 LTC Bullet: Bridging LTC Silos Friday, May 1, 2026 Seattle— LTC Comment: LTC providers and insurers communicate too little, hewing jealously to their professional bailiwicks. We try to narrow the gap after the ***news.*** *** LTC CLIPPINGS: Did you catch these stories this week? Our LTC Clippings subscribers received them in real time including Steve Moses’s always trenchant, often ironic, sometimes humorous, usually concise “LTC Comments.” To subscribe or for a free trial, contact Damon at 206-283-7036 or damon@centerltc.com. Examples below: 4/28/2026, “New Law Caps Home Equity for Medicaid Long-Term Care,” by Lee Pruitt, ElderLawAnswers Quote: “A new federal law, effective in 2028, will cap the amount of home equity a person can have and still qualify for Medicaid long-term care at $1 million. This $1 million limit will not increase with inflation, meaning more homeowners will be affected over time as property values rise. If your home equity is near or above $1 million, consult an elder law attorney now to explore options like reverse mortgages or legal transfers before the 2028 deadline.” LTC Comment: Good advertising hook for Medicaid planners, huh? An open invitation to ignore private LTC insurance and rely on taxpayers to protect home equity from LTC risk. What’s even worse, the same Medicaid planners will tell people with less home equity and a lot of cash to convert the countable cash to exempt status by added spending on the home. After they pay the attorney’s fee first, which is also exempt. Just another example of “What’s Worse than Medicaid Fraud.” ---------------------- 4/27/2026, “Medicaid Waste, Fraud, and Abuse: Why CMS’s Improper Payment Rate Can’t Be Trusted,” by Chris Medrano and Brian Blase, Paragon Health Institute Quote: “Medicaid’s improper payment rate is widely misunderstood. PERM provides a narrow compliance estimate and is not a reliable measure of waste, fraud, abuse, or total improper payments in Medicaid. Major gaps in eligibility determinations and managed care payments make PERM incomplete. The program does not fully capture eligibility errors and fails to examine managed care payments at the provider level—despite managed care representing the majority of Medicaid spending. Low reported error rates risk creating a false sense of security. Because PERM relies on limited samples and lagged data, its findings understate risks and the scale of improper payments. Policymakers should strengthen PERM to improve accountability and enable enforcement actions in Medicaid.” LTC Comment: Bottom line: no one knows how much fraud, waste and abuse permeate Medicaid because such limited measurements as exist are fatally flawed. How refreshing that this critical subject is finally getting the attention it deserves. ***
LTC BULLET: BRIDGING LTC SILOS LTC Comment: Have you noticed how little the people and companies responsible for providing long-term care (LTC) communicate with the people and companies responsible for funding LTC? You would think these two industries should have much to discuss. Nursing homes and home health agencies desperately need revenue. LTC insurers struggle to attract buyers. But the two professions rarely work together. Both face a common problem. Medicaid pays LTC providers too little, often less than the cost of providing the care. Easy access to Medicaid when care is needed crowds out demand for private LTC insurance. Logically, LTC providers and insurers would unite and mobilize to advocate for policies that target Medicaid benefits to the neediest Americans and divert the well-to-do toward private financing, so that they pay economically sustainable market rates. The Center for Long-Term Care Reform has published dozens of national and state-level studies proposing policy solutions along those lines. Most recently, “Long-Term Care: The Problem” and “Long-Term Care: The Solution” with the Paragon Health Institute. At the same time, we have placed articles and columns in trade journals and other publications intended to link the interests of LTC providers and insurers. Following are some examples from October 2021 through April 2024. We hope you’ll open and read some of them and that they will help tie together the interests and policies of LTC providers and insurers.
|