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A Medicaid Reform Worth Exploring

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Virginia is faced with a serious problem as are all states: the aging population requires us all to figure out how to handle the “costs” that this is going to bring to government and personal budgets.

Long Term Care is one of the more important problems facing all families as parents, brothers and sisters and aunts and uncles live longer and longer.

What are the costs today, what the projections for these costs in the future, and how should we consider restructuring this need for Long Term Care in order for those who need it receive it, and that the burden on government – on the taxpayers – is kept within reasonable bounds?

It is these questions and concerns that prompted the Thomas Jefferson Institute to ask Stephen Moses of the Center for Long Term Care Reform to look into our program and, with his expertise from doing similar work in other states, to suggest what we ought to do here to prepare for this growing need within our society. The full study can be found here.

Four concerns popped out to me in this study that need to be opening and frankly discussed. They are:

Long-term care is expensive, funded mostly by Medicaid (considered part of our nation’s welfare program), heavily dependent on already strained state and federal revenue, and facing an on-coming wave of aging boomers who will test the adequacy of scarce public resources.

Virginia is one of only seven states in which the age 85 plus population, the cohort most likely to need long term care, is projected to more than quadruple between 2012 and 2050, up 307%! So financing long-term care in Virginia will become a huge problem.

The Commonwealth has doubled down on its Medicaid-financed long term care system by implementing major new programs to (a) “rebalance” services from nursing home care to home care (making Medicaid more desirable) and (b) to “manage” care by turning it over to large managed care organizations (making Medicaid recipients more vulnerable to cost cutting and quality problems).

While ramping up Medicaid for long-term care, Virginia has not done enough to encourage private sources of LTC financing that could relieve financial pressure on the tax-financed program. Asset spend down, estate recovery, home equity conversion and private long-term care insurance could and should contribute far more to financing quality LTC services.

This study, “The Index of Long-Term Care Vulnerability: A Case Study in Virginia,” focuses on this problem and offers some policy alternatives.

The policy changes recommended in this study includes urging the state legislature to not rely on Medicaid long term care as a financially stable program in the long term. That means that alternatives have to be found.

Medicaid long term care should be focused on the most needy among us and others should be financing long term care themselves. Ways that this can be done is buying long-term care insurance. This is reasonable and logical and creative ways must be found to encourage people to buy such policies.

Home equity can be used to help pay for long term care and that should be encouraged according to this study. Federal law allows the cost of long term care to be “paid back” after the patient dies from the value is his or her estate. Virginia can do much more in this area and the study shows how other states are doing this to a greater extent than we are.

There may be other policy changes that could take place at the state and national level. But the point is that Medicaid is supposed to be for the most needy among us. However, a system has been set up that allows middle class and upper middle class citizens to legally “move” their assets or put a fence up around those assets so that they can qualify of a program originally set up the poor.

This study (here) is fascinating and should be read by anyone who is interested in try to untangle the incredible entitlement mentality in our country. And as the legislatively mandated Medicaid Reform Commission continues to decide what reforms should take place before Medicaid is expanded here in Virginia, the reforms in that program’s long term care advocated in this new study  should be implemented if we are serious about controlling government spending and protecting the next generation from overwhelming government financial crises.

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