to bring the findings to the attention of key state and federal decision makers.


Executive Summary from “The Index of Long-Term Care Vulnerability:  A Case Study in New Jersey,” by Stephen A. Moses, published simultaneously by the Common Sense Institute of New Jersey here and by the Center for Long-Term Care Reform here, on January 15, 2014.

Long-term care (LTC) for the elderly is already a large risk and expense for private citizens and public programs.  The need for and cost of LTC will increase radically with the aging of the baby-boom generation.  Most expensive long-term care, including care provided in nursing homes or by professional aides in family homes for more than nominal durations, is paid for by Medicaid, a means-tested public assistance program. 

Medicaid already strains federal and state budgets, including New Jersey’s.  Yet major initiatives at the federal level and in New Jersey are underway to expand Medicaid coverage in general and to make the program’s LTC benefits more attractive, accessible and efficient.  New Jersey’s “Comprehensive Medicaid Waiver” aspires to achieve those goals by rebalancing care from mostly institutional services to mostly home and community-based services and by turning over management of long-term care for more recipients with higher acuity care needs to managed care organizations.

New Jersey faces multi-faceted long-term care problems including (1) a rapidly increasing elderly population with (2) much higher numbers of disabled or demented people coming soon and (3) Medicaid already strained as the principal LTC payer dependent on (4) funding from the heavily indebted federal government as supplemented by (5) state revenues constrained by recessionary pressures and poor future economic prospects with (6) very little private financing of LTC to relieve the budgetary pressure on public programs in the context of (7) heavy public dependency on social programs already and a growing “entitlement mentality” among the citizenry.

By focusing on improving the state’s current long-term care service delivery and financing program instead of taking into account this full range of problems and addressing it, New Jersey runs the risk of modifying a broken LTC system that cannot survive the larger on-coming demographic, economic and social challenges.  This report offers a way to take account of these broader challenges by applying an Index of Long-Term Care Vulnerability.  It recommends that New Jersey reassess its current LTC initiatives and move in the direction of reducing dependency on public programs while attracting much more private revenue into the LTC financing mix.