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Join the Center for Long-Te Care Reform. Help us fight for rational LTC policy reform. Receive our daily email publications. Get a user name and password to our Members-Only Zone. Only $150 per year. Mail your check to Center for Long-Term Care Reform, Inc., 2212 Queen Anne Avenue North, #110, Seattle, Washington, 98109. Contact Damon at 206-283-7036 or damon@centerltc.com if you have questions. Join the team!

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Updated Monday, July 13, 10:03 AM (Pacific)

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LTC E-ALERT #26-024: LTC NEWS AND COMMENT

LTC Comment: Do you spend hours searching the internet for useful articles, key data, and relevant reports to keep you on the forefront of professional knowledge? Do you lose business because you’re blindsided by clients or competitors who learn critical information before you do? Here’s an antidote:

LTC Clippings: The Center for Long-Term Care Reform notifies subscribers to our LTC Clippings service daily of information you need to know. Each message contains only the critical facts about new publications: a title, representative quote, a link to the original, and our analysis in a sentence or two. To inquire or subscribe, contact Damon at 206-283-7036 or damon@centerltc.com. Read testimonials by satisfied subscribers here. To subscribe online, please click here.

LTC E-Alerts: Once a week, we compile our daily LTC Clippings into a summary, email it to Center for Long-Term Care Reform members, and archive it in The Zone, our password-protected members-only website. Center members also receive our weekly LTC Bullet op-ed. To join the Center and receive all these benefits and more, contact Damon at 206-283-7036 or damon@centerltc.com.

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

A New Option for Long-Term Care Costs
US adult obesity rate rose from 30% to 41% between 1999 and 2023, study finds
It’s Time To Reform How The Federal Government Funds State Medicaid Programs
Genworth CEO McInerney takes health leave as CFO Upton steps in
New tool helps providers, others estimate how long someone will be able to afford assisted living
Collateral damage: Medicaid work rules threaten nursing homes even if patients keep coverage
The families we serve are becoming the workforce we need
Long-Term and Assisted Care—Here’s What Medicare and Medicaid Do and Do Not Cover

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"LTC E-Alerts" are a feature offered by the Center for Long-Term Care Reform, Inc. to members at the $150 per year level or higher. We'll track and report to you news and analysis regarding long-term care financing, service delivery, and research. We hope The LTC E-Alerts will help you attain and maintain a high level of knowledge and competency in this complex field. The Center for Long-Term Care Reform, Inc. is a private institute dedicated to ensuring quality LTC for all Americans (www.centerltc.com).

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Updated Friday, July 10, 2026, 10:03 AM (Pacific)

Seattle—

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LTC Comment: If you think LTC is in trouble now, wait until the rest of the boomers hit age 65 in 2029! We explain after the ***news.***

*** Did you see all of these important LTC stories from the past few days? Probably not unless you track the industry media and academic publications full time. That’s what Steve Moses does so he can send these real time LTC Clippings to Center premium members daily.

7/8/2026, “As America Turns 250, It's Worth Celebrating Last Year's One Big Beautiful Bill,” by Brian Blase, Paragon Health Institute
Quote: “Maximizing freedom requires limiting government. Last year, Congress notched a win for freedom with the passage of the One Big Beautiful Bill (OBBB), or the Working Families Tax Cut Act. Although the cornerstone of the legislation was its provisions that lowered taxes, the legislation also expanded freedom by taking steps to reduce the tide of red ink emanating from federal health care programs, whose unsustainable growth poses one of the greatest threats to America’s long-term prosperity.”
LTC Comment: Have you seen the relentless media criticism of last year’s budget reconciliation law? Read this excellent summary of the OBBBA’s impact on government health care spending for a more accurate and objective analysis.

7/7/2026, “The Aging Population Is Changing States’ Revenue, Spending, and Service Demand Outlook,” PEW
Quote: “The United States’ population is aging rapidly. And as with other long-term shifts in social and economic conditions, the transition to an older population is already affecting state revenue and expenditures. Understanding and preparing for these ongoing changes will be critical to states’ future fiscal sustainability.”
LTC Comment: Read this report to learn now states are already in a world of fiscal hurt due to population aging. Then contemplate how much worse it will be without the ongoing federal Medicaid matching funds bonanza as new limits on the use of provider taxes, intergovernmental transfers, and state-directed payments take effect. No amount of planning will shield states from what’s coming. Expect less government help for LTC, not more.

If you’re not already a member of the Center for Long-Term Care Reform, join here. Check out our “Membership Levels and Benefits” for all the individual and corporate membership options. Join our campaign to ensure quality long-term care for all Americans. ***

LTC BULLET: HOW MUCH WORSE CAN LONG-TERM CARE GET?

LTC Comment: U.S. long-term care (LTC) is in a world of hurt. The symptoms are well known: access and quality problems, caregiver shortages, excessive reliance on unpaid family caregivers, exploding public costs, and so on. Bad as it is, however, evidence suggests it could, and likely will, get much worse.

Two articles in the current issue of Health Affairs support that discouraging conclusion. “National Health Expenditure Projections, 2025–34: Strong Utilization Growth Initially, Legislative Impacts Later” tells us that the key components of LTC spending will grow annually on average from 2025 to 2034 by the following percentages arriving at total spending across all payers in billions of dollars as follows:

Nursing care facilities and continuing care retirement communities: 4.4%, $338.3
Home health care: 8.1%, $367.8
Other health, residential, and personal care: 6.7%, $615.0

OK, that’s bad enough considering the 2024 numbers for the nursing homes, home health and other categories were only $219.9, $169.4 and $320.5, respectively. But consider how much worse LTC spending could get if the insights from the other Health Affairs article are not adequately reflected in these estimates.

According to “Trends In Care Needs Among Older US Adults Diverged By Age, 2011–22,” a new cohort of markedly more unhealthy baby boomers is about to throw current expectations about LTC utilization and spending into a cocked hat.

For starters, consider the status quo: “Nearly half of older adults in the United States experience disability, often defined in later life as limitations with daily activities … .” (p. 790) Half have ADL deficiencies? Already? That’s alarming enough. But consider what’s coming according to the “trends” article.

Among younger baby boomers, “swelling numbers” are living with ADL limitations, receiving paid care, and experiencing unmet care needs. Among older age groups, however, there were declines in care received in all settings without increases in unmet care needs. Overall, averaging the younger and older cohorts, trends for the 65 and older population appeared stable with half having ADL deficiencies.

But that current stability is misleading. This study only analyzed the front half of the baby boom generation. Future studies will address all the baby boomers and will not be balanced by the better health and LTC characteristics among the older cohort in the current study.

The trend article authors conclude “the sizable rise in the numbers of adults ages 65–74 with activity limitations (an additional five and a half million), receiving care (an additional three million), and with unmet care needs (an additional two million) over a relatively short period is sobering.” (p. 796)

“Sobering” is an understatement. America’s over 85 age population will triple by 2050 dramatically increasing the number needing LTC. The article therefore concludes:

Taken together, study findings point to continued swelling in the numbers of older adults with care needs as the second half of this generation reaches later life. They also suggest that the share of older adults with care needs, which has been flat for more than two decades, may soon begin to rise. (p. 796)

From its beginning in 1946, the baby boom generation dramatically transformed American society, culture and economy. It’s about to shake up LTC services and spending commensurately. The first tranche of baby boomers has more ADL limitations, requires more paid care, and has more unmet LTC needs than previous generations. Add in the younger boomers with LTC characteristics as bad or worse and we can expect the LTC service delivery and funding challenge to worsen radically.

So, what is to be done? Do either of the Health Affairs articles offer helpful suggestions? Alas, no. The projections article concludes “policy makers will undoubtedly continue to explore options for addressing the significant financing challenges for a sector that is expected to account for more than one-fifth of the economy by 2034.” (p. 732) Want to hang our hopes on policy makers finding a better funding source?

The trends article is no more helpful. “Study findings reinforce the need for robust policies, including innovations in workforce development and family supports, to address the growing care needs of older adults and their families.” (p. 797) Where will the money come from to reinforce robust policies? That’s typical doubletalk.

What these articles have in common with most others of their ilk is that they analyze symptoms and recommend solutions, but never ask why LTC is so dysfunctional in the first place. With no idea of the source of LTC’s many problems, such analysts have nowhere to go with their recommendations than to call for more government spending and regulation.

For an entirely different approach that addresses the cause of LTC problems first and then proposes solutions, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. To find ample private funds for LTC, check out “Medicaid’s $100+ Billion Leak.” For what not to do, see “Medi-Cal-amity: California’s Reckless Expansion of Medicaid Long-Term Care to the Affluent.” See also “Better Long-Term Care for Billions Less.” Much more on long-term care here.

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Updated Monday, July 6, 10:03 AM (Pacific)

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LTC E-ALERT #26-023: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

Data detail extent of senior living and care provider reliance on immigrant workers
Sector challenges, skilled nursing turnover present opportunity for first-time entrepreneurs, ‘innovators’
BREAKING: CMS unveils aggressive plan to fine, more easily expel noncompliant Medicare providers
Lear's age of suffering
Nearly Four Million Medicare Beneficiaries Met the Eligibility Criteria in 2023 for the Medicare GLP-1 Bridge
Medicare Advantage by Default
Medicaid HCBS growing, but worker wages falling, new study finds

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Updated Monday, June 29, 10:03 AM (Pacific)

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LTC E-ALERT #26-022: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

John O’Connor and McKnight’s: A 36-year run like no other
‘Confounding and heartbreaking’: Provider groups decry Supreme Court decision that could see the departure of immigrant workers
National Health Expenditure Projections, 2025–34: Strong Utilization Growth Initially, Legislative Impacts Later
Testimony of Bill Hammond on Medicaid’s Consumer Directed Personal Assistance Program
Protecting Patients and Taxpayers: Combating Healthcare Fraud and Leakage to Strengthen Program Integrity
What Surprises Aging Guru Ken Dychtwald
Americans Fear Navigating Long-Term Care Alone More Than Affording It
I quit my job to care for my sick husband. A little-known program provided training and pays me to do it
Political Insights from the 2026 Social Security and Medicare Trustees’ Reports

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Updated Friday, June 26, 2026, 10:03 AM (Pacific)

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LTC BULLET: LTC HOAX?

LTC Comment: The media and researchers constantly misrepresent Medicaid LTC spend down. Is it a genuine misunderstanding, a deliberate hoax, or something else? Answers after the ***news.***

*** TODAY'S LTC BULLET is sponsored by Claude Thau (BackNine Insurance). BackNine gives you a free personalized website at no cost. Your clients (& family & friends) can, with as little or as much of your involvement as you or they want, buy life insurance and LTCi, and can speed issue by scheduling a paramed and uploading medical records immediately. We quote stand-alone LTCi, linked-benefit and life with a LTC rider side-by-side. Claude is the lead author of Milliman’s annual Broker World LTCi Survey & a past Chair of the Center for Long-Term Care Financing. Contact him at 913-707-8863 or claude@back9ins.com to learn about more great BackNine features and services. ***

*** CASE IN POINT: Here’s the LTC Hoax in action. I penned the following letter to the editor of Health Affairs about an article the journal published that gets Medicaid LTC financial eligibility wrong. Of course, my letter wasn’t published. Here’s why. Peer review is like a moat protecting the LTC Narrative that government is the solution to all LTC problems

Letter to the editor of Health Affairs regarding “Medicaid Asset Limits And Enrollment Among Older Adults And People With Disabilities” (https://doi.org/10.1377/hlthaff.2025.01437)

This article on Medicaid asset limits displays a misunderstanding of Medicaid’s purpose and operation in long-term care (LTC). Medicaid is not designed to promote savings or minimize enrollment barriers; it is a safety net intended for those who lack the means to pay for necessary care. To evaluate it through the lens of enrollment friction obscures its core function.

The authors focus on nominal asset limits, yet these limits are often circumvented in practice. Applicants can convert countable assets into exempt forms—such as home equity, personal property, or prepaid funeral expenses—allowing individuals with substantial wealth to qualify. Similarly, income eligibility rules permit high-income individuals to qualify once private medical expenses are deducted. As a result, Medicaid LTC eligibility often extends well beyond the truly needy.

The article’s empirical findings—that some individuals who exceed asset thresholds are less likely to enroll—are unsurprising and add little insight. More important is what the analysis omits: how current rules enable middle- and upper-income individuals to access publicly funded care while lower-income individuals must spend down to near-total impoverishment before qualifying.

This dynamic has broader consequences. More affluent individuals can access higher-quality providers by paying privately before transitioning to Medicaid, while providers must absorb lower reimbursement rates once that transition occurs. This strains the care system and limits resources available for the most vulnerable.

A more relevant line of inquiry would examine why individuals with substantial assets can qualify for Medicaid LTC at all, and how policy design might better align the program with its intended role as a safety net for those most in need. ***

LTC BULLET: LTC HOAX?

I’ve wondered for years how the actual results of Medicaid LTC spend down policy—easy access to benefits while preserving wealth—can be so radically different from the way they are presented in the media and scholarly publications, that is, catastrophic spend down for care until total impoverishment. Do the experts really not understand how Medicaid financial eligibility works? Or do they know the truth but evade the reality because it doesn’t fit their ideological proclivity toward government intervention? Perplexed, I decided to enlist AI to help answer the question.

My Query to Gemini:

Medicaid financial eligibility rules for long-term care (LTC) benefits allow people with high incomes to qualify if their private medical or LTC expenses are commensurately high because those private expenditures are deducted from their income before the program's low income standard is applied. Likewise, high asset people can qualify because most large assets seniors own are exempt and countable assets are easily converted to exempt status by simply using them to purchase non-countable resources. Unlike the requirement for income spend down, that it be for documented private health care expenses, however, there is no such requirement for asset spend down. Asset spend down can be used to convert countable into non-countable wealth in any amount. See “Medicaid’s $100+ Billion Leak” for details. Although this is true and indisputable, the conventional wisdom repeated constantly in the media and often in scholarly sources is that Medicaid LTC eligibility requires "impoverishment" and that people all across America are spending down into destitution for LTC before they qualify for Medicaid. Please give me a dozen or more examples of media or academic sources that say Medicaid LTC eligibility requires impoverishment. Then opine on why this mismatch between the reality and the reporting persists decade after decade.

Gemini’s Answer:

You’ve identified a significant gap between the technical reality of Medicaid planning and the "impoverishment" narrative that dominates public discourse. Technically, the "spend down" for assets does not require destitution in the way it is often portrayed. Strategies like Medicaid Compliant Annuities, Caregiver Agreements, and Equity-to-Exempt transfers allow for the preservation of significant wealth. However, the media and academic framing consistently emphasize a binary choice: pay out-of-pocket until broke, or qualify for Medicaid only after reaching rock bottom.

Below are 12+ examples of this narrative across mainstream media, advocacy groups, and academic contexts.

Media & Journalism

These sources often frame Medicaid LTC as a "safety net for the destitute," frequently omitting the legal mechanisms used to protect assets.

AP News (2026): "Deliberately putting yourself or a relative into poverty so Medicaid picks up the costs... Assistive living and nursing home care often force families to exhaust their resources before qualifying." — A Medicaid ‘spend down’ may get an older person LTC coverage.
The New York Times (2023): In various "Your Money" and "The New Old Age" columns, the narrative often focuses on the "catastrophic" cost of care that "drains life savings" to reach the $2,000 asset limit. Has referred to the "Catch-22" of Medicaid where seniors must "spend down until they are virtually penniless."
CNBC (2024): Business reporting frequently highlights that Americans are "forced to spend down into poverty" to access long-term care benefits.
KFF (Kaiser Family Foundation): While technically accurate on rules, their public briefs often headline the "limited financial resources" and "low-income" nature of beneficiaries as a prerequisite.
The Washington Post: Often features op-eds or "Health & Science" features describing the "vicious cycle of spending down every last cent" to qualify for nursing home coverage. Reports on families "spending down to the bone" to meet the $2,000 asset limit.
Forbes: While some articles discuss "Medicaid planning," many general finance columns warn that LTC requires you to "impoverish yourself" to let the government take over.
The Wall Street Journal: Often describes the "cruel choice" of "emptying the bank account" to qualify for government help with long-term care.
NPR: Features stories on the "exhausting process" of "becoming poor enough" to get Medicaid coverage for a spouse.
PBS NewsHour: Has framed segments on long-term care around the idea that Americans must "become destitute to get help."
CNBC: Articles on retirement planning frequently warn that "long-term care can impoverish you" before Medicaid kicks in.

Advocacy & Public Interest Groups

These organizations often use the "impoverishment" language to argue for better funding or policy changes.

AARP: Frequently publishes guides stating that to qualify for Medicaid, you must have "very little in the way of assets," reinforcing the idea that the program is only for the poor.
Center for Medicare Advocacy: Highlights that current rules result in the "impoverishment of older people and people with disabilities" due to the high cost of out-of-pocket care. Notes that without spousal protections, many would be "left with, literally, no income at all" and that residents are "in jeopardy" of destitution.
American Health Care Association (AHCA): Often refers to the Medicaid population in nursing homes as "low-income seniors" or "vulnerable residents" who have no other options.
Justice in Aging: Focuses on the "economic insecurity" of seniors, framing the eligibility process as a transition into poverty.
NCOA (National Council on Aging): Explains that "you must spend down into poverty" to qualify for the Medically Needy program in many states.

Academic & Policy Research

Even in scholarly work, the "Spend Down = Destitution" model is often the baseline assumption for policy simulation.

Health Affairs: Numerous articles over the decades use the term "Medicaid Spend-Down" as a synonym for the depletion of wealth by middle-class seniors. Frequently discusses the "risk of impoverishment" for those needing long-term services and supports (LTSS), framing the lack of social insurance as a path to "financial destitution."
Journal of the American Medical Directors Association (JAMDA): Recent studies emphasize that facilities are serving "the most impoverished communities," linking Medicaid status directly to lack of wealth.
The Gerontologist: Academic papers frequently explore the "psychological toll of spend-down," describing the process as one where seniors must "bankrupt themselves" to get care. Research papers often categorize the "medically needy" as those who have reached a state of "functional poverty" through medical expenses.
Urban Institute: Policy briefs often describe Medicaid as the program for those who have "exhausted their private resources" through the high cost of long-term services.
ASPE (HHS): "Asset spend-down in nursing homes is the process by which individuals... deplete their available assets... and then enroll in the Medicaid program once they are impoverished." — A Synthesis and Critique of Studies on Medicaid Asset Spenddown.
Milbank Quarterly: "Elderly persons with functional impairments must impoverish themselves by incurring large out-of-pocket expenditures on nursing-home care before becoming eligible for Medicaid benefits." — Long-term Care, Medicaid, and Impoverishment of the Elderly.
Journal of the American Geriatrics Society (JAGS): Uses the term "Medicaid-induced impoverishment" to describe the transition of middle-class seniors into the program.
Center for Retirement Research (Boston College): Often frames studies around the "likelihood of impoverishment" for retirees facing nursing home stays.
Georgetown University (LTC Financing Project): Policy briefs frequently state that Medicaid acts as a "safety net for those who have exhausted their resources."

Key Nuance: The "Myth" vs. The Narrative

There is a counter-academic movement—most notably led by Stephen A. Moses of the Center for Long-Term Care Reform—who has published extensively on "The Myth of Medicaid Spend-Down."

The Reality: While the media highlights the $2,000 asset limit, they rarely mention that a primary residence (up to ~$700k–$1M+ depending on the state), a vehicle, and irrevocable burial trusts are exempt. Additionally, "Income Spend Down" is actually a "Spend Through," where the applicant uses their income to pay their share of cost, while the government covers the rest—hardly "destitution" if the care is being provided.

The Reality vs. The Narrative

As you noted, the "indisputable" reality includes several legal avenues that prevent literal destitution, yet they are rarely the focus of general reporting:

The "Impoverishment" Narrative	The Technical Reality
"You must be penniless."	You can keep a primary residence (up to ~$713k–$1.07m equity), one car, and personal belongings.
"You must spend all money on care."	You can spend "countable" cash on "exempt" assets (e.g., home repairs, prepaying funerals, buying a better car).
"The spouse is left with nothing."	Spousal Impoverishment Rules (CSRA) allow the community spouse to keep up to ~$154,140 in assets (2024/25 levels).
"High income disqualifies you."	"Income caps" can often be bypassed via Miller Trusts (Qualified Income Trusts) in many states.

LTC Comment: Follow up: based on your findings, do you think this commonplace misrepresentation of the reality is intentional to support an ideological bias or based only on ignorance?

AI: The gap between the "impoverishment" narrative and the actual mechanics of Medicaid eligibility isn't easily reduced to just a malicious lie or just simple ignorance. Instead, it is a classic example of structural bias—where institutional complexities, media incentives, and political ideologies converge to create a distorted public perception.

If you analyze the behavior of the groups pushing this narrative, you can see a mix of well-meaning oversimplification, strategic political positioning, and commercial interest.

Here is how the motivations break down across the spectrum:

1. The Media: The "Path of Least Resistance" & Human Drama

For journalists, the misrepresentation is driven less by a deep ideological conspiracy and more by occupational constraints:

Complexity: Medicaid is a labyrinth of federal guidelines and 50 distinct sets of state rules. Explaining "Medically Needy" income spend-down or the mechanics of a Qualified Income Trust (Miller Trust) requires too many column inches and bores the general reader.
The "Unplanned" Reality: For the vast majority of middle-class families who do not hire an elder law attorney in advance, the experience feels like impoverishment. They enter a crisis (e.g., a sudden stroke), go to a nursing home, and are told they must pay $10,000/month out-of-pocket until their liquid bank accounts hit $2,000. That is the story that reaches reporters. The reporter writes about the crisis, missing the fact that a proactive lawyer could have sheltered those assets.
Narrative Arc: "Local senior forced into poverty by broken healthcare system" is a compelling, high-engagement headline. "Local senior successfully shifts wealth into exempt asset categories using legal loopholes" is a technical financial column.

2. Left-Leaning Academics and Policy Advocates: Supporting Universal Care

For progressive think tanks and advocates, framing Medicaid as requiring "impoverishment" serves a specific ideological goal: the expansion of the social safety net.

The Goal: They want a universal, Medicare-for-all-style long-term care benefit.
The Strategy: To build political will for universal care, you must convince the middle class that they too are at risk. If the middle class believes they can easily navigate Medicaid rules to protect their inheritances, they won't vote for expensive new government programs. By highlighting the $2,000 asset limit and framing it as "destitution," they create pressure for systemic reform.

3. Right-Leaning/Fiscal Conservative Groups: Highlighting Welfare Abuse

Conversely, some conservative groups actually agree with your premise—that Medicaid is easily manipulated—but they use it to argue for stricter asset recovery and tighter rules:

They argue that middle-class or wealthy seniors are "crowding out" the truly poor by hiding wealth in exempt assets (like high-value homes or annuities).
However, when these groups write public-facing warnings, they often emphasize the "harshness" of the rules to discourage people from relying on Medicaid, unintentionally reinforcing the narrative that the program is punitive.

4. The Elder Law and Long-Term Care Insurance Industries

There is a massive commercial incentive to keep the "impoverishment" narrative alive:

Long-Term Care Insurance (LTCI) Companies: To sell a policy, they must terrify you. Their marketing materials constantly declare: "A nursing home will wipe out your life savings and leave you destitute!" They rarely mention that a good attorney can shelter your assets without their insurance.
Elder Law Attorneys: Ironically, even though these lawyers specialize in proving Medicaid doesn't require destitution, their marketing often leads with the threat of impoverishment to get clients through the door: "Don't let the nursing home take your house!"

Summary: Ignorance Filtered Through Incentives

The Verdict: It is rarely pure, conscious ignorance, but rather strategic framing.

Every player in the ecosystem has a reason to emphasize the "scary" $2,000 cash limit rather than the "lenient" exempt asset rules:

Advocates want to show the system is cruel so it will be changed.
Journalists want a dramatic story about human suffering.
Businesses want to sell you a product (insurance or legal services) to protect you from that cruelty.

The legal reality you pointed out—that a senior can buy a $500,000 exempt home, buy a brand new car, pay off a mortgage, and prepay funerals to qualify for Medicaid—is an open secret among lawyers, but a deeply inconvenient truth for almost every major narrative or commercial interest in the space.

Closing LTC Comment: Well, there you have it. Misrepresenting Medicaid financial eligibility policy to suggest it requires spend down into impoverishment is not a hoax (deliberate deceit) according to AI, but only different groups pursuing their self-interests. Smooth, I say. That lets everyone off the hook of thinking about what would be better public policy. Maybe you can excuse senior advocates and business enterprises for pursuing their narrow interests. But should we exonerate Medicaid planners who manipulate the rules to help affluent clients for big fees at the expense of the genuinely needy? Should scholars who ought to pursue objective truth get a pass? No, I think the term “LTC Hoax” applies accurately to them. They allow a self-serving lie to take precedence over truthful analysis in pursuit of better public policy.

To make sense of what ails LTC, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. To find ample private funds for LTC, check out “Medicaid’s $100+ Billion Leak.” For what not to do, see “Medi-Cal-amity: California’s Reckless Expansion of Medicaid Long-Term Care to the Affluent.” See also “Better Long-Term Care for Billions Less.” Find much more on long-term care here.

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Updated Monday, June 22, 10:03 AM (Pacific)

Seattle—

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LTC E-ALERT #26-021: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

What is Socialism?
‘Will I spend my 50s or 60s as a caregiver?’: A woman in an age-gap relationship started doing 'grief math' — and it exposed a financial blind spot
Senior living communities charging more for the room, less for the care
5 Contentious Reasons the Middle Class Hasn't Bought Long-Term Care Insurance
Social Security Is In Far Worse Shape Than We're Being Told: The System's $71.9 Trillion Unfunded Liability Is Over Twice What its ‘Trustees’ Mention
Spending on Medicaid State Directed Payments Before New Limits Take Effect
Federal Medicaid Spending Through State Directed Payments Nears $100 Billion Annually Across 41 States, With New Limits Set to Reduce Funding to States
Senior living industry backs new CMS Medicaid waiver oversight rules

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Updated Monday, June 15, 10:03 AM (Pacific)

Seattle—

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LTC E-ALERT #26-020: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

A New Option for Long-Term Care Costs
Advisors Aren't Ready For The 30-Year Retirement, Ken Dychtwald Argues
Medicare Advantage Organizations overturned most SNF denials, OIG finds
The Nation's Fiscal Health: Urgent and Sustained Action Needed to Improve the Fiscal Outlook
What’s in the 2026 Medicare Trustees Report?
Social Security funds could run short by 2032, program's Trustees warn
A Closer Look at the IRS LTC Guidance
What to Know About Recent Federal Actions Involving State Medicaid Program Integrity
Ohio suspends 49 home health providers from Medicaid program over fraud concerns
Long-term care reform plans spark widespread backlash in Germany

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Updated Friday, June 12, 2026, 10:03 AM (Pacific)

Seattle—

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LTC BULLET: WHAT IS MEDICAID FOR?

LTC Comment: These scholars publishing in a peer-reviewed journal do not understand Medicaid’s purpose, nor how it hurts the poor and helps the well-to-do. We explain after the ***news.***

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By sharing an audio or written story through the SEEQ platform, caregivers can help deepen understanding of the emotional and practical realities they face, and contribute to more effective support(s) in the future.

Eligible participants receive a $25 gift card.

Learn more and participate: https://sharemorestories.com/working-caregiver-experience-carescout-seeq/ ***

LTC BULLET: WHAT IS MEDICAID FOR?

LTC Comment: The following article in the current issue of Health Affairs is a confused mishmash of mistaken notions that never should have passed peer review. The complete piece does not deserve your attention, but the abstract is worth our brief scrutiny. It displays the confusion, common among Medicaid LTC researchers, regarding the Medicaid program, its legitimate purpose and how it diverges in practice from official objectives. Here’s the article, its abstract, and our line-by-line review.

“Medicaid Asset Limits and Enrollment Among Older Adults and People With Disabilities,” by Andrew Anderson, Chau Huynh, and Catherine K. Ettman, Health Affairs, 45, NO. 6 (2026): 708–715.

ABSTRACT Medicaid asset limits determine how many countable resources older adults and people with disabilities may retain while qualifying for coverage. Although intended to target benefits to those with the greatest financial need, these rules may discourage saving and create administrative barriers to enrollment. Amid recent federal and state reforms to update asset limits and a new federal home equity cap of $1 million taking effect in 2028, we examined how many income-eligible older and disabled adults are affected by Medicaid asset limits and whether exceeding these limits is associated with lower enrollment. Using nationally representative data for 2023, we estimated that among 6.2 million income-eligible adults not enrolled in Medicaid, 1.5 million (24.7 percent) exceeded their state’s financial asset limit and 387,525 (8.6 percent) exceeded the home equity limit. Regression discontinuity models indicated that exceeding financial asset thresholds was associated with lower enrollment among unmarried adults. Asset limits thus exclude a modest share of otherwise-income eligible people overall but may disproportionately burden subgroups with limited financial resources.

LTC Comment: Let’s dissect this abstract sentence by sentence to see if we can make sense of it, or at least explain what it gets wrong.

Abstract: “Medicaid asset limits determine how many countable resources older adults and people with disabilities may retain while qualifying for coverage.”

LTC Comment: This is true and the limit on countable resources is usually very low, often $2,000. But the official limit is irrelevant because there is no cap on how much countable wealth applicants can convert to non-countable status simply by purchasing exempt assets. Pay off a mortgage or add a room to increase home equity, buy a nicer car, prepay funeral expenses, purchase expensive new personal and household belongings, acquire a business or rental property, and so on. There is practically no limit to how much wealth the affluent can shelter and retain in this way. See “Medicaid’s $100+ Billion Leak for details.”

Abstract: “Although intended to target benefits to those with the greatest financial need, these rules may discourage saving and create administrative barriers to enrollment.”

LTC Comment: What a peculiar notion. The purpose of Medicaid is not to encourage savings or avoid administrative barriers to enrollment. It is to provide a financially viable safety net of LTC services for people who have failed to save and have become a financial and administrative burden on the state. Medicaid should target benefits to those most in need and exclude others of lesser or no need. These authors have Medicaid’s role upside down and backwards.

Abstract: “Amid recent federal and state reforms to update asset limits and a new federal home equity cap of $1 million taking effect in 2028, we examined how many income-eligible older and disabled adults are affected by Medicaid asset limits and whether exceeding these limits is associated with lower enrollment.”

LTC Comment: What kind of question is that? If exceeding asset limits is not associated with lower enrollment, something is obviously wrong. Otherwise, why set limits on assets in the first place? Regarding the million dollar home equity limit, it prevents very few people from qualifying for Medicaid LTC benefits because the median home equity of elderly Americans, $250,000, is only one-fourth of that amount. A better research question would be: how many people with home equity approaching a million dollars receive welfare-financed Medicaid benefits and why is that allowed?

Abstract: “Using nationally representative data for 2023, we estimated that among 6.2 million income-eligible adults not enrolled in Medicaid, 1.5 million (24.7 percent) exceeded their state’s financial asset limit and 387,525 (8.6 percent) exceeded the home equity limit.”

LTC Comment: Yes, and so, what’s their point? Affluent people don’t qualify for Medicaid LTC benefits? If it were only that simple! These authors do not understand how Medicaid LTC eligibility works in the real world. Forget the low income and asset caps. What really happens is that income can be very high because private health expenses are deducted before the low cap is applied. Consequently, someone with $10,000 a month of income who has a nursing home bill of comparable size is eligible based on income. Nor are their assets actually limited because countable wealth is easily converted to exempt resources as explained above.

Abstract: “Regression discontinuity models indicated that exceeding financial asset thresholds was associated with lower enrollment among unmarried adults.”

LTC Comment: Do they really need fancy econometric models to discover that capping income and assets excludes some people from eligibility? The resulting inequity is much worse than these authors grasp as explained below.

Abstract: “Asset limits thus exclude a modest share of otherwise-income eligible people overall but may disproportionately burden subgroups with limited financial resources.”

LTC Comment: Well, yes, of course. And who do you think are the subgroups with limited financial resources who are excluded? Answer. The poor, whom Medicaid was supposed to help first. Private nursing home or home health expenses quickly consume the limited resources of financially vulnerable people leaving them totally impoverished. The middle class and affluent, on the other hand, who should not rely on public welfare, are able to qualify for Medicaid LTC benefits using the methods just described and others, such as irrevocable income-only trusts. Even worse, these more financially able people co-opt the best care Medicaid offers because they can afford to pay privately for a time before they switch to Medicaid. That is because the best nursing homes and home health agencies compete for private residents who pay 150% of the Medicaid rate on average. After the financially comfortable make the switch to Medicaid, state and federal laws prohibit their being discharged simply because their source of payment changes. LTC providers get stuck with the new low-revenue from formally private-pay Medicaid recipients. This inhibits their ability to pay caregivers adequately and to provide quality care.

Closing LTC Comment: Is it clear now what is really going on? Instead of a safety net for the poor, Medicaid forces the most vulnerable, least financially solvent people to impoverish themselves. But the middle class and affluent not only qualify quickly but they get the best care available through Medicaid. Worse yet, instead of paying privately at market rates for their care, which would contribute desperately needed revenue to the service delivery system, these previously private-pay residents generate only 70% of the private pay rate as Medicaid recipients. On top of everything, this system effectively desensitizes most Americans to LTC risk and cost leaving them uninsured and dependent on public assistance when their need arises. How different this reality is from the confused Health Affairs hodgepodge!

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Updated Monday, June 8, 10:03 AM (Pacific)

Seattle—

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LTC E-ALERT #26-019: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

What This Year's Biggest Medicare Changes Mean for You
Poverty and Dependency in the United States, 1939–2023
End-of-life costs at least 50 percent higher for adults younger than 65, study finds
DHS: Only 2,000 of 5,600 high-risk Medicaid providers revalidated upon review
How to Help Regular Clients Handle Long-Term Care Costs
Immigration bans expected to lead to healthcare workforce shortages, researchers say
Why 1035 Exchanges Are Becoming a Bigger Part of LTC Planning Conversations
We couldn't afford to pay for my mom's dementia assisted living anymore. She moved into a tiny house next door to me

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Updated Monday, June 1, 10:03 AM (Pacific)

Seattle—

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LTC E-ALERT #26-018: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

Sticker Shock In Seattle Over WA Cares' $36,500 Lifeline
IRS Guidance Shines Light on Post-SECURE 2.0 Long-Term Care Distributions
The growing long-term care dilemma
Senior living and care increasingly bifurcated, with no room for the middle, experts say
Key Facts About Health Care Affordability for People With Medicare
Proposed legislation signals broader trends senior living providers should be watching, experts say
Annuities May Help Clients Live Longer: Study
Senators call for new Medicare benefit for home care, more Medicaid HCBS funding

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Updated Friday, May 29, 2026, 10:03 AM (Pacific)

Seattle—

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LTC BULLET: AN OPEN INVITATION TO LTC FRAUD

LTC Comment: Government’s good intentions opened the flood gates for LTC fraud. We explain after the ***news.***

*** LTC CLIPPINGS notify Center premium members of news and analysis in real time. Steve Moses scans the media and academic journals; he picks the most important news and analysis to keep you at the professional forefront; and he gives you the source, a representative quote, and his brief analysis. A couple examples follow. Find our “Membership Levels and Benefits Schedule” here. Join the Center and become a premium member here. Or contact damon@centerltc.com for details.

5/27/2026, “Key Facts About Health Care Affordability for People With Medicare,” by Nancy Ochieng, Meredith Freed, Juliette Cubanski, Jeannie Fuglesten Biniek, and Tricia Neuman, KFF
Quote: “Long-term services and supports, which are not covered by Medicare, are unaffordable for all but the highest-income Medicare beneficiaries. In 2025, the median annual costs of common long-term services and supports in the U.S were $80,080 for full-time non-medical caregiver services (including home health aide and homemaker services for people who need help with instrumental activities of daily living such as preparing meals and doing laundry), $129,575 for a private room in a nursing home, and $305,760 for round-the-clock home health aide services (Figure 9). These costs greatly surpass median income ($43,200) and savings ($110,100) among people with Medicare. Long-term care services are generally not covered by Medicare, regardless of whether a beneficiary is enrolled in traditional Medicare or Medicare Advantage.”
LTC Comment: Every few years, KFF publishes a version of this message saying that Medicare beneficiaries are too poor to afford LTC. You’re supposed to conclude that LTC costs devastate people on Medicare who need extended care that Medicare does not cover. The truth is that Medicaid pays the catastrophic LTC costs of Medicare beneficiaries who have the need. We explained how this works in two LTC Bullets: Hoist with its Own Petard and KFF Hoisted Again. Read them for relief from KFF’s dystopian views and for ideas on how to fix LTC financing without adding it to Medicare.

5/26/2026, “Senators call for new Medicare benefit for home care, more Medicaid HCBS funding,” by John Roszkowski, McKnights Home Care
Quote: “A group of Democratic United States senators last week expressed the need for a new Medicare benefit for in-home care and expanded Medicaid funding for home- and community-based services as part of a larger plan to increase funding for long-term care services.”
LTC Comment: First, float the Titanic (Medicare) before adding more deck chairs (LTC benefits). ***

LTC BULLET: AN OPEN INVITATION TO LTC FRAUD

LTC Comment: Health care fraud is all over the news lately. Medicaid and Medicare are the fraudsters’ favorite targets. Medicaid LTC is especially vulnerable because most of it (87.1% at latest count) is provided in unsupervised home and community-based settings. That makes billing for undelivered services and other fraudulent measures tempting, easy and hard to catch.

The Centers for Medicare and Medicaid Services (CMS) is fighting a rearguard action to rein in health care fraud. The Administration’s Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative and a Task Force to Eliminate Fraud aim to curtail fraud in CMS programs estimated to cost $100 billion per year. Some say these measures are too little, too late. Why hasn’t the government fought fraud more aggressively up to now?

Efforts to fight fraud in public benefit programs face many obstacles. The huge volume of transactions; legal limits on the government’s ability to exclude questionable providers, and sluggish public sector implementation of technological advances, all impede progress against fraud. Third parties, especially Medicaid and Medicare, fund most health care, including LTC, which creates a moral hazard that invites fraud. The gigantic size of government health care programs and the fragmentation between programs and between federal and state-level funding and administration of Medicaid impair fraud identification and control.

All these factors contribute, but the biggest obstacle to public sector fraud control comes from legal constraints. Medicaid and Medicare were created in 1965 as part of Lyndon Johnson’s Great Society war on poverty. The new programs entitled people to a wide range of medical and LTC services. After enactment, their costs exploded immediately. State and federal efforts to control costs led to litigation aimed at protecting the public’s access to the new entitlements. Two major court cases addressed this issue.

In Goldberg v. Kelly [1970], the Supreme Court ruled that before the government can terminate an individual’s statutory entitlement like welfare or health benefits, it must provide a pre-termination hearing. This means if the government suspects fraudulent billing or ineligibility in Medicaid, it cannot simply stop payments immediately. It must give the recipient notice and an opportunity to be heard, making swift fraud intervention administratively burdensome. Consequently, nearly all government fraud control must be done using a “pay and chase” approach as opposed to preventing fraudulent payments before they occur.

A second court case moderated Goldberg’s highly constrictive decision. In Mathews v. Eldridge, [1976] the Court set a balancing test that agencies use to determine if a pre-termination hearing is mandatory. It requires reviewing: (1) the individual's private interest in uninterrupted benefits, (2) the risk of erroneous deprivation, and (3) the government's interest, including fiscal and administrative burdens. Thus, Mathews allowed the termination of Social Security Disability benefits without a prior hearing. The Court reasoned that disability determinations rely on objective medical evidence (unlike the subjective, need-based criteria in Goldberg). Disabled workers were deemed less likely to face immediate, life-threatening destitution than welfare recipients, making retroactive post-termination payments an acceptable remedy if the government is proven wrong.

These precedents show that fighting fraud is not a simple cut-and-dry process for the government. Because Medicaid and Medicare provide life-saving health care and are treated as protected property rights, the government faces strict constitutional (due process) constraints on how it halts patient benefits or revokes provider billing privileges. Agencies must establish extensive, time-consuming administrative protocols to minimize the risk of wrongly targeting innocent recipients, which slows down their ability to stop illegitimate payments.

Modern agencies struggle to maintain accurate decision-making while dealing with millions of claims. The tension between providing "court-like" procedures and managing immense administrative systems frequently pushes federal programs into an operational crisis. Administrative safeguards have created a decade-long appeals backlog. This delay causes immense economic pressure on care providers, even though many are eventually cleared of wrongdoing. Constitutional due process requirements directly collide with available agency funding, IT systems, and personnel.

There is a tension between the Goldberg requirement for extensive pre-termination hearings and the practical need for Medicaid Fraud Control Units (MFCUs) to make immediate, summary suspensions to halt fraudulent billing. The mandatory continuation of HCBS benefits pending an administrative appeal allows unscrupulous providers and ineligible beneficiaries to continue receiving funds, draining agency resources while lengthy fraud investigations conclude. Goldberg v. Kelly’s strict pre-termination hearing requirements—paired with the Eldridge balancing test—impair state efforts to combat fraud, overbilling, and abuse in Home and Community-Based Services (HCBS) programs.

Bottom line, what began as the government’s intention to help people obtain health and long-term care has deteriorated into an open invitation for criminals to profit from the public largesse. This outcome is only one example of a larger problem. When government replaces personal responsibility and initiative with a legally enforceable right to publicly funded benefits, all kinds of negative consequences occur. People thus “protected” are less likely to recognize, evaluate and prepare privately for life’s many risks. This leaves them dependent on and vulnerable to whatever promises government has made. The sad irony is that after decades of the U.S. government promising Social Security, Medicare and Medicaid, the American public is unprotected today against the increasingly likely retrenchment of those programs. When that happens, the unenforceable assurances from court cases like Goldberg v. Kelly and Mathews v. Eldridge will be cold comfort.

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Updated Tuesday, May 26, 10:03 AM (Pacific)

Seattle—

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LTC E-ALERT #26-017: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

9 million older adults are missing out on $58 billion in help with food, medicine, daily costs
Reed: Can these assets be saved?
Guaranteed income streams better predictor of retirement stability than assets
Senate Democrats Vow To Develop A Long-Term Care Reform Plan
Policyholders Who Sold Their Life Insurance Received Nearly 9x More Than Insurers Offered In 2025
IRS Starts to Implement a Long-Term Care Insurance Tax Incentive
Call for public consultation on Global Standards for Long-Term Care
Fixing long-term care coverage
Long-Term Care Claimant Was Working Full Time in Demolition, Transamerica Says

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Updated Monday, May 18, 10:03 AM (Pacific)

Seattle—

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LTC E-ALERT #26-016: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

AARP report says state of assisted living sector is ‘cause for concern,’ but industry says it helps residents ‘live well’
My dad's dementia care costs $9,000 a month. I'm selling my parents' home to pay for it
White House cuts $1.3 billion in Medicaid payments to California
Medicare’s 6-month enrollment freeze on home health and hospice: What senior living providers need to know
Genworth's CareScout Unit Gets a Line in the Financial Report
Eighth Circuit hands Unum a clean win on long-term-care denial
[Updated] CMS issues six-month moratorium on new hospices, home health agencies nationwide
Housing costs affect older adults’ ability to pay for assisted living, and here’s where costs hit hardest
State Reverses Managed Medicaid for Nursing Homes After $91M Cost Spike in First Year
New ‘economic architecture’ needed for aging population, report says
Financial Shocks, Caregiving Gaps and Inflation Pressures Persist For Retirees

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Updated Friday, May 15, 2026, 10:03 AM (Pacific)

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LTC BULLET: PROTECTING WHAT MATTERS

LTC Comment: Today’s LTC Bullet is a shout out to LTC insurance maven and radio-talk-show host Barry Fisher along with a link to our latest online conversation, after the ***news.***

*** CRUSH FRAUD—Dominating the LTC financing news this week is the federal government’s growing effort to identify, discourage and prosecute health care fraud. Medicaid-funded home care services are especially susceptible to fraud because of the inherent difficulty of measuring and monitoring them. LTC Clippings recently highlighted some of the fraud news. Examples follow. If you don’t have a subscription to LTC Clippings, contact damon@centerltc.com or call 206-283-7036. Premium Center members receive all Center publications including the bi-weekly LTC Bullets, weekly LTC E-Alerts, and daily LTC Clippings. For all membership options, check out the Center’s “Membership Levels and Benefits Schedule.”

5/13/2026, “White House cuts $1.3 billion in Medicaid payments to California,” by Robert King, Politico
Quote: “The Trump administration is withholding $1.3 billion in Medicaid reimbursements to California for failing to combat fraud, escalating a feud with the state over its management of hospice care. … Though the administration has repeatedly criticized California’s fraud oversight, this is the first time the Centers for Medicare and Medicaid Services has targeted payments to the state.”
LTC Comment: Do you think that’s excessive? Is it more important to support services freely than to be vigilant about fraud? That’s the attitude of some who criticize the current crackdown. Before you buy into the “be happy, don’t worry” dialogue, go to Paragon Health Institute, search for “California,” and read the papers that pop up. Check out Paragon’s Health Care Fraud Dashboard. And don’t miss Paragon president Brian Blase’s interview of Dr. Mehmet Oz, Administrator of CMS.

5/14/2026, “Medicare’s 6-month enrollment freeze on home health and hospice: What senior living providers need to know,” by Kimberley Bonvissuto, McKnights Senior Living
Quote: “A six-month, federal moratoria on new Medicare enrollment for home health and hospice agencies has the potential to affect a growing percentage of senior living residents, but the action has the support of senior living industry advocacy groups, provided the stoppage achieves the government’s intended goal of allowing legitimate providers to deliver quality services. The Centers for Medicare & Medicaid Services announced the moratoria on Wednesday, effective immediately, in an effort to ‘protect Medicare beneficiaries and taxpayer dollars.’ The move will enable CMS to temporarily halt the influx of new providers into what it calls ‘high-risk categories’ for fraudulent activity.”
LTC Comment: CMS shuts down new home health and hospice activity and the industry is in favor? Sounds counterintuitive until you consider that companies currently in the business are protected from new competition entering the field. It reminds me of the impact of certificate of need laws, intended to control costs, that had the actual effect of protecting the nursing home industry from competition. Let’s hope the current moratoria have the intended effect of keeping new bad actors out of the business without unfairly benefiting current companies. ***

LTC BULLET: PROTECTING WHAT MATTERS

LTC Comment: Barry Fisher, of Blaze ‘n Bear Insurance Services, Inc., is a longtime friend and fellow fighter to improve long-term care. Barry’s insurance career spans more than four decades working in the field of personal financial well-being and responsibility. During most of that time he has generously provided both financial and moral support for our work at the Center for LTC Reform. With broad expertise in life, disability and long-term care insurance he works with individuals, business owners and allied professionals helping them provide protection for themselves and those they care about. Barry’s long and distinguished career prepared him uniquely to create and host a radio talk show he named “Protecting What Matters.”

“Protecting What Matters” is “the broadcast that helps you become better informed about services and products to protect various aspects of your life and property.” Topics covered are wide-ranging, but all hew to the theme of helping listeners become better, more successful consumers. Show subject matter examples include: life, disability and long-term care planning and insurance; commercial and personal property and casualty insurance; personal finance and investment; business valuation; commercial and residential lending; property rights; personal and spiritual growth; pets and animal husbandry; physical, emotional and intellectual well-being; economics; history; energy policy; taxes and legal matters; relationships; “And whatever strikes our fancy!”

Of course, a recurring theme in “Protecting What Matters” is long-term care financing, Medicaid, Medicare, and the perverse public policies that have made such a mess of that critical field. Barry brought me on to discuss LTC financing for the third time on his Tuesday, May 12, 2026 show. You can hear what we had to say here. Just scroll down until you see the Audio Player. Our section on LTC begins at 27 minutes, 24 seconds into the program.

You can enjoy past shows of Protecting What Matters on the show’s dedicated website and tune in Tuesdays at 1pm Pacific Time on KPRL 1230 AM 99.3FM or listen to the live feed here.

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Updated Monday, May 11, 10:03 AM (Pacific)

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LTC E-ALERT #26-015: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

New ASHA publication helps industry disprove senior living, home care misconceptions
My Beloved Husband Has Early-Stage Dementia. He Is 'Doing Well,' but How Do I Protect Our $1.6 Million Savings Right Now?
Rural residents less likely to receive HCBS than urban counterparts, study finds
Long-Term Care Costs Are Hollowing Out Generational Wealth
Majority Of Americans At Risk Of Outliving Their Retirement Savings
Study: Poor housing affordability associated with higher risks of frailty, mortality
Medicaid self-directed care has a fraud problem, Addus CEO says
What To Do About Medicaid’s Long-Term Care Benefit?
Family caregiving inflicts emotional, financial toll, new US News survey finds
The Old Guard

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Updated Monday, May 4, 10:03 AM (Pacific)

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LTC E-ALERT #26-014: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

At the Tipping Point: Liberating a New Age of Aging
New Law Caps Home Equity for Medicaid Long-Term Care
Alzheimer’s deaths have more than doubled between 2000 and 2024, new report finds
The Association of Medicaid Estate Recovery with Homeownership, Home Equity, and Medicaid Enrollment
Kennedy’s recent comments on paid family caregivers ‘deeply concerning,’ advocates say
Medicaid Waste, Fraud, and Abuse: Why CMS’s Improper Payment Rate Can’t Be Trusted
BREAKING NEWS: CMS issues updated 2026 spousal impoverishment standards
The longevity revolution is here. Our systems still think we die at 65

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Updated Friday, May 1, 2026, 10:03 AM (Pacific)

Seattle—

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LTC BULLET: BRIDGING LTC SILOS

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.”

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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.

“The Medicaid LTC snafu,” by Stephen A. Moses, McKnights LTC News, April 15, 2024 (PDF version.) This article shows how Medicaid’s generous eligibility rules allow people with significant income and assets to use Medicaid’s scarce resources.
“Setting the Record Straight on Long-Term Care Policy,” by Stephen A. Moses and Brian Blase, Townhall, April 14, 2024 (PDF version.) This article debunks the claim, presented in The New York Times’ recent series Dying Broke, that catastrophic long-term care expenses are wiping out the savings of American middle-class families.
“How government prevaricates about long-term care,” by Stephen A. Moses, McKnights LTC News, February 23, 2024 (PDF version.) This article explores the biases in how federal officials and the media report long-term care expenditures. It deconstructs the conventional wisdom about out-of-pocket spending data.
“Government must encourage personal responsibility, prohibit easy access to Medicaid,” by Steve Moses and Brian Blase, Washington Times, November 30, 2023. (PDF version.) Save Medicaid LTC for the needy by engaging self-interest and personal responsibility.
“The federal Medicaid bait and switch,” by Stephen A. Moses, McKnight’s LTC News, November 6, 2023. (PDF version.) Medicaid promised LTC providers generous revenue but reneged creating shortfalls that hurt providers and consumers.
"What’s Wrong With Long-Term Care?," by Stephen A. Moses, RealClear Policy, November 2, 2022. (PDF version.) This article is a succinct explanation of what’s wrong with our long-term care system and how to fix it.
“LTC insurance sales suddenly surge,” by Stephen A. Moses, McKnight’s LTC News, August 10, 2022. (PDF version.) It took Washington State’s public long-term care insurance program to excite private LTC insurance demand in that state to unbelievable levels. This article explores this curious phenomenon and its important public policy implications.
“Long-term care’s mortal risk,” by Stephen A. Moses, McKnight’s LTC News, June 6, 2022. (PDF version.) What if our long-term care system collapses? This article explores how feeble our long-term care system actually is.
“Long-Term Care Epiphany,” by Stephen A. Moses, Broker World, June 2022. (PDF version.) What if the so-called “long-term care crisis” was really “no biggie”? This article reconceptualizes the LTC conundrum and provides a solution.
“Trappings of LTC system leave operators trapped,” by Stephen A. Moses, McKnight’s Long-Term Care News, February 23, 2022. (PDF version.) This article is a “thought experiment” exploring how a true free market can vastly improve our long-term care system.
“The Great Long-Term Care Compromise,” by Stephen A. Moses, Broker World, January 1, 2022. (PDF version.) Using Washington State’s WA Cares as a model, this article shows how to solve the long-term care crisis by mandating people to choose between social or private LTC insurance.
“The irony of long-term care advocacy,” by Stephen A. Moses, McKnight’s Long-Term Care News, December 17, 2021. (PDF version.) This article examines the disconnect between the long-term care people want and the long-term care public policy they get.
“Long Term Care Irony,” by Stephen A. Moses, Broker World, December 1, 2021. (PDF version.) When forced to choose between public and private options for long-term care, Washington State saw an unprecedented influx of private LTCi applications. This article examines the historical context and primary LTC myth driving such consumer behavior.
“What works for long-term care and what doesn’t,” by Stephen A. Moses, McKnight’s LTC News, November 17, 2021. (PDF version.)
This article gives a historical perspective of what’s gone wrong with public financing of long-term care and how private financing can improve it.
“What’s better for senior living and care — the market or government?,” by Stephen A. Moses, McKnight’s Senior Living, October 25, 2021. (PDF version.)
This article explains why and how markets succeed while government usually fails.

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Updated Monday, April 27, 2026, 10:03 AM (Pacific)

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LTC E-ALERT #26-013: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

CMS asks states to submit Medicaid provider revalidation strategies, increase oversight
Medigap Premiums Leap, and Consumers Have Few Alternatives
Dr. Oz announces a 50-state audit of Medicaid program oversight
Exploring Early Uses of Artificial Intelligence in Long-Term Care Systems
House hearing highlights ‘systemic failure’ at heart of hospice, home health fraud
Americans Believe They Will Need $1.46 Million to Retire Comfortably
Needing long-term care in retirement one of Americans’ greatest fears, survey finds
State indicts 9 people on charges of fraud and theft involving Medicaid

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Updated Monday, April 20, 2026, 10:03 AM (Pacific)

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LTC E-ALERT #26-012: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

What’s worse than Medicaid fraud?
Henry Paulson Says U.S. Should Prepare for a 'Vicious' Bond Crash
Alternative Contingency Policies for When the Social Security Trust Fund Is Exhausted
The Trump Administration’s Anti-Waste in Health Care Campaign
$5,400 a Month for Assisted Living Is the New Reality—How Families Are Making It Work
Report: Home health providers ordered to pay over $100M in restitution for fraud in 2025
America Built No System For Aging: The Largest Generation In History Just Started Turning 80

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Updated Friday, April 17, 2026, 10:03 AM (Pacific)

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LTC BULLET: LTC INSURANCE FRAUD

LTC Comment: As health insurance fraud surges nationwide, we consider how it impacts LTC insurance in the private and public sectors after the ***news.***

*** LTC CLIPPINGS: Did you catch these stories recently? Our LTC Clippings subscribers received them in real time including Steve Moses’s 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:

4/13/2026, “Report: With spend-down of assets, US long-term care system ‘effectively penalizes aging’,” by Kathleen Steele Gaivin, McKnights Senior Living

Quote: “Costs associated with the provision of long-term care in a system that requires lower- and middle-class older adults to spend down their assets to pay for home care or life in an assisted living community or skilled nursing facility perpetuates ‘cycles of wealth inequality,’ making it difficult for future generations to build financial security, according to a new study published by the Roosevelt Institute. … ‘This spend-down process interrupts the potential for intergenerational wealth building, after what is often a lifetime of work and saving by low-income and middle-class families, perpetuating cycles of wealth inequality,’ Forden said. ‘Meanwhile, these costs are increasingly captured by profit-driven corporations and private equity firms.’”

LTC Comment: Medicaid asset spend down is the most misunderstood concept in LTC financing jargon. It crushes the poor and lower middle class but gives the middle-class and affluent an off ramp. Unlike income spend down that requires spending for care, asset spend down can be done simply by using countable wealth to purchase exempt resources. I explained how that works and estimated how much it costs Medicaid (and taxpayers) in “Medicaid’s $100+ Billion Leak.” Blaming “profit-driven corporations” for the damage spend down does to those in need is just socialist claptrap. It’s the “progressive” political proclivity to give everything to everyone and print the money to pay for it that is the root of the problem. To make sense of what ails LTC, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. To find ample private funds for LTC, check out “Medicaid’s $100+ Billion Leak.” For what not to do, see “Medi-Cal-amity: California’s Reckless Expansion of Medicaid Long-Term Care to the Affluent.” Much more on long-term care here. ***

4/16/2026, “Henry Paulson Says U.S. Should Prepare for a 'Vicious' Bond Crash,” by Christopher Amstey, Financial Advisor

Quote: “Former Treasury Secretary Henry Paulson called on U.S. authorities to prepare a back-up plan in order to avert a potential collapse in demand for Treasuries — an event that he warned would have ‘vicious’ effects. … U.S. budget experts have for years warned of the potential for a ‘doom loop,’ where investors start demanding higher yields on Treasuries due to risks tied to the government’s swelling debt burden, which then causes an increase in the government’s interest payments — in turn widening the deficit. … ‘It’s going to take increased revenues, taxes, and dealing with expenses,’ he said. It would also mean overhauling Social Security and health care programs, he said. ‘You can raise the revenues without a big drag on growth, if you close preferences and loopholes in the tax code.’”

LTC Comment: Remember when Modern Monetary Theory told us the U.S. government could spend without restraint by printing money to fill funding gaps? Whoops! Turns out there’s a limit to that strategy. When you borrow so much that no one is willing to loan you more, you’re stuck. This reality is what will finally force America to confront problems like out-of-control entitlement spending. The good news is that we have plenty of realistic solutions to draw from to fix LTC.

LTC BULLET: LTC INSURANCE FRAUD

LTC Comment: LTC insurance fraud was a frequent topic at the recent Intercompany Long-Term Care Insurance (ILTCI) conference in Orlando, Florida. We covered that conference and its fraud sessions in detail a couple weeks ago in LTC Bullet: ILTCI 2026 Virtual Visit.

In the meantime, your Center for Long-Term Care Reform has started digging deeper into LTC insurance fraud. We’re especially interested in measures LTCI carriers have taken to identify, mitigate, and prosecute fraud. We will conduct a literature search and interview some of the experts who presented at the ILTCI meeting. We also invite anyone with expertise on this topic to share your insights and suggestions by contacting smoses@centerltc.com.

Our special interest in this topic is to identify best fraud control practices developed by private LTCI carriers that may be transferable to ameliorate the much bigger problem in public programs, especially Medicaid and Medicare. For now, we’re scoping out the general subject of health care fraud. These are some of the issues, suggested by AI, that we plan to explore in a draft paper and op-eds.

Insurance Fraud Incidence
Finding precise, "hard" data for long-term care (LTC) fraud is challenging because it is often grouped into broader "healthcare fraud" or "improper payment" categories. However, recent industry reports and government snapshots provide these estimated figures for 2023–2025:

Private Sector LTC Insurance Fraud
In the private sector, fraud is often measured as a percentage of total claims paid.

Estimated Fraud Rate: Experts from firms like illumifin and the Coalition Against Insurance Fraud estimate that 5% to 10% of all LTC insurance claims involve some form of fraud, waste, or abuse.
Financial Impact: With the industry paying approximately $14.1 billion in benefits in 2023, the estimated annual loss to fraud is roughly $700 million to $1.4 billion.
Case Severity: For sentenced healthcare fraud cases in 2024, the median loss per case was approximately $2.5 million, with nearly 20% of cases involving losses over $9.5 million.

Health Care Fraud
LTCi becoming more of a target for fraud
What Data Says About Health Care Fraud

Public Sector (Medicare & Medicaid) LTC Fraud
The public sector primarily tracks "Improper Payment Rates." It is critical to note that while improper payments include fraud, they also encompass administrative errors like missing documentation.
Medicare Program Integrity and Efforts to Root Out Improper Payments, Fraud, Waste and Abuse
Fiscal Year 2024 Improper Payments Fact Sheet

Medicaid (FY 2025 Estimates):
- Improper Payment Rate: 6.12% ($37.39 billion), an increase from 5.09% in FY 2024.
- Fraud Specifically: Of these improper payments, only a fraction is confirmed fraud. Most (over 77%) are attributed to insufficient documentation.
Medicare (FY 2025 Estimates):
- Fee-for-Service (FFS): 6.55% ($28.83 billion).
- Medicare Advantage (Part C): 6.09% ($23.67 billion), often due to lack of documentation for diagnoses.
Enforcement Outcomes (FY 2024): State Medicaid Fraud Control Units (MFCUs) reported 1,151 convictions and recovered $1.4 billion.

5 Key Facts About Medicaid Program Integrity – Fraud, Waste, Abuse and Improper Payments
Fiscal Year 2025 Improper Payments Fact Sheet
Medicaid Fraud Control Units Annual Report: Fiscal Year 2024
Improper Payments and Fraud: How They Are Related but Different
Types of Corporate Fraud

Fraud Tolerance
There is evidence suggesting that a segment of the public, particularly younger generations, has developed a higher tolerance for certain types of non-violent fraud, such as insurance fraud and digital scams. While many still view these actions as illegal, studies indicate a growing trend of rationalizing or accepting "lower-level" fraud, often viewing it as a victimless crime against large, wealthy corporations rather than individuals.

Survey Finds Younger Generations Have a Higher Tolerance For Insurance Fraud – What Insurers Should Know

Fraud Types Shared by Public and Private Insurers

"Phantom" care and billing: Submitting claims for services never provided, such as x-rays, drugs, or home care hours.
Upcoding: Misrepresenting a patient's diagnosis or severity to bill for a higher rate of reimbursement.
Medical Identity Theft: Fraudsters visiting facilities to collect Medicare or Medicaid numbers under the guise of offering "free" services, later used for bogus billing.
Kickbacks: Financial incentives given to physicians or facilities to steer patients toward specific high-cost therapies or services.
These practices often involve predatory actors working on both the public and private sides.

Common Red Flags

Early Duration Claims: Claims filed soon after a policy is purchased.
Unusual Billing: Inconsistent, high, or rapidly increasing hours.
Pressure Tactics: Salespeople rushing decisions or pushing to handle all documentation.
Too-Good-To-Be-True: Policies promising to cover everything.

Around 38.5% of companies surveyed reported provider misrepresentation of services as a significant risk.

Critical Vulnerability: Cognitive Impairment
A major finding in current research is that populations with diminished capacity are disproportionately targeted. Both private and public sectors are now prioritizing caregiver-specific audits and specialized training for claim examiners to detect when a patient is being manipulated into signing falsified logs or timesheets . Common LTC Fraud Schemes Targeting Vulnerable Seniors

Private Sector Lessons Transferable to the Public Sector
Private insurers have pioneered several strategies that are now considered best practices for public side enforcement: 6 Claims Best Practices for Life Insurance Fraud Prevention

Electronic Visit Verification (EVV): Originally a private-sector tool, Medicaid now mandates EVV to use GPS data to ensure caregivers are physically present at the reported time and location. Innovation and Long-Term Care Insurance (Robert Eaton)
Predictive Analytics & AI: Public agencies like the DOJ and HHS-OIG are scaling machine learning tools—similar to those used by private actuaries—to flag outlier billing and risk-adjustment irregularities in real-time. Healthcare Fraud Enforcement Trends to Expect in 2026
Cross-Sector Collaboration: The National Association of Insurance Commissioners (NAIC) and the Coalition Against Insurance Fraud emphasize that sharing fraud data between private carriers and government regulators is essential for identifying "double billing" rings that target both systems simultaneously.
Focused Field Surveillance: Private insurers often use targeted surveillance for suspicious home care claims; public programs are increasingly using similar "Strike Force" tactics to investigate high-risk geographic clusters.

The public sector can enhance its anti-fraud efforts by adopting the private sector’s focus on individual-level behavioral verification and formalized cross-payer data integration. While programs like Medicare and Medicaid excel at large-scale algorithmic detection, private insurers often utilize more "on-the-ground" investigative techniques that can identify sophisticated schemes where the billing data itself appears legitimate.
Fraud Control in the Health Care Industry: Assessing the State of the Art

1. Shift from "Pay and Chase" to Real-Time Prevention
The public sector can adopt private-sector strategies to move from reactive recovery to proactive prevention:

Adopting "Pre-Payment" Edits: Private insurers use sophisticated "claim scrubbing" applications to flag anomalies before payment is issued. Implementing similar real-time root-cause analysis in public systems can reduce the need for expensive post-payment investigations.
Electronic Visit Verification (EVV) Optimization: Public programs can learn from private insurers' use of GPS and biometric data to ensure caregivers are physically present at the reported care location, a key defense against "phantom" billing.

Public-Private Partnership to Prevent Health Care Fraud Announced by Health and Human Services
Best practices for employers to combat claims-related healthcare fraud
Long-Standing State-Based Efforts to Combat Fraud Against Medicaid Continue to Improve

2. Enhanced Behavioral and Field Investigations
Private insurers often identify fraud by looking beyond the billing codes to the actual lifestyle and behavior of the parties involved:

Targeted Surveillance: Private sector "field investigations" frequently uncover fraud—such as patients performing activities they claim to be unable to do—that purely data-driven public audits might miss.
Caregiver-Specific Audits: Focusing research on the caregiver’s lifestyle, professional licensing, and historical litigation can uncover systemic fraud rings.

Long-Standing State-Based Efforts to Combat Fraud Against Medicaid Continue to Improve

3. Formalized Information Sharing Networks
Public-private partnerships are the most direct way for the public sector to benefit from private-sector progress:

Healthcare Fraud Prevention Partnership (HFPP): This voluntary program allows federal and state agencies to share data with private plans to gain a "cross-payer" view. This helps identify "double billing" where a provider bills both a private LTC policy and Medicare for the same service on the same day.
Unified Fraud Hotspots: By sharing data on specific suspicious billing codes and geographic fraud "hotspots," the public sector can direct its high-intensity enforcement teams more effectively.

About the Partnership
Public-Private Partnership to Fight Fraud Formed
Public-Private Partnership to Fight Fraud Formed
Public-Private Partnership to Prevent Health Care Fraud Announced by Health and Human Services

4. Improving Public Awareness and Reporting
The public sector can refine its "whistleblower" and awareness campaigns by studying what motivates individuals in the private sector to report fraud:
The Public’s Self-Avoidance and Other-Reliance in the Reporting of Medical Insurance Fraud: A Cross-Sectional Survey in China

Incentivizing Reporting: Research shows a "free-rider" mentality often prevents people from reporting public insurance fraud. Strengthening whistleblower protections and creating stronger incentives—similar to those in private litigation—can improve the flow of actionable leads to Medicaid Fraud Control Units (MFCUs).

Long-Standing State-Based Efforts to Combat Fraud Against Medicaid Continue to Improve

Education on Specific Red Flags: Adopting private-sector training that teaches beneficiaries to look for "red flags" like pre-filled timesheets or inconsistent care plans can empower them as a front-line defense.

Long-Term Care Fraud (NAIC)

Key Trend: Both sectors identify Personal Care Services (PCS) as the highest risk area. In Medicaid, PCS attendants and agencies accounted for the most fraud convictions (326 in FY 2025), a trend mirrored in private sector reports identifying home care as a "major industry challenge".
Medicaid Fraud Control Units recover $700,000 in assisted living cases, with 300+ investigations still open

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Updated Monday, April 13, 2026, 10:03 AM (Pacific)

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LTC E-ALERT #26-011: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

Report: With spend-down of assets, US long-term care system ‘effectively penalizes aging’
How Long-Term Care Costs Drain the Middle Class and Deepen Intergenerational Wealth Inequality
Less than half of Americans are planning for their retirement healthcare needs, survey finds
Skilled nursing emerging among most attractive real estate sectors
Layin’ It on the Line: The long-term care crisis in Utah: Why national plans fail here and how to shield your assets (Part 2)
Future long term care expenditure trajectories across OECD countries
The Five Biggest Medicaid Planning Mistakes — and How to Avoid Them
Rising Long-Term Healthcare Costs Pose Growing Threat to Farm Family Legacies
Providers must educate prospects to cut gap between expectations, realities of senior living rates: report
Eight arrested in $50M hospice fraud scheme as oversight intensifies

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Updated Monday, April 6, 2026, 10:03 AM (Pacific)

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LTC E-ALERT #26-010: LTC NEWS AND COMMENT

We no longer post our LTC E-Alerts on the Center’s public access website, but here’s what today’s LTC E-Alert contained: links, quotes and comments on the following articles, reports, or data:

CMS CRUSH initiative alone not sufficient to fight fraud, groups say
Federal Debt Management: Treasury Is Meeting Borrowing Needs but the Deteriorating Fiscal Outlook Poses Risks
Home care groups CRUSH plans for more anti-fraud requirements
What Happens When the Social Security Trust Fund Is Exhausted?
Who should pay for older adults’ care? Caregivers answer differently
Waste, Fraud, and Abuse in Government Health Care Programs is No Joke
We Are 63 With $5.7 Million. My Wife Wants to Buy Long-Term Care Insurance, but I Want to Self-Insure. Who Is Right?
New Medicare HCBS model, designed for California, targets ‘overlooked middle’
Top economist finds silver lining for skilled nursing amid nation’s uncertain outlook

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Updated Friday, April 3, 2026, 10:03 AM (Pacific)

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LTC Bullet: ILTCI 2026 Virtual Visit

LTC Comment: ILTCI ’26 was another successful industry convocation. This “virtual visit” to the conference is intended to give those who could not attend a sense of what it was like and to encourage them to consider attending in the future. It follows the ***news.***

*** HAPPY BIRTHDAY to the Center for Long-Term Care Reform. We completed our 28^th year on April 1, 2026. Check out the Center’s many state- and national-level policy studies here. Read dozens of published articles here. Speeches, here. Review hundreds of LTC Bullets, organized by topic and chronologically, here. This is how we announced our mission in “Center for Long-Term Care Financing Established; "LTC Bullets" Opening Salvo”: “The Center will advocate public policy that targets scarce public resources to the neediest, while encouraging people who are young, healthy and affluent enough, to take responsibility for themselves. We believe that private insurance and investment can guarantee quality long-term care for prosperous seniors and help to save the Medicaid long-term care program for the truly needy. The Center will offer a range of fee-for-service products to public and private clients including consulting, publishing, training and public speaking.” It’s been a great run and it will continue as long as we have your support and collegiality in our common mission to improve long-term care for all Americans. ***

LTC BULLET: ILTCI 2026 VIRTUAL VISIT

LTC Comment: The 2026 Intercompany Long-Term Care Insurance Conference convened March 8–11, 2026 in Orlando, FL at the Rosen Shingle Creek Resort. The meeting’s theme this year was "Dream… Design… Deliver: Reimagining the Future of LTC.” Conference chair, Gina Besz from “illumifin,” opened the proceedings. She told the 1000-plus attendees what to expect, thanked the organizers, presenters and sponsors, and disclosed (always a topic of great interest) the city hosting next year’s conference: Indianapolis, March 14-17, 2027. She also surprised us by sharing where the meeting will convene the following year: Houston, April 2-5, 2028.

Next came announcement of the ILTCI Recognition Award recipients for 2026. This award “honors the trailblazers, innovators, and lifelong contributors advancing long-term care insurance and shaping the future of aging in America.” Steve Serfass, Partner, Faegre Drinker Biddle and Reath, LLP, received the individual award. Two companies shared the organization award: Lincoln Financial and One America. Congratulations to these award recipients for their many years of dedication and hard work in our common mission to improve long-term care for all Americans.