State Reports
(continued)
Several states have contracted Center
President Stephen Moses to find ways to reduce excessive demand for Medicaid
long-term care benefits. The exact
scope of each report varies, depending on each state's individual needs
and demographics, though all focus on reducing Medicaid dependency. The length
and depth of research was contingent upon available funding; the most
comprehensive report was done for Illinois. You may order state reports by calling
206-283-7036, faxing 206-283-6536, or
e-mail info@centerltc.com (prices vary)
*Reports available to read online in pdf
format.
The Heartland Manifesto: How
to Finance Long-Term Care for Middle America, A Case Study in South Dakota,
LTC, Incorporated, Seattle, Washington, 1996, 67 pages, $13.95 (hard copy
or disk) return
to top
This study applies the Magic Bullet principles and analysis to a sparsely
populated Great Plains state and concludes: "South Dakota should not
try to solve the long-term care financing problem by denying the succor of
medical care to more of her citizens. She should not address these issues
by reducing provider reimbursement rates below the minimum required for
adequate care. She should not correct the system by plunging ever more of
the taxpayers' money into the black hole of institutional long-term care.
The real solution is simple, economically sound and politically feasible.
Merely change the incentives in the system so that South Dakotans plan
ahead for long-term care, purchase private long-term care insurance, tap
the equity in their homes, and utilize private home and community-based
services. Divert them from the sorry fate of ending up in nursing homes on
welfare prematurely by default. By doing so, the state can save Medicaid
for the truly needy who cannot manage without it, relieve the overburdened
taxpayers, empower the providers of long-term care with more private
payers, and supercharge the financial services and long-term care
insurance industries."
The Jersey Share: How to Pay
for Long-Term Care with Less Federal Money, A Case Study in New Jersey,
LTC, Incorporated, Seattle, Washington, 1996, 104 pages, $23.95 (hard
copy), $14.95 (disk) return
to top
This study, commissioned by the New Jersey Department of Health and Senior
Services, examines the state's long-term care financing crisis, explores
the problem of Medicaid estate planning, and warns about the risks of
making Medicaid even more attractive to the middle class by facilitating
access to publicly financed home and community-based services. The report
offers 46 recommendations, provides an extensive bibliography of related
publications, and supplies a model state statute.
The Magic Bullet: How to Pay
for Universal Long-Term Care, A Case Study in Illinois, LTC,
Incorporated, Seattle, Washington, 1995, 142 pages, $29.95 (hard copy),
$17.95 (disk) return to top
This study, commissioned by the Illinois Department of Public Aid,
disproves the idea that Medicaid requires impoverishment, debunks 11
fallacies about Medicaid nursing home eligibility, and provides 88
specific recommendations on how Medicaid can save $5 billion per year
(nationally) while improving access to and quality of care. This widely
publicized report, the magnum opus of LTC Inc.'s "Magic Bullet"
series, was the basis for the Heritage Foundation's $25 billion, five-year
savings proposal to Congress.
Read it here: http://www.centerltc.org/pubs/MAGIC_Bullet.pdf
The
Long-Term Care Financing Crisis: Danger or Opportunity?, A Case Study in
Maryland, LTC,
Incorporated, Seattle, Washington, 1995, 51 pages, $23.95 (hard copy),
$13.95 (disk) return
to top
This study analyzes the Medicaid nursing home cost explosion, offers a
practical plan of corrective action and includes a model state statute to
expedite long-term care savings and improvements. Legislators,
policy-makers and administrators will find this report invaluable in
controlling Medicaid expenditures.
The
Florida Fulcrum: A Cost-Saving Strategy to Pay for Long-Term Care, LTC,
Incorporated, Kirkland, Washington, 1994, 181 pages, $22.95 (hard copy),
$12.95 (disk) return to top
The Florida State Legislature mandated this study to "develop a
proposal to limit resource and asset transfers for the specific purpose of
obtaining Medicaid eligibility for long-term care services." The
report concludes that Florida can recover $2 million dollars per year from
recipients' estates and save another $160 million annually by closing
Medicaid loopholes and encouraging private long-term care financing
options. These savings would empower the state to replace its draconian
"income cap" with a more generous "medically needy"
nursing home eligibility system. The report includes (1) 44
recommendations on how to target Medicaid nursing home benefits to the
neediest, (2) the most comprehensive bibliography on Medicaid estate
planning ever published, and (3) the results of a nationwide survey on
state Medicaid asset transfer, lien and estate recovery policies and
practices.
Read it here: http://www.centerltc.org/pubs/FLORIDAREP.pdf
Medicaid
Estate Planning in Kentucky: How to Identify, Measure and Eliminate Legal
Excesses, LTC, Incorporated, Kirkland, Washington, 1993, 27 pages,
$9.95 (hard copy), $7.95 (disk) return
to top
What are the major "loopholes" in Medicaid nursing home
eligibility? How do Medicaid estate planning attorneys take advantage of
elasticity in the rules to benefit their affluent clients? What are the
best ways to document the frequency and magnitude of these practices? What
measures can states take to control Medicaid planning and limit financial
expenditures to affordable levels? This report answers these questions
succinctly for Kentucky. It applies equally well to other states with
generous Medicaid nursing home eligibility rules.
Medicaid
Estate Recoveries in Maine: Planning to Increase Non-Tax Revenue and
Program Fairness, LTC, Incorporated, Kirkland, Washington, 1993, 7
pages, $9.95 (hard copy), $7.95 (disk) return
to top
"Eighty percent of all residents in Maine's nursing homes are already
covered by the Medicaid program. The remaining 20 percent could be on
Medicaid within 30 days (days, not months!) if they chose to hire one of
the attorneys we interviewed or to buy one of the self-help guides we
discussed." This report explains how Maine can save $35.5 million per
year (20 percent of the state's Medicaid nursing home budget) by recovering
efficiently from estates and encouraging the purchase of private long-term care insurance.
Long-Term
Care in Montana: A Blueprint for Cost-Effective Reform,
LTC, Incorporated, Kirkland, Washington, 1993, 86 pages, $19.95 (hard
copy), $12.95 (disk) return
to top
The Montana Department of Social and Rehabilitation Services commissioned
this project to learn how "to get the most out of OBRA '93." The
purpose of the study was to develop a long-term care policy for Montana
which reduces public assistance expenditures by diverting affluent
citizens to privately financed care while simultaneously ensuring access
for everyone to high quality home, community-based and nursing-home care.
The report contains 8 pages of detailed recommendations on how to close
Medicaid loopholes, maximize estate recoveries, and divert prosperous
people to private long-term care insurance and away from Medicaid.
The
Senior Financial Security Program: A Plan for Long-Term Care Reform in
Wisconsin, LTC,
Incorporated, Kirkland, Washington, 1992, 76 pages, $19.95 (hard copy),
$10.95 (disk) return
to top
This case study of Medicaid estate planning, commissioned by Wisconsin
Governor Tommy Thompson, covers the techniques people use to qualify for
Medicaid nursing home benefits without spending down, the status and
growth of this practice, the potential impact on the state budget, and
methods to control the damage, reverse the process and encourage more
responsible long-term care planning. A major finding: "Medicaid
nursing home eligibility is so generous in Wisconsin that most seniors who
need long-term care qualify financially even without any sophisticated
financial planning. Anyone else can qualify quickly, often overnight, by
using techniques such as joint accounts, trusts, purchase of exempt
assets, or multiple divestment... Wisconsin could save $106 million per
year by diverting ten percent of future nursing home caseloads into
private pay status" in accord with the report's recommendations.
A
Minnesota Prospectus for the Senior Financial Security Program, LTC,
Incorporated, Kirkland, Washington, 1992, 5 pages, $9.95 (hard copy),
$7.95 (disk) return
to top
This report summarizes the status of "Medicaid Mining in
Minnesota," draws the comparison to Wisconsin, which has already
acted aggressively to control Medicaid planning abuses, enumerates the
questions Minnesota must answer before taking action itself, and recommends
a quick turnaround study to provide the solutions.
Medicaid
Estate Recoveries in Massachusetts: How to Increase Non-Tax Revenue and
Program Fairness, LTC, Incorporated, Kirkland, Washington 1990, 9
pages, $9.95 (hard copy), $7.95 (disk) return
to top
This paper reports on a quick turnaround study of divestiture, asset
sheltering and estate recoveries in Massachusetts. State eligibility staff reported that
"long-term care units
are barraged by [Medicaid planning] attorneys...it goes on all day...the
system leaks all
over the place...the laws and policy set us up for failure...the workers
feel intimidated...it gets outrageous...it is morally terrible."
Thirty to 50 percent of Medicaid nursing home cases in the prosperous
suburbs of Boston involve the use of divestment or sheltering techniques.
Massachusetts could constrict the loopholes and collect an extra $30
million from estates by implementing 23 "best practices" from
other states.
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