LTC Bullet:  Cassandra’s LTC Recommendations 

Friday, January 29, 2016


LTC Comment:  Our recommendations for federal and state long-term care policy changes follow the ***news.***

*** TAKE THE KFF’S MEDICAID AND LTC QUIZ:  We sent the following LTC Clipping to our clippings subscribers last week.

 1/27/2016, “Medicaid and Long-Term Care Quiz,” Kaiser Family Foundation

Quote:  “Medicaid and Long-Term Care Quiz:  Medicaid, the nation’s major publicly-financed health insurance program, plays an important role in the delivery and financing of long-term care (LTC) services. These services include a broad range of paid and unpaid medical and personal care assistance. Long-term care is not medical in nature. Instead, it provides help with regular daily activities to support independent living. People may need LTC over a period of weeks, months, or years.  How much do you know about Medicaid and LTC?  Get Started

LTC Comment:  I aced the quiz and I bet most LTC Clippings readers will too. ***

*** WHY SUBSCRIBE TO LTC CLIPPINGS:  To counsel prospects and clients responsibly, financial advisors--including insurance agents--need to know more than basic demographic facts and product knowledge.  Good LTC planning requires understanding the six “blind men” of long-term care and how they interact:  government, consumers, advocates, providers, insurers and financiers.  For the details on that observation, read “The Elephant, The Blind Men and LTC” here.

How can you keep abreast of those complicated topics and their interactions?  You can spend dozens of hours every week canvassing the internet for relevant articles, speeches and reports.  Then scan volumes of useless information to find and absorb the few valuable gems of knowledge they contain.   Or you can subscribe to LTC Clippings and let us do that part of the job for you.

If you subscribe to LTC Clippings and invest a few minutes of your time each week to read and consider them, we promise you a plentiful and profitable source of actionable information and insights.  Contact Damon at 206-283-7036 or for details and to subscribe. ***

*** WIGGIN’ OUT FOR ALZHEIMERS VIDEO:  Steve Moses keynoted the ACSIA Partners 2016 Kick-Off Conference in Austin, Texas recently.  We published his remarks in LTC Bullet:  The Long-Term Care Crisis:  Why Now But Not Yet?, January 15, 2016.  Now see what Steve had to say at ACSIA Partners’ “Wiggin’ Out for Alzheimers” event that raised $19,000 for the Alzheimer’s Association.  Here’s the link: It may take a while to load. ***



LTC Comment:  Last week’s LTC Bullet brought you the “Summary” and “Conclusion” from our forthcoming report “Cassandra’s Quandary:  The Future of Long-Term Care in New Hampshire.”

We warned “From the foregoing analysis, it is hard to reach any other conclusion than to expect the current long-term care service delivery and financing system to face severe, possibly fatal challenges as the Age Wave crests and crashes on America.”

We concluded “that long-term care scholarship should angle away from narrow, marginal reforms of specific LTC service and financing problems toward comprehensive analysis and potentially radical restructuring with much heavier reliance on private planning and individual responsibility and much less dependency on public programs and funding.”

That said, what should federal and state policy makers do about the impending crisis in long-term care service delivery and financing?


Recommendations from “Cassandra’s Quandary:  The Future of Long-Term Care in New Hampshire” by Stephen A. Moses; to be published soon by
Federalism in Action and the Center for Long-Term Care Reform



1.  Change federal monetary policy (low interest rates, credit expansion, easy money) which has enriched the affluent by increasing equity and real estate values but hurt the poor and middle class by impeding job creation and nearly eliminating safe income from savings.

2.  Change federal fiscal policy (deficit spending) which has grown the national debt from $10.8 trillion in January 2009 to $18.9 trillion today, undermined social safety net programs with trillions of dollars in unfunded liabilities, and diverted capital away from productive private uses thus damaging the economy and inhibiting job creation.

3.  Change the Federal Medical Assistance Percentage (FMAP) system of funding Medicaid so that it does not incentivize excessive program expenditures and disproportionately benefit wealthier states and people at the expense of poorer states and people.

4.  Block grant Medicaid or cap federal funding with fewer mandates and controls in order to encourage and enable states to experiment with new, potentially more cost-effective approaches to long-term care service delivery and financing. 

5.  Let states target Medicaid to the needy by allowing them more freedom to set their own Medicaid long-term care eligibility standards.  For example, eliminate or radically reduce the mandatory home equity exemption currently set at between $552,000 and $828,000 while retaining reasonable protections for community spouses.

6.  Review federal restrictions on Medicaid estate recovery, encourage and publicize the responsibility of recipients with exempt wealth to repay Medicaid for their care from their estates, and use some of the savings to educate consumers about long-term care planning, home equity conversion, and long-term care insurance as options to fund LTC.

7.  Reassess waiver and incentive programs that encourage rebalancing from institutional to home-based care.  Programs that make Medicaid more attractive should await successful re-targeting of LTC benefits to the truly needy so they do not discourage private financing and overwhelm the publicly funded system.

8.  Reduce future numbers of Medicaid’s most expensive users, the dual eligibles, by tightening financial eligibility rules, including much longer transfer of assets lookback restrictions, so people will know they need to plan for long-term care many years before they become eligible for Medicare and vulnerable to Medicaid dependency.

9.  Reassess incentives for expanding LTC managed care and delay implementation, especially for dually eligible recipients, until demonstrations show more conclusively that Managed Care Organizations can handle the special challenges such patients entail.

10.  Recognize the damage done by the growing entitlement mentality and start weaning Americans, especially the non-poor off the dole in all its forms.

State Recommendations

1.  Advocate for the federal changes described above.

2.  Eschew complacency.  Take aging demographics much more seriously.  Focus on preparing for 2050 and 2025 will take care of itself.

3.  Review New Hampshire’s 209-B status for ways to tighten eligibility for Medicaid long-term care benefits.

4.  Enhance private LTC revenue sources by tightening eligibility, disallowing Medicaid planning wherever possible, encouraging personal responsibility for long-term care, publicizing estate recovery responsibility, and endorsing reverse mortgages and private long-term care insurance as preferable to Medicaid dependency.

5.  Reduce Medicaid LTC participation, utilization and costs so that the program can afford to pay adequately for a continuum of care for a smaller number of genuinely needy recipients.  In the meantime, don’t discourage “free” care by making Medicaid home and community-based care more attractive and easier to get. 

6.  Recognize the roles of Social Security and Medicare in sustaining Medicaid long-term care at sub-cost reimbursement rates.  Account for those programs’ fiscal vulnerability so that the state is not surprised and devastated by potential, and increasingly likely, federal cutbacks.

7.  Reduce dependency on federal funds in general.  End provider taxes specifically.

8.  Drop out of the Affordable Care Act, ObamaCare program before it makes New Hampshire even more dependent on dubious future federal funding.

9.  Take managed care for the aged, blind and disabled slowly, especially for duals. Reduce future duals by stronger eligibility controls and early consumer education.

10.  Enhance state revenue prospects by aspiring to better scores on economic rating systems.  Stop New Hampshire’s economic freedom slide.  Encourage economic activity by lowering taxes.  End Medicaid LTC financing by county property taxes or give counties a much stronger role in eligibility and other policies.  Fund the state pension system.