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Addressing the Challenge: Public and Private Solutions for Long-Term Services

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Addressing the Challenge: Public and Private Solutions for Long-Term Services & Supports Long-Term Care Financing Advisory Committee Meeting October 15, 2009 – PowerPoint PPT presentation

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Title: Addressing the Challenge: Public and Private Solutions for Long-Term Services


1
  • Addressing the Challenge Public and Private
    Solutions for Long-Term Services Supports

Long-Term Care Financing Advisory Committee
Meeting October 15, 2009
For Advisory Committee Policy Discussion Purposes
2
Outline of the Presentation
  • Public Awareness Campaign
  • Informal Caregiver Supports
  • Setting the Stage for Comprehensive Reform
  • Goals and Principles
  • Review of the Challenge
  • Solutions that hold Promise for Massachusetts
  • The Long-Term Care Partnership Program (LTCP)
  • The Contribution Program
  • Cost Impact Analysis
  • MassHealth Data Analysis
  • Committee Business

For Advisory Committee Policy Discussion Purposes
3
Public Awareness CampaignA public awareness
campaign to increaseunderstanding of LTS options
financing
For Advisory Committee Policy Discussion Purposes
4
Why Encourage Adults to Plan for LTS?
  • Complement other statewide IR activities
  • Address public concern that the demand for LTS
    will exceed available resources
  • Educate about shared public/private
    responsibility
  • Improve quality of life in later years
  • Support individual preferences, choice and
    dignity
  • Enable families to support aging relatives
  • Encourage proactive LTS planning
  • Help future generations to maintain financial
    security
  • Avoid/reduce Medicaid costs

For Advisory Committee Policy Discussion Purposes
5
Elements of CMS Campaign
  • State role
  • Solicit Governors buy-in
  • Pay for initial mailing of letter/brochure
  • Issue press release/ hold press conference
  • Other activities as desired
  • TV, radio ads
  • Educational sessions
  • Website-800AGEINFO
  • CMS role
  • Print Governors letter/ brochure
  • Arrange initial mailing
  • Produce toolkit (booklet/CD)
  • Staff call center
  • Distribute toolkit to callers (including mailing
    charges)
  • Provide technical assistance other materials

For Advisory Committee Policy Discussion Purposes
6
Campaign Materials
  • Governors Letter
  • Brochure
  • Booklet and CD

For Advisory Committee Policy Discussion Purposes
7
Chapters of Campaign Booklet
  • Introduction
  • Embrace the future!
  • Where should I start?
  • Lifestyle planning
  • Legal and estate issues
  • Staying at home
  • Financial Planning for LTS
  • LTC Insurance
  • Reverse Mortgages
  • Additional options available in Mass
  • Planning for your Care
  • For more information

For Advisory Committee Policy Discussion Purposes
8
Planned activities
  • Initial Mailing
  • Approximately 450,000 households
  • Other components
  • TV/radio ads
  • Educational sessions
  • Website

For Advisory Committee Policy Discussion Purposes
9
Next Steps Timetable
  • Finalize campaign materials 10/23/09
  • Solicit Governors Buy-in 11/01/09
  • Print materials 12/15/09
  • Update 800AGEINFO Website 12/30/09
  • Launch campaign 1/15/10
  • Governors press conference
  • Public service ads
  • Initial mailing responses
  • Regional educational sessions 4/10-6/10
  • Campaign funding ends 9/30/10

For Advisory Committee Policy Discussion Purposes
10
Informal Caregiver Support
For Advisory Committee Policy Discussion Purposes
11
Informal Caregivers provide an immense amount of
LTS in Massachusetts
  • Informal Caregivers provide about 36 of the LTS
    received by elders nationally1
  • In Massachusetts, there are about 690,000
    informal caregivers of people of all ages at any
    given time, and about 1,040,000 at any time
    during the year2
  • These caregivers provide the equivalent of 8.9
    billion worth of care
  • Nationally, 17 of informal caregivers provide
    40 hours per week of care, 8 provide 21-39
    hours, 23 provide 9-20 hours, and 48 provide 8
    hours or less3

1 Hagen, S. Financing Long-Term Care for the
Elderly, Congressional Budget Office, April
2004. 2 National Family Caregivers Association
Family Caregiver Alliance. (2006). Prevalence,
Hours and Economic Value of Family Caregiving
Updated State-by-State Analysis of 2004 National
Estimated by Peter Arno, PhD. Kensington, MD
San Francisco, CA FCA. 3 National Alliance for
Caregiving and AARP. Caregiving in the U.S.
Bethesda National Alliance for Caregiving, and
Washington, DC AARP, 2004.
For Advisory Committee Policy Discussion Purposes
12
The majority of Informal Caregiver supports are
currently offered through Elder Affairs
Types of Program Program Agency
Training and Support including counseling, support groups, and training Family Caregiver Support Program Elder Affairs
Information and Assistance, programs that assist caregivers in accessing supports in the community Family Caregiver Support Program 800-AGE-INFO MADIL Elder Affairs Elder Affairs EOHHS
Respite programs that provide informal caregivers with a break from their caregiving responsibilities Family Caregiver Support Program Home Care Respite Program HCBS Waivers Elder Affairs Elder Affairs MassHealth with Elder Affairs, DDS, MRC
Other Programs that can provide support to informal caregivers including financial assistance Adult Day Health and Supportive Day PCA (by paying family members) AFC (by paying family members) Elder Affairs MassHealth
For Advisory Committee Policy Discussion Purposes
Respite is also disparately available through
MRC and its SHIP program, MCB, and DDS
13
Given the number of Informal Caregivers in the
state, very few are receiving publicly-funded
services
Programs that offer Caregiver-Specific Services Programs that offer Caregiver-Specific Services State Expenditures Utilization2
Family Caregiver Support Program1 Family Caregiver Support Program1
In-Home Other Respite 611,500 1,046
In-home counseling, Support Groups, Caregiver Training 1,960,000 7,049
General Information and Referral 1,300,000 13,449
Home Care Respite Program Home Care Respite Program 6,800,000 30,696
Elder TBI Waiver Elder TBI Waiver 41,4443 134
Totals Totals 10,712,944 52,889
Additionally, DDS provided 515 respite
opportunities in 2009.
Sources Executive Office of Elder Affairs and
MassHealth. 1 Family Caregiver Support program
expenditures include federal Title III-E, state
and local funds. 2 FCSP utilization numbers
are the only ones that are unduplicated. 3 Does
not include DDS Expenditures
For Advisory Committee Policy Discussion Purposes
14
There are other services that support Informal
Caregivers
  • Adult Day Health provides daily respite for
    caregivers. No data collected by MassHealth on
    how many participants have caregivers.
  • FY08 62,700,000
  • 6,998 MassHealth clients in FY09 - 923 in
    Complex level of care, which means they meet NF
    LOC, and are therefore likely to have caregivers
    at home
  • Adult Foster Care allows family members to be
    providers, paying them for providing care for
    individuals who live in their home. No data
    collected on how many providers are family
    members.
  • Personal Care Attendants (PCA) Allows clients to
    hire family members as PCA.
  • In the past year, 5,005 PCAs were hired family
    members, which is 19 of all PCAs hired.

For Advisory Committee Policy Discussion Purposes
15
Training Informal Caregivers reduces other LTS
costs
  • In one key study, training and support programs
    created a median delay in nursing facility
    placement of 577 days, or 1.5 years
  • A randomized 17-year-long study of 406 spouse
    caregivers of individuals with Alzheimers
    Disease
  • Intervention was two individual and four family
    counseling sessions tailored to specific
    situation, encouragement of support group
    participation, and the availability of ad hoc
    telephone consultation.
  • Mittelman, M. Haley, W. Clay, O. Roth, D.
    Improving caregiver well-being delays nursing
    home placement of patients with Alzheimer
    disease. Neurology 200667(9)1592-9.

For Advisory Committee Policy Discussion Purposes
16
Paying Informal Caregivers could address a number
of issues related to LTS financing
  • Decrease other LTS costs1
  • Increase pool of possible workers
  • Expand access to LTS for rural areas
  • Raise questions about familial responsibility and
    substitution of care

1 Dale, S., and Brown, R. Reducing Nursing Home
Use Through Consumer-Directed Personal Care
Services. Medical Care. 44(8)760-767, August
2006. Brown, R., Carlson, B., Dale, S., Foster,
L., Phillips, B., and Schore, J. Cash
Counseling Improving the Lives of Medicaid
Beneficiaries Who Need Personal Care or Home and
Community-Based Services. Princeton, NJ
Mathematica Policy Research, Inc., August, 2007
For Advisory Committee Policy Discussion Purposes
17
Possible Short-Term Actions to improve Informal
Caregiver Supports
  • Increase awareness, and therefore utilization, of
    existing supports through increased outreach and
    education
  • Understand whether and why many caregivers do not
    get information they need and can use about
    available supports
  • Encourage implementation of evidence-based
    programs for caregivers of people with
    disabilities across the lifespan
  • Press for full funding of the National Lifespan
    Respite Care Act
  • Press for increased funding for National Family
    Caregiver Support Act

For Advisory Committee Policy Discussion Purposes
18
Setting the Stage for Comprehensive Reform
For Advisory Committee Policy Discussion Purposes
19
CF Olmstead Plan goals
  1. Help individuals transition from institutional
    care.
  2. Expand access to community-based long-term
    supports.
  3. Improve the capacity and quality of
    community-based long-term supports.
  4. Expand access to affordable and accessible
    housing with supports.
  5. Promote employment of people with disabilities
    and elders.
  6. Promote awareness of long-term supports.

For Advisory Committee Policy Discussion Purposes
20
LTC FAC Advisory Committee goal
  • To identify and prioritize short-term and
    long-term strategic options for reforming the
    financing system for LTS for elders and
    individuals with disabilities in Massachusetts to
    support a range of LTS and a sustainable mix of
    personal and familial responsibility, private
    financing mechanisms and public assistance in a
    manner that
  • maximizes independence and
  • assures access to the necessary continuum of LTS.

For Advisory Committee Policy Discussion Purposes
21
CF Olmstead Plan principles
  1. People with disabilities and elders should have
    access to community living opportunities and
    supports.
  2. The principle of community first should shape
    policy development and funding decisions.
  3. A full range of long-term supports, including
    HCBS, housing, employment opportunities and
    nursing facility services, are needed.
  4. Choice, accessibility, quality, and
    person-centered planning should be the goals in
    developing LTS.
  5. Systems of community-based care and support must
    be strengthened, expanded and integrated to
    ensure access/efficiency.
  6. Public and private mechanisms of financing LTS
    must be expanded.
  7. LTS must address the diversity of individuals
    with disabilities and elders in terms of race,
    ethnicity, language, ability to communicate,
    sexual orientation, and geography.

For Advisory Committee Policy Discussion Purposes
22
LTS Financing Principles (Draft 2)
  • The reformed LTS financing system will
  • Ensure a strong public safety net for the poor
    and most vulnerable.
  • Limit financial pressure on the state financing
    system so that state funds are preserved for
    those most in need.
  • Encourage personal responsibility for financing
    LTS to the maximum extent possible.
  • Enable middle income people of all ages to access
    the LTS they need without becoming impoverished.
  • Ensure appropriate participation of and support
    for informal caregivers.

For Advisory Committee Policy Discussion Purposes
23
Other Olmstead Plan and Community First Activities
  • Olmstead Plan objectives available online at
    www.mass.gov/hhs/communityfirst
  • December meeting will include discussion of
    related activities around the following topics
  • Transportation
  • Employment
  • Housing
  • Workforce Development
  • Care Integration
  • Information and Awareness
  • Consumer Choice / Self-Direction

For Advisory Committee Policy Discussion Purposes
24
People with LTS Disabilities who need assistance
with Self-Care or Every Day Tasks
Total 562,385 Scale Low-income(0-199 FPL) Low-income(0-199 FPL) Middle-income (200-499 FPL) Middle-income (200-499 FPL) Higher-income Highest (500 FPL) Higher-income Highest (500 FPL)
Total 562,385 Number of ("Need Public Assistance") ("Need Public Assistance") ("Medicaid-bound" or Tweeners) ("Medicaid-bound" or Tweeners) ("Private Savings") ("Private Savings")
Total 562,385 Individuals Total 258,823 (46) Total 258,823 (46) Total 204,341 (36) Total 204,341 (36) Total 99,221 (18) Total 99,221 (18)

Kids (5-18)   N 9,941 (2 of total LTS) N 9,941 (2 of total LTS) N 7,709 (1) N 7,709 (1) N 3,366 (1) N 3,366 (1)
Kids (5-18)              
Kids (5-18)   Self Care Everyday Tasks Self Care Everyday Tasks Self Care Everyday Tasks
Kids (5-18) 10,000 5,601 4,340 4,650 3,059 2,248 1,118
Kids (5-18) 5,000            
Kids (5-18) -            
Adults (19-64)   N 144,718 (26) N 144,718 (26) N 97,437 (17) N 97,437 (17) N 52,884 (9) N 52,884 (9)
Adults (19-64)              
Adults (19-64) 100,000            
Adults (19-64) 90,000            
Adults (19-64) 80,000            
Adults (19-64) 70,000            
Adults (19-64) 60,000            
Adults (19-64) 50,000            
Adults (19-64) 40,000            
Adults (19-64) 30,000            
Adults (19-64) 20,000 Self Care Everyday Tasks Self Care Everyday Tasks Self Care Everyday Tasks
Adults (19-64) 10,000 39,597 105,121 23,496 73,941 9,938 42,946
Adults (19-64) -            
Seniors (65)   N 104,164 (19) N 104,164 (19) N 99,195 (18) N 99,195 (18) N 42,971 (8) N 42,971 (8)
Seniors (65)              
Seniors (65) 70,000            
Seniors (65) 60,000            
Seniors (65) 50,000            
Seniors (65) 40,000            
Seniors (65) 30,000            
Seniors (65) 20,000 Self Care Everyday Tasks Self Care Everyday Tasks Self Care Everyday Tasks
Seniors (65) 10,000 33,400 70,764 26,609 72,586 12,535 30,436
Seniors (65) -            
For Advisory Committee Policy Discussion Purposes
Does not include persons who were
institutionalized, in military group quarters or
college dormitories, or unrelated individuals lt
age 15. Source 2007 American Community Survey
(ACS), US Census Bureau, tabulations by authors.
25
Need for LTS Resources (Informal and Financial)
Depends on Time in Need AND Type of Services
UsedSimulated Distribution of Years of LTSS Need
at 65
For Advisory Committee Policy Discussion Purposes
  • Kemper (2005)

26
Distribution of LTSS SpendingSimulated for
65-year-old (2004)
For Advisory Committee Policy Discussion Purposes
  • Kemper (2005)

27
Current LTS Financing System
State Programs
High LTS NEED Low
Medicaid Spend-down
Medicaid Other State Programs
Personal Resources (includes Informal Caregivers)
LTC Insurance
Low

High FINANCIAL RESOURCES
For Advisory Committee Policy Discussion Purposes
28
Zero in on the Challenges
  • The Elderly
  • Substantial Need 68 of the Elderly Need Care
  • Medicaid is the Only Option for Many
  • Private LTC Insurance is Unaffordable for
    Low/Middle Incomes
  • Middle Income Spend Down to Medicaid
  • Upper Income fare best today
  • Limited community-based care
  • The Under 65 Disabled
  • Private LTC Insurance is an option only before
    become disabled
  • Limited community-based care
  • MassHealth CommonHealth is only option for many

For Advisory Committee Policy Discussion Purposes
29
Solutions That Hold Promise For Massachusetts
For Advisory Committee Policy Discussion Purposes
30
Todays Presentation for the LTC FAC
  • Responds to the Goals of the Advisory Committee
  • Responds to the LTS Financing Principles of the
    Committee
  • Introduces Public Private Models to Finance LTS
  • Recommends a Model for Massachusetts

For Advisory Committee Policy Discussion Purposes
31
How to Evaluate Each Model
  • Target Population
  • How many people will benefit from the model?
  • Who will not benefit?
  • Benefit Coverage
  • What benefit does the model offer? Does it meet
    the need?
  • How much long-term services support coverage
    does it provide?
  • Costs (Costs and Savings Impact Analysis)
  • Who bears the costs?
  • Is it cost effective?
  • Is this a solution for today or tomorrow?

For Advisory Committee Policy Discussion Purposes
32
Cut to the Chase There is No Silver Bullet!
  • Each existing model leaves someone out
  • Existing models offer partial solutions
  • Our Challenges
  • How can we design our model to achieve our goals?
  • Can we combine models to improve coverage?
  • How can we improve upon existing models?

For Advisory Committee Policy Discussion Purposes
33
Preview Where we might end up
  • A Complementary approach
  • Private Insurance
  • Expand to Middle Income people
  • Public Insurance
  • Meet the Challenge of Covering Disabled Middle
    Income people
  • Medicaid Adjust to fill gaps
  • Massachusetts as a State Laboratory
  • Massachusetts embraces its role as a State
    Laboratory for Change
  • Take what exists and improve upon it
  • Start small

For Advisory Committee Policy Discussion Purposes
34
Two Models that Hold Promise for Expanding
Coverage
  • Two Models to Insure the Elderly Disabled
  • Privately sponsored The LTC Partnership Program
  • Publicly sponsored The Contribution Program
  • Walk-Through of Each Model
  • Background
  • Key Bullets
  • The Pros Cons of Each Model
  • Changes for Massachusetts
  • Where does it leave us?

For Advisory Committee Policy Discussion Purposes
35
Privately Sponsored The LTC Partnership
  • Private Insurance for Long-Term Care (or LTS)
  • Focused on currently healthy people planning for
    future LTS need
  • Represents an alliance between State Government
    Private Industry
  • RWJF 1988 grants to states
  • Goals of the LTC Partnership Program
  • Reduce Medicaid LTC Costs
  • Protect Consumers from Impoverishment Protect
    some/all assets
  • Offer Consumers back-end protection Asset
    Disregard Incentive
  • Connecticut Case Study An Early Pioneer in the
    LTC Partnership
  • Handout Connecticut Case Study 101,Prepared
    for Committee Meeting, 10/15/09

For Advisory Committee Policy Discussion Purposes
36
The Connecticut Case Study Key Bullets
  • Who wins?
  • Upper Income Persons
  • Lower out of pocket costs for those who use care
  • Who loses?
  • Middle Income and Disabled Persons Left Out
  • What about the costs and savings?
  • The Verdict is Out on Medicaid Savings
  • Program is solvent, so far

For Advisory Committee Policy Discussion Purposes
37
Long Term Care Insurance Participation
  • More people in Connecticut have LTC Insurance
    than in Massachusetts (includes group policies)

For Advisory Committee Policy Discussion Purposes
38
The Connecticut Case Study Pros Cons
  • The Pros of the Model
  • Long-running program, 17 years an experienced
    Director
  • Great Consumer Protections
  • Great Insurance for Upper Income
  • Comprehensive Care Policies (high premium cost)
  • Dollar for Dollar Coverage/Asset Protection
  • Lower out-of-pocket costs
  • The Cons of the Model
  • Low rate of participation (unaffordable to many)
  • Benefits accrue to Upper Income Elderly Persons
  • Middle Income Disabled left out of the program
  • Consumers find the purchase decision to be a
    complex one
  • Limited Portability

For Advisory Committee Policy Discussion Purposes
38
University of Massachusetts Medical School EBD
Consulting Services, LLC
39
Premiums Must be More Affordable for Middle
Income
  • Higher income people buy LTC insurance (green)
  • We need to make LTC insurance affordable for
    middle income (yellow)

For Advisory Committee Policy Discussion Purposes
39
University of Massachusetts Medical School EBD
Consulting Services, LLC
40
LTS Financing System With LTC Partnership Program
State Programs
High LTS NEED Low
Medicaid Spend-down
Medicaid Other State Programs
Personal Resources Consumer Protections Informal
Caregiver Support
LTC Insurance LTC Partnership
Low

High FINANCIAL RESOURCES
For Advisory Committee Policy Discussion Purposes
41
Where does the LTC Partnership Program Leave Us?
  • It will not meet everyones needs
  • Those with current LTS needs or current chronic
    conditions
  • Low income people who cannot afford to pay
    premiums
  • But with changes, it can be effective
  • Middle to Upper Income
  • Individuals who can afford to pay premiums over a
    long period of time
  • Healthy individuals who may need LTS in the future

For Advisory Committee Policy Discussion Purposes
42
The Connecticut Case Study Changes for
Massachusetts
  • Prerequisite Must enact NAIC Model Act
  • Implement consumer protections
  • What would we want to do differently?
  • Target middle income persons who are at risk to
    spend down
  • Question to FAC Are these the design features
    we want to work on?
  • Target middle income population
  • Encourage more people to buy, and at a younger
    age
  • Create an affordable benefit package
  • Make purchase decision easy for consumers
  • Consider incentives?

For Advisory Committee Policy Discussion Purposes
42
University of Massachusetts Medical School EBD
Consulting Services, LLC
43
Publicly Sponsored The Contribution Program
  • Public Model for LTS
  • A contributory program for paying for the cost of
    LTS
  • Everyone included (large risk pool)
  • Federal Plan Supported by Senator Kennedy, AAHSA
  • Federal plan included in 2 out of 3 National
    Health Care Reform bills (House HELP CBO
    scores as a savings)
  • Goals
  • Provide some coverage in affordable way
  • Offer consumers a life-time benefit for some of
    their future LTS needs
  • Meets some not all of a persons needs
  • Spread the risk broadly across all persons, no
    health screen
  • Example The CLASS Act

For Advisory Committee Policy Discussion Purposes
44
The CLASS Act Key Bullets
  • Cash benefit
  • Everyone is included, with voluntary opt out
  • Vested in 5 years People with current needs can
    begin drawing benefit in 5 years.
  • Portability from state to state
  • Big commitment on the part of the government to
    provide LTS financing over the long-term

For Advisory Committee Policy Discussion Purposes
45
The CLASS Act Skinny might be OK for some
  • Age 55 in 2009
  • Premiums 65/Month 780/Year
  • Premiums are very likely to be raised over time
  • Benefit 50/day or 100/day (used 75, here)
  • Age 75 in 2029
  • Benefit Assumes 75 cash daily/benefit in 2009
    at 5 compounded inflation

For Advisory Committee Policy Discussion Purposes
45
University of Massachusetts Medical School EBD
Consulting Services, LLC
46
The CLASS Act Solvency of a Contribution Program
  • Premiums must be sufficient to fund the program
  • Questions about the Solvency of the Program
  • 65 may not be sufficient in the long run
  • AAHSA Yes, program is solvent
  • CBO Maybe, in the middle
  • American Academy of Actuaries No

For Advisory Committee Policy Discussion Purposes
47
The CLASS Act Pros Cons
  • The Pros of the Model
  • Everyone gets something
  • Cash benefit based on need
  • Complements other plans for LTC
  • Benefits do not count against Medicaid
    eligibility
  • Great way to provide some coverage for middle
    income individuals
  • Great way to provide some coverage for disabled
    individuals
  • The Cons of the Model
  • Concerns about sustainability over long-term
  • Younger persons and/or upper income persons may
    opt out
  • Lower rates of participation lead to adverse
    selection
  • Program is viewed as serving all the needs
  • Benefit too skinny

For Advisory Committee Policy Discussion Purposes
47
University of Massachusetts Medical School EBD
Consulting Services, LLC
48
LTS Financing System with Contribution Program
Only
State Programs
High LTS NEED Low
Medicaid Spend-down
Medicaid (Enhanced) Other State Programs
Personal Resources (includes Informal Caregivers)
LTC Insurance
Contribution Program
Low

High FINANCIAL RESOURCES
For Advisory Committee Policy Discussion Purposes
49
Where does the Contribution Program Leave Us?
  • It will not meet everyones needs
  • Those with current LTS needs or current chronic
    conditions
  • Low income people who cannot afford to pay
    premiums
  • But with changes, a Limited Cash Benefit can
  • Address the need for home- and community-based
    care
  • Individually-tailored needs that are not
    presently covered by insurance or Medicaid
  • Support the informal care network

For Advisory Committee Policy Discussion Purposes
50
The CLASS Act Changes for Massachusetts
  • What would we want to do differently?
  • Ensure solvency over many years
  • Ensure high participation levels
  • Question to FAC Are these the design features
    we want to work on?
  • Lower premium contribution for low income
    individuals
  • Portability for individuals who move to another
    state
  • Pair benefit with Medicaid Asset Protection?
  • Consider other incentives?
  • Consider a mandatory program?

For Advisory Committee Policy Discussion Purposes
51
Model Comparisons (Part 1 of 2)
Title Partnership for Long-Term Care Title The CLASS Act
Enhance Private Insurance Create Contribution Program
Description Private Insurance Public Insurance Trust, could serve as a complement to Private Insurance and/or Medicaid
Participation Voluntary purchase Voluntary (opt out)
Target Population Those who can afford a long-term care insurance policy and with assets to protect, meet health screen Workers age 18 eligible to enroll Can continue to be in the plan after retired (need to keep paying premiums)
Covered Covers Elderly and Adults who buy before become disabled Covers both Elderly and lt65 Disabled
For Advisory Committee Policy Discussion Purposes
52
Model Comparisons (2 of 2)
Title Partnership for Long-Term Care Title The CLASS Act
Enhance Private Insurance Create Contributory Program
Excluded Low income who cannot afford premiums, middle income whose out of pocket costs would erode asset protection disabled and others who fail to meet the health screen Persons too poor to pay regular premiums or too rich for subsidized premium also, persons with certain cognitive functional limitations that fail to meet the test (triggers follow HIPAA rules)

Health Screen Yes No
Risk/Selection Potential for cherry picking Potential for adverse selection

Benefit 99 of policies are comprehensive, including both NF and HC 50 or 100 per day
For Advisory Committee Policy Discussion Purposes
53
A Complementary Public-Private Model
  • A Complementary approach
  • Private Insurance
  • Expand to Middle Income people
  • Public Insurance
  • Meet the Challenge of Covering Disabled Middle
    Income people
  • Medicaid Adjust to fill gaps
  • Massachusetts as a State Laboratory
  • Massachusetts embraces its role as a State
    Laboratory for Change
  • Take what exists and improve upon it
  • Start small

For Advisory Committee Policy Discussion Purposes
54
LTS Financing System with LTC Partnership AND
Contribution Program
State Programs
High LTS NEED Low
Medicaid Spend-down
Personal Resources Consumer
Protections Informal Caregiver Support
Medicaid (Enhanced) Other State Programs
LTC Insurance LTC Partnership
Contribution Program
Low

High FINANCIAL RESOURCES
For Advisory Committee Policy Discussion Purposes
55
Next Steps Timeline
  • Cost Impact Methodology
  • MassHealth Data
  • November Meeting

For Advisory Committee Policy Discussion Purposes
56
Highlights of Cost Impact Methodology
  • Population
  • Benefits
  • Premiums/Costs
  • Assumptions
  • Assessment

For Advisory Committee Policy Discussion Purposes
57
Cost Impact Methodology Analysis
For Advisory Committee Policy Discussion Purposes
58
MassHealth Data Analysis
  • Review Population and Spending
  • What we know about the Populations
  • What we know about MassHealth Spending
  • How to Collect Analyze MassHealth Data
  • Examine populations by income, etc.
  • Examine costs by type of LTS
  • External Data Sources

For Advisory Committee Policy Discussion Purposes
59
A Quick Review of the ChallengeLTS Cost
Pressures in Massachusetts
  • Numbers Illustrate Cost in 20 Years from Today
  • MetLife Survey

For Advisory Committee Policy Discussion Purposes
60
LTS Costs Unaffordable for Many
  • Massachusetts - 3 years in a Nursing Home in 2029
    will run close to 900K

For Advisory Committee Policy Discussion Purposes
61
MassHealth Data Members
For Advisory Committee Policy Discussion Purposes
62
MassHealth Data Spending
For Advisory Committee Policy Discussion Purposes
63
Committee Business
For Advisory Committee Policy Discussion Purposes
64
Committee Business
  • Public input process
  • Save the Date
  • Wednesday, November 18th 12 PM 230 PM,
    MetroWest Area
  • Monday, November 23rd 530 PM 8 PM, Holyoke
  • Next meeting
  • Date Thursday, November 12th, 2009 from 900
    -1130am
  • Location One Beacon Street, MassHousing Board
    Room
  • Future meeting reminder
  • Additional meeting scheduled for Thursday,
    December 10th

For Advisory Committee Policy Discussion Purposes
64
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