Thursday, March 31, 2005
Long-term care "Lone Ranger" Steve Moses
[Richard L. Peck, "Long-term care’s lone realist rides again," Nursing Homes/Long Term Care Management, March 2005.]
This is a great interview with Stephen Moses, President of the Center for Long-Term Care Financing. Moses has completed a thorough audit of Nebraska's long-term care system and has come to Kansas a number of times through Flint Hills to make the case for Medicaid reform:
Peck: Your Realist’s Guide offers a fascinating tour of the LTC planning approaches of several states, defining some that are close to “basket cases” and others that are closer to what might be described as “model” states. What are the patterns that seem to define them one way or another?
Moses: First of all, I wouldn’t use the term “model” states. They’re all basket cases to some degree or another, although it’s not entirely their fault. They’re hampered by various federal restrictions. But some are doing less well than others with the tools already at hand to ease their Medicaid burdens.
For example, California is still allowing a pyramid divestiture schedule—outlawed by OBRA ’93—that allows the wealthy to give away as much as $1 million in assets in a small fraction of the time allowed by federal law to qualify for Medi-Cal. Georgia, Michigan, and Texas have only just started implementing estate recoveries to reimburse their Medicaid programs for long-term care expenses. I predict that none of these three states will recover enough to pay for the estate recovery program itself because of the exclusions and exemptions they’ve built into their programs. Oregon has been doing estate recoveries since the inception of its Medicaid program, and today collects $15 for every $1 invested in running the program. In fact, it was the Oregon program that fi rst got me interested in this question when I was at HCFA in the early 1980s. I calculated back then how much the country as a whole would save in Medicaid expenditures if it did the same thing as Oregon and published the results for the Office of Inspector General. Since then it’s become even more clear that the potential to help support Medicaid for the poor and wake up baby boomers to their financial risks in relying on Medicaid is huge if and when Medicaid estate recoveries are pursued cost effectively.
This does not necessarily have to be a political problem, by the way, as some have called it. To get across the appropriateness of estate recovery, you show the public how the genuinely poor are hurt as they lose access to Medicaid-funded services, while the affluent just skate by.
Minnesota has a relatively strong estate recovery program and strict eligibility rules, along with a 10 to 14% penetration of long-term care insurance and active home equity conversion. Although its recent HCBS push has been counterproductive in the absence of stronger eligibility controls, it has a Medicaid nursing home census of only 59%. So it’s less a “basket case” than some others.
In general, the states do have options to make Medicaid eligibility more rational, and we need the federal government to give states more authority to do so. The market is heading in that direction. All I’m saying is, let’s expedite this and get the thing fixed before the whole system collapses.
[Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]
[Richard L. Peck, "Long-term care’s lone realist rides again," Nursing Homes/Long Term Care Management, March 2005.]
This is a great interview with Stephen Moses, President of the Center for Long-Term Care Financing. Moses has completed a thorough audit of Nebraska's long-term care system and has come to Kansas a number of times through Flint Hills to make the case for Medicaid reform:
Peck: Your Realist’s Guide offers a fascinating tour of the LTC planning approaches of several states, defining some that are close to “basket cases” and others that are closer to what might be described as “model” states. What are the patterns that seem to define them one way or another?
Moses: First of all, I wouldn’t use the term “model” states. They’re all basket cases to some degree or another, although it’s not entirely their fault. They’re hampered by various federal restrictions. But some are doing less well than others with the tools already at hand to ease their Medicaid burdens.
For example, California is still allowing a pyramid divestiture schedule—outlawed by OBRA ’93—that allows the wealthy to give away as much as $1 million in assets in a small fraction of the time allowed by federal law to qualify for Medi-Cal. Georgia, Michigan, and Texas have only just started implementing estate recoveries to reimburse their Medicaid programs for long-term care expenses. I predict that none of these three states will recover enough to pay for the estate recovery program itself because of the exclusions and exemptions they’ve built into their programs. Oregon has been doing estate recoveries since the inception of its Medicaid program, and today collects $15 for every $1 invested in running the program. In fact, it was the Oregon program that fi rst got me interested in this question when I was at HCFA in the early 1980s. I calculated back then how much the country as a whole would save in Medicaid expenditures if it did the same thing as Oregon and published the results for the Office of Inspector General. Since then it’s become even more clear that the potential to help support Medicaid for the poor and wake up baby boomers to their financial risks in relying on Medicaid is huge if and when Medicaid estate recoveries are pursued cost effectively.
This does not necessarily have to be a political problem, by the way, as some have called it. To get across the appropriateness of estate recovery, you show the public how the genuinely poor are hurt as they lose access to Medicaid-funded services, while the affluent just skate by.
Minnesota has a relatively strong estate recovery program and strict eligibility rules, along with a 10 to 14% penetration of long-term care insurance and active home equity conversion. Although its recent HCBS push has been counterproductive in the absence of stronger eligibility controls, it has a Medicaid nursing home census of only 59%. So it’s less a “basket case” than some others.
In general, the states do have options to make Medicaid eligibility more rational, and we need the federal government to give states more authority to do so. The market is heading in that direction. All I’m saying is, let’s expedite this and get the thing fixed before the whole system collapses.
[Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]
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