LTC Bullet: Medicaid and Long-Term Care

Friday, January 17, 2020


LTC Comment: We publish today the Center for Long-Term Care’s new flagship report titled “Medicaid and Long-Term Care.” Read it here after the ***news.***

*** We are aware of formatting problems in the new report, especially missing spaces. These occurred converting from Word to a .pdf. We’ll fix them, but in the meantime, the report is readable and we want to abide by the previously announced publication schedule. ***

*** ILTCI CONFERENCE NEWS: The 2020 Intercompany Long-Term Care Insurance Conference, scheduled for March 29 to April 1 in Denver, Colorado, has named its keynote speaker: Anders Sörman-Nilsson. He is a “global futurist and innovation strategist who helps leaders decode trends, decipher what’s next and turn provocative questions into proactive strategies.” That definitely sounds like something the private LTCI industry can use. Register for the conference here. Book your hotel before February 22. Early registration discounts ended January 16, but “sponsor applications” are still being accepted. ***

*** ILTCI CONFERENCE BACKGROUND: Organizers expect the highest attendance ever for this year’s conference. They have a new, semi-permanent byline for the annual meeting: “Inspire | Lead | Trust | Collaborate | Innovate.” The ILTCI conference has a long and distinguished history. Read all about it in our History of LTC Insurance Conferences with year-by-year summaries of each meeting, some with pictures and links to the more detailed contemporaneous reports. ***


LTC Comment: So many questions plague the issue of long-term care. Our new report answers them all:

  • If long-term care is such a big risk and cost, why don’t people worry about it enough to prepare?

  • How did nursing homes become the main care venue when most people prefer home care?

  • Why does America fund long-term care through a welfare program?

  • Does Medicaid long-term care eligibility really require impoverishment?

  • How much income and how many assets can someone keep and still have Medicaid pay for long-term care?

  • Why do most analysts completely ignore the vast popular and legal literature on qualifying for Medicaid without spending down?

  • Is another compulsory government entitlement program our only option as most analysts and their studies insist?

  • Or could private LTC financing predominate if Medicaid became a better safety net for the poor?

  • Does anyone care anymore about America’s exploding deficit and debt? If not, why not, and so what?

Steve Moses answers all these questions in “Medicaid and Long-Term Care.” We provide the paper’s “Abstract” below and urge you to read the full paper here:


How to provide and finance long-term care for a burgeoning elderly population bedevils scholars and policy makers. The existing service delivery and financing system, dominated by public funding, is highly dysfunctional, fraught with problems of access, quality, reimbursement, discrimination and institutional bias.

Most long-term care scholarship analyzes these symptoms, without explaining their cause, and recommends expanding government’s role, usually by means of a new or expanded mandatory, tax-funded social insurance program. This paper takes a different tack, first explaining why the long-term care market has the problems it does and then suggesting how to remove their causes.

At the root of all long-term care problems is Medicaid, the dominant payer. By providing only nursing home care—including room, board, and medical care—funded with virtually unlimited federal and state matching funds, Medicaid (1) exploded in cost, (2) created institutional bias, (3) caused access and quality problems by paying providers too little, (4) enriched plaintiff’s attorneys with the resulting tort liability cases, (5) crowded out private markets for home care and long-term care insurance, and (6) kept poor people poor with punishing spend down rules, while (7) letting the affluent save and benefit through eligibility loopholes.

The key to fixing the problems that plague long-term care is to make Medicaid a better safety net for the poor while diverting the general public to private financing alternatives. This paper explains how to do that while reducing government funding and regulation, which arguably caused the long-term care problems in the first place.