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State Reports (continued)

Several states have contracted Center President Stephen Moses to find ways to reduce excessive demand for Medicaid long-term care benefits. The exact scope of each report varies, depending on each state's individual needs and demographics, though all focus on reducing Medicaid dependency. The length and depth of research was contingent upon available funding; the most comprehensive report was done for Illinois.  You may order state reports by calling 206-283-7036, faxing 206-283-6536, or e-mail  (prices vary)





New Jersey



South Dakota






*Reports available to read online in pdf format.  

The Heartland Manifesto: How to Finance Long-Term Care for Middle America, A Case Study in South Dakota, LTC, Incorporated, Seattle, Washington, 1996, 67 pages, $13.95 (hard copy or disk)  return to top

This study applies the Magic Bullet principles and analysis to a sparsely populated Great Plains state and concludes: "South Dakota should not try to solve the long-term care financing problem by denying the succor of medical care to more of her citizens. She should not address these issues by reducing provider reimbursement rates below the minimum required for adequate care. She should not correct the system by plunging ever more of the taxpayers' money into the black hole of institutional long-term care. The real solution is simple, economically sound and politically feasible. Merely change the incentives in the system so that South Dakotans plan ahead for long-term care, purchase private long-term care insurance, tap the equity in their homes, and utilize private home and community-based services. Divert them from the sorry fate of ending up in nursing homes on welfare prematurely by default. By doing so, the state can save Medicaid for the truly needy who cannot manage without it, relieve the overburdened taxpayers, empower the providers of long-term care with more private payers, and supercharge the financial services and long-term care insurance industries."


The Jersey Share: How to Pay for Long-Term Care with Less Federal Money, A Case Study in New Jersey, LTC, Incorporated, Seattle, Washington, 1996, 104 pages, $23.95 (hard copy), $14.95 (disk)  return to top

This study, commissioned by the New Jersey Department of Health and Senior Services, examines the state's long-term care financing crisis, explores the problem of Medicaid estate planning, and warns about the risks of making Medicaid even more attractive to the middle class by facilitating access to publicly financed home and community-based services. The report offers 46 recommendations, provides an extensive bibliography of related publications, and supplies a model state statute.


The Magic Bullet: How to Pay for Universal Long-Term Care, A Case Study in Illinois, LTC, Incorporated, Seattle, Washington, 1995, 142 pages, $29.95 (hard copy), $17.95 (disk)  return to top

This study, commissioned by the Illinois Department of Public Aid, disproves the idea that Medicaid requires impoverishment, debunks 11 fallacies about Medicaid nursing home eligibility, and provides 88 specific recommendations on how Medicaid can save $5 billion per year (nationally) while improving access to and quality of care. This widely publicized report, the magnum opus of LTC Inc.'s "Magic Bullet" series, was the basis for the Heritage Foundation's $25 billion, five-year savings proposal to Congress.

Read it here:


The Long-Term Care Financing Crisis: Danger or Opportunity?, A Case Study in Maryland, LTC, Incorporated, Seattle, Washington, 1995, 51 pages, $23.95 (hard copy), $13.95 (disk)  return to top

This study analyzes the Medicaid nursing home cost explosion, offers a practical plan of corrective action and includes a model state statute to expedite long-term care savings and improvements. Legislators, policy-makers and administrators will find this report invaluable in controlling Medicaid expenditures.


The Florida Fulcrum: A Cost-Saving Strategy to Pay for Long-Term Care, LTC, Incorporated, Kirkland, Washington, 1994, 181 pages, $22.95 (hard copy), $12.95 (disk)  return to top

The Florida State Legislature mandated this study to "develop a proposal to limit resource and asset transfers for the specific purpose of obtaining Medicaid eligibility for long-term care services." The report concludes that Florida can recover $2 million dollars per year from recipients' estates and save another $160 million annually by closing Medicaid loopholes and encouraging private long-term care financing options. These savings would empower the state to replace its draconian "income cap" with a more generous "medically needy" nursing home eligibility system. The report includes (1) 44 recommendations on how to target Medicaid nursing home benefits to the neediest, (2) the most comprehensive bibliography on Medicaid estate planning ever published, and (3) the results of a nationwide survey on state Medicaid asset transfer, lien and estate recovery policies and practices. 

Read it here:


Medicaid Estate Planning in Kentucky: How to Identify, Measure and Eliminate Legal Excesses, LTC, Incorporated, Kirkland, Washington, 1993, 27 pages, $9.95 (hard copy), $7.95 (disk)  return to top

What are the major "loopholes" in Medicaid nursing home eligibility? How do Medicaid estate planning attorneys take advantage of elasticity in the rules to benefit their affluent clients? What are the best ways to document the frequency and magnitude of these practices? What measures can states take to control Medicaid planning and limit financial expenditures to affordable levels? This report answers these questions succinctly for Kentucky. It applies equally well to other states with generous Medicaid nursing home eligibility rules.


Medicaid Estate Recoveries in Maine: Planning to Increase Non-Tax Revenue and Program Fairness, LTC, Incorporated, Kirkland, Washington, 1993, 7 pages, $9.95 (hard copy), $7.95 (disk)  return to top

"Eighty percent of all residents in Maine's nursing homes are already covered by the Medicaid program. The remaining 20 percent could be on Medicaid within 30 days (days, not months!) if they chose to hire one of the attorneys we interviewed or to buy one of the self-help guides we discussed." This report explains how Maine can save $35.5 million per year (20 percent of the state's Medicaid nursing home budget) by recovering efficiently from estates and encouraging the purchase of private long-term care insurance.


Long-Term Care in Montana: A Blueprint for Cost-Effective Reform, LTC, Incorporated, Kirkland, Washington, 1993, 86 pages, $19.95 (hard copy), $12.95 (disk)  return to top

The Montana Department of Social and Rehabilitation Services commissioned this project to learn how "to get the most out of OBRA '93." The purpose of the study was to develop a long-term care policy for Montana which reduces public assistance expenditures by diverting affluent citizens to privately financed care while simultaneously ensuring access for everyone to high quality home, community-based and nursing-home care. The report contains 8 pages of detailed recommendations on how to close Medicaid loopholes, maximize estate recoveries, and divert prosperous people to private long-term care insurance and away from Medicaid.


The Senior Financial Security Program: A Plan for Long-Term Care Reform in Wisconsin, LTC, Incorporated, Kirkland, Washington, 1992, 76 pages, $19.95 (hard copy), $10.95 (disk)  return to top

This case study of Medicaid estate planning, commissioned by Wisconsin Governor Tommy Thompson, covers the techniques people use to qualify for Medicaid nursing home benefits without spending down, the status and growth of this practice, the potential impact on the state budget, and methods to control the damage, reverse the process and encourage more responsible long-term care planning. A major finding: "Medicaid nursing home eligibility is so generous in Wisconsin that most seniors who need long-term care qualify financially even without any sophisticated financial planning. Anyone else can qualify quickly, often overnight, by using techniques such as joint accounts, trusts, purchase of exempt assets, or multiple divestment... Wisconsin could save $106 million per year by diverting ten percent of future nursing home caseloads into private pay status" in accord with the report's recommendations.


A Minnesota Prospectus for the Senior Financial Security Program, LTC, Incorporated, Kirkland, Washington, 1992, 5 pages, $9.95 (hard copy), $7.95 (disk)  return to top

This report summarizes the status of "Medicaid Mining in Minnesota," draws the comparison to Wisconsin, which has already acted aggressively to control Medicaid planning abuses, enumerates the questions Minnesota must answer before taking action itself, and recommends a quick turnaround study to provide the solutions.


Medicaid Estate Recoveries in Massachusetts: How to Increase Non-Tax Revenue and Program Fairness, LTC, Incorporated, Kirkland, Washington 1990, 9 pages, $9.95 (hard copy), $7.95 (disk)  return to top

This paper reports on a quick turnaround study of divestiture, asset sheltering and estate recoveries in Massachusetts. State eligibility staff reported that "long-term care units are barraged by [Medicaid planning] goes on all day...the system leaks all over the place...the laws and policy set us up for failure...the workers feel gets is morally terrible." Thirty to 50 percent of Medicaid nursing home cases in the prosperous suburbs of Boston involve the use of divestment or sheltering techniques. Massachusetts could constrict the loopholes and collect an extra $30 million from estates by implementing 23 "best practices" from other states.






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