 LTC Bullet: LTC Almanac Update Friday, August 12, 2022 Seattle— LTC Comment: We’ve updated the “Almanac of Long-Term Care” in The Zone. More on the LTC Almanac and today’s update after the ***news.*** *** SUBSCRIBE to LTC Clippings and Steve Moses (2019 ILTCI Recognition Award Honoree) will become your research assistant. Steve will tip you twice a day (on average) with news and views on things you need to know to stay at the forefront of professional expertise. You’ll see the latest articles, reports, data, and op-eds before your clients confront you with them. You’ll get trenchant analysis and valuable ideas on how to address objections and complaints. Contact Damon at 206-283-7036 or damon@centerltc.com for details or subscribe directly here: http://www.centerltc.com/newonlinepaymentspage.htm. Choose “Premium Membership” to receive our LTC Clippings. For example, here are some recent LTC Clippings. 8/4/2022,
“Facing
stagnant Medicaid rates, this state has lost 10 percent of SNF beds in
2022,” by John Hall, McKnight’s LTC News 8/2/2022,
“As
new Alzheimer’s drugs have failed, scientists are shifting focus to other
potential causes,” by Berkeley Lovelace, Jr., NBC News 7/28/2022,
“Funding,
unionization needed to improve wages, working conditions in long-term
care: report,” by Kimberly Bonvissuto, McKnight’s Senior Living
LTC BULLET: LTC ALMANAC UPDATE LTC Comment: Center members know and appreciate our "Almanac of Long-Term Care" in The Zone, our password-protected website. *** SPECIAL: We are making access to The Zone, including the "Almanac of Long-Term Care," free for two weeks—today through Friday, August 26, 2022. To access this introductory peek into The Zone, go to http://www.centerltc.com/members/index.htm and use the following case-sensitive user name and password: UN: IntrotoZone / PW: FreeTrial. Like what you see? Then join the Center for Long-Term Care Reform here. Or contact Damon at 206-283-7036 or damon@centerltc.com. *** Suggestion: Read through the following update to stay current on new resource materials. Then browse the full LTC Almanac at your leisure. When you need a quick fact or the latest research on a particular topic, you'll know right where to go. Enjoy. The LTC Almanac is divided into 11 sections:
Aging Demographics Each section is divided into sub-sections and under each sub-section we provide a list by date of the most important reports and articles published on the topic, usually with a few highlights and sometimes with analysis. The Almanac of Long-Term Care is a great way to find statistics you need quickly or to get current on topics you need to know the latest information about. The Zone and the LTC Almanac are for Center for Long-Term Care Reform members only, except during the current free trial offer. Join the Center here: http://www.centerltc.com/support/index.htm. Call or email Damon at 206-283-7036 or damon@centerltc.com. He can give you a user name and password to open up The Zone even before your dues payment arrives. Individual annual memberships are $150. Premium memberships with access to our “Clipping Service” start at $250. Premium Elite and “Regional Representative” membership (if you qualify professionally) are $500. Corporate memberships with many extra benefits start at $1,000. See our "Membership Levels and Benefits" schedule here. Caveat: With time, some hyperlinks go bad. In a huge document like the "LTC Almanac," we can't keep all the links current all the time. If you find a bad link, but want to get to the material, contact us. We often have an electronic copy of the document and we can usually find a current live link. We'll also fix the link in the LTC Almanac so it will be current again for others. -------------- Chapter 1: Aging Demographics United States General Stats 2020 Older Americans, Key Indicators of Wellbeing URL: https://agingstats.gov/docs/LatestReport/OA20_508_10142020.pdf 10/29/2020,
“Older Americans 2020: Key Indicators of Well-Being,” AgingStats.gov 2019 Profile of Older Americans: LINK 7/21/2020,
“Now Available: 2019 Profile of Older Americans,” Administration for
Community Living
Chapter 2: International General Weiner, Coe, Hoffman and Werner, 0420: LINK POLICY OPTIONS FOR FINANCING LONG-TERM CARE IN THE U.S. Janet Weiner, Norma B. Coe, Allison K. Hoffman, and Rachel M. Werner Abstract: Unlike many other developed nations, the U.S. has no system that protects its residents against the high costs of long-term care, which many people will need as they age. Medicaid coverage kicks in only after families have exhausted their resources. Until then, families bear the financial and caregiving burden of LTC themselves. In the absence of a national system, several states have considered or passed programs that offer some support for LTC. Many peer nations have more comprehensive systems to spread the risk for LTC costs across their population, through social insurance or other mechanisms. This Issue Brief reviews international models of financing LTC, as well as recent state efforts, to help U.S. policymakers design a program that can meet the LTC challenges of an aging population. LTC Comment: This papers makes the false assumption that “Medicaid coverage kicks in only after families have exhausted their resources” and concludes that “the U.S. has no system that protects its residents against the high costs of long-term care.” It is exactly the U.S. system that prevents early and responsible personal long-term care planning by indemnifying elders and their heirs with public LTC financing after care is needed and with generous financial eligibility rules riven with loopholes that allow families to retain substantial assets. This “moral hazard” is what ails U.S. long-term care, not the lack of government imposed regulations and funding.
Chapter 4: Long-Term Care Covid COVID-19 and
the Future of Long-Term Care: The Urgency of Enhanced Federal Financing ABSTRACT The economic threat posed by responses to COVID 19 endangers financing for long-term care across the states that is already inadequate and inequitable. Increasing the federal share of Medicaid spending as unemployment rises would mitigate fiscal pressure on states and preserve public services. But unlike the demand for Medicaid’s health care protections, which rises when economic activity declines, the demand for long-term care protections will grow even in a healthy economy as the population ages. Enhanced federal support is urgent not only to cope with the virus today but also to meet the long-term care needs of the nation’s aging population in the years to come. Long-term care financing policy should be modified to either adjust federal matching funds by the age of each state’s population, or fully federalize the funding of LTC expenses of Medicaid beneficiaries who are also eligible for Medicare.
Chapter 6: Long-Term Care Financing LTC Approaches and Studies New Approaches to Long-Term Care Access for Middle-Income Households by the Milken Institute
LTC Bullet: Milken Groupthink Fumbles LTC Financing LTC Comment: You might expect innovative ideas from the Milken Institute, but when it comes to long-term care financing, all you get is ideological retreads. We explain below. LTC BULLET: MILKEN GROUPTHINK FUMBLES LTC FINANCING LTC Comment: The Milken Institute, chaired by former junk-bond king, now philanthropist Michael Milken, modestly bills itself as a “catalyst for practical, scalable solutions to global challenges.” Toward that end they “conduct research and analysis and convene top experts, innovators, and influencers from different backgrounds and competing viewpoints.” Lately, the Milken Institute tackled the problem of providing and financing long-term care for the broad American middle class. Last week it published “New Approaches to Long-Term Care Access for Middle-Income Households,” a timely look at a critical topic that begs for fresh analysis and ideas. Did the Milken Institute deliver? Yes and no. The report does a yeoman’s job of describing the problem. It offers creative ideas to address service delivery problems, proposing for example a “Medicare Advantage Demonstration Project” and that the country should “Scale Up Integrated Care Programs.” But when it comes to how to pay for long-term care, the report founders as its many predecessors have done. It makes no attempt to understand why long-term care financing is so inadequate in the United States. It parrots the prevailing academic shibboleths, ignores critical facts, and proposes nothing new or promising. We get no original analysis or ideas. We’re asked to hang our hopes on a fatally flawed exercise in political futility, the LTC Trust Act in Washington State. What went
wrong? Following are quotes from the Milken Institute’s “New
Approaches to Long-Term Care Access for Middle-Income Households”
followed by our comments.
Nursing Home and Home Care Expenditure Data from CMS and Health Affairs National Health Expenditure Projections, 2021–30: Growth To Moderate As COVID-19 Impacts Wane: https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00113 ABSTRACT Although considerable uncertainty remains, the COVID-19 pandemic and public health emergency are expected to continue to influence the near-term outlook for national health spending and enrollment. National health spending growth is expected to have decelerated from 9.7 percent in 2020 to 4.2 percent in 2021 as federal supplemental funding was expected to decline substantially relative to 2020. Through 2024 health care use is expected to normalize after the declines observed in 2020, health insurance enrollments are assumed to evolve toward their prepandemic distributions, and the remaining federal supplemental funding is expected to wane. Economic growth is expected to outpace health spending growth for much of this period, leading the projected health share of gross domestic product (GDP) to decline from 19.7 percent in 2020 to just over 18 percent over the course of 2022–24. For 2025–30, factors that typically drive changes in health spending and enrollment, such as economic, demographic, and health-specific factors, are again expected to primarily influence trends in the health sector. By 2030 the health spending share of GDP is projected to reach 19.6 percent. National Health Care Spending In 2018: Growth Driven By Accelerations In Medicare And Private Insurance Spending: https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01451 ABSTRACT US health care spending increased 4.6 percent to reach $3.6 trillion in 2018, a faster growth rate than the rate of 4.2 percent in 2017 but the same rate as in 2016. The share of the economy devoted to health care spending declined to 17.7 percent in 2018, compared to 17.9 percent in 2017. The 0.4-percentage-point acceleration in overall growth in 2018 was driven by faster growth in both private health insurance and Medicare, which were influenced by the reinstatement of the health insurance tax. For personal health care spending (which accounted for 84 percent of national health care spending), growth in 2018 remained unchanged from 2017 at 4.1 percent. The total number of uninsured people increased by 1.0 million for the second year in a row, to reach 30.7 million in 2018. Who Will Pay for LTC? (includes "Not the VA")
“The middle ground for fixing long-term care
costs: the WISH act” Roughly one week before Americans celebrated the July 4 holiday, Representative Thomas Suozzi (D-NY) introduced a revolutionary bill (H.R. 4289) designed to repair our broken system for financing long-term services and supports (LTSS). The “WISH Act”—Well-Being Insurance for Seniors to be at Home—is based on an idea first put forward by a group of long-term care experts known as the Long-Term Care Financing Collaborative, which was convened in 2012 by the Convergence Center for Policy Resolution and included the authors of this blog post. The idea was developed further in a 2018 paper presented at the Bipartisan Policy Center. If enacted, the WISH Act could significantly transform our LTSS financing system by harnessing the best of what the public and private sectors can jointly do to solve a problem that neither sector seems able to solve on its own. And it does this in a fiscally responsible way. LTC Comment: This dream come true for advocates of government funding petered out when Thomas Suozzi (D-NY) decided to run for New York Governor.
Cohen, Tell on State Initiatives 0720: https://www.ltsscenter.org/wp-content/uploads/2020/07/State-LTSS-Financing-Executive-Summary-July-2020.pdf 7/27/2020, “New Report: Exploring LTSS Social Insurance Strategies in 6 States,” by Marc Cohen, et al., LeadingAge LTSS Center @UMass Boston and the Center for Consumer Engagement in Health Innovation Quote: “A new analysis from the LeadingAge LTSS Center @UMass Boston and the Center for Consumer Engagement in Health Innovation examines activity across 6 states that are exploring social insurance initiatives to help finance long-term services and supports (LTSS). The Robert Wood Johnson Foundation supported the study. Learning from New State Initiatives in Financing Long-Term Services and Supports, a 48-page report detailing findings from the analysis, was developed in partnership with Community Catalyst’s Center for Consumer Engagement in Health Innovation. A 12-page Executive Summary is also available. The study was led by Marc Cohen, LTSS Center co-director; Ann Hwang, director of the Center for Consumer Engagement in Health Innovation; and Michael Miller, director of strategy policy at Community Catalyst.” LTC Comment: Can more government regulation and compulsion improve a long-term care system ruined by excessive government interference and financing? How will the epidemiological, monetary and fiscal consequences of the pandemic affect the answer? Are bankrupt states reliant on overextended federal largesse and driven by anti-market ideology part of the solution or much of the problem? Hopefully, this report, written by two distinguished LTC insurance scholars (Cohen, Tell plus others) will give us some answers. I’m eager to dig into it and will share my perspective in a future LTC Bullet. [LTC Bullet: Umpteenth Long-Term Care Study Disappoints. Friday, August 14, 2020]
Chapter 7: Long-Term Care Insurance Criticism Esworthy, Tumlinson and Cohen on LTC insurance, 0620: https://atiadvisory.com/wp-content/uploads/2020/06/Protecting-Consumers-and-Medicaid-from-Catastrophic-Long-Term-Care-Costs_June-2020.pdf “Protecting
Consumers and Medicaid from Catastrophic Long-Term Care Costs: “The long-term care insurance (LTCi) market has been on a twenty year downward spiral, driven by an unfavorable (i.e., declining) interest rate environment, higher than expected benefit costs, and lower than expected voluntary lapse rates.1 Some carriers have exited the industry entirely, whether voluntarily or via insolvency. Those carriers who have remained in the market have turned to premium increases in order to remain viable.2 LTCi is a financial product that promises over 7 million policyholders.” LTC Comment: Kicking LTC insurance when it’s down.
Chapter 9: Long-Term Care Providers Assisted Living Suggested
citation:
Chapter 10: Medicaid Medicaid Financing and Burwell Data Medicaid
Long Term Services and Supports Annual Expenditures Report Executive
Summary Medicaid Eligibility KFF on
Medicaid Financial Eligibility Hest,
Alarcon and Blewitt on Modeling Financial Eligibility for Medicaid
Longterm ABSTRACT Medicaid plays a significant role in financing long-term services and supports (LTSS) for low-income elderly (65+) in the United States. We modeled the impact of changing income, home equity, and asset limitations on Medicaid eligibility across states. We found that one in five elderly adults (10 million individuals) meet all three tests and would be financially eligible for Medicaid LTSS. Imposing additional restrictions on income allowances and eligibility thresholds had greatest impact on financial eligibility for Medicaid LTSS. Few states have opted to restrict financial eligibility and are instead looking for ways to keep people living independently in the community. LTC Comment: I analyzed this article in LTC Bullet: Rethink LTC Financing. Friday, February 19, 2021 Blewitt and
Hest, 0520 “Emergency Flexibility for States to Increase and Maintain Medicaid Eligibility for LTSS under COVID-19”b Lynn A. Blewett & Robert Hest To cite this article: Lynn A. Blewett & Robert Hest (2020) Emergency Flexibility for States to Increase and Maintain Medicaid Eligibility for LTSS under COVID-19, Journal of Aging & Social Policy, 32:4-5, 343-349, DOI: 10.1080/08959420.2020.1774312 To link to this article: https://doi.org/10.1080/08959420.2020.1774312 Medicaid Managed LTSS GAO on Medicaid Managed Care 1220 URL: https://www.gao.gov/assets/720/710680.pdf 12/16/2020, “Medicaid Long-Term Services and Supports: Access and Quality Problems in Managed Care Demand Improved Oversight,” Government Accountability Office, GAO-21-49 Quote: “Medicaid spends about a third of its budget on long-term services and supports for adults and children with disabilities and chronic conditions. Over half of states contract with managed care organizations to provide those services. We examined 6 states, each of which reported finding significant problems with the quality of care provided through these contracts. In some cases, the problems led to patient injury or neglect. This suggests that problems may be widespread, raising concerns given gaps we found in monitoring and oversight. Our recommendations include drafting a national oversight strategy.” LTC Comment:
This was never going to end well as we observed in this “LTC Bullet:
How the Government Ruined LTC (and We’ll Fix It)” on June 10, 2016: Medicaid Estate Recovery (and Liens) MACPAC,
“Medicaid and CHIP Payment and Access Commission” recommended curtailing
Medicaid estate recoveries in its We analyzed and critiqued their proposal in two LTC Bullets: 040221
LTC Bullet #1302--MACPAC Captured Little has been heard of this misguided proposal since.
|