To The Editor:

Who says the country is not experiencing a growing long-term care crisis? We better all wake up to the facts!

Its all about the lack of straightforward information about private care planning and care financing. But still today the majority (63%) of people 65 and older think its taken care of. And to make matters worse, the baby boomers havent begun to plan and 95% dont know what LTC insurance is!

So eventually, when care is needed, they will have to spend-down their assets and income and end up on Medicaid (Title 19). The majority of the population is simply uninformed.

Two months ago, CareQuest reported on the growing nursing home trend of cost-shifting Medicaid (Title 19) patient costs to the private pay patients because their particular state had maxed out their Medicaid budget and the Medicaid daily payment level was not enough to sustain the cost of care, creating cash shortfalls for the providers. And, as some of us already know, even under the best of conditions Medicaid does not pay a fair-market-value to the provider for the daily services of most patients.

One month ago we read more about a rash of nursing homes that were evicting Medicaid patients (nothing new, by the way), because the nursing home(s) decided to reduce the number of Medicaid beds to make room for more private pay patients.

The law does allow a nursing home to maintain Medicaid/Medicare certification under certain bed reduction levels. This is not new, its been going on over the last 8 or 9 years. However, now the media is picking up on the eviction process because its happening more frequently. Some people have even died as a result of transfer trauma–now lawsuits are being filed by family members.

Another growing practice among nursing homes and other care services that are Medicaid/Medicare certified, is to decertify completely and evict all except for private pay patients–also legal. It doesnt take a mathematical genius to figure this one out. Certain services and facilities that have a growing private pay patient load may cut their losses, or even make money, by having empty beds rather than staff and resource for underpaid beds. As our aging population grows and outpaces available care services and facilities, those that will receive their choice of care are those who can privately pay.

Why wont the State/Federal Medicaid system increase their payment levels to care providers, similar to Medicare (Title 18)? Well, first, it was never designed to be an entitlement program–it was designed for the needy and impoverished who could not plan ahead. Second, if Medicaid (Title 19) cant even fund care at a fair-market-value today, try to imagine how they (the taxpayers) are going to fund it for the baby boomers. The math simply doesnt work. Its just too big!

The problem with Medicaid (Title 19) payment levels today is they cant increase the daily reimbursements because of the increasing number of people joining the Medicaid rolls–supply and demand.

What is the solution and what can you do? Every chance you get, let our insurance agents and financial planners know the hazards and consequences of being a Medicaid recipient for long-term care. They in turn must share this knowledge with the public every chance they get. The public must know they are not covered for LTC by their health insurer or Medicare, and need to plan for this probability–Medicaid is not the answer!

That is the only solution to this crisis–but our federal government has to make the same effort to communicate this message directly to boomers and seniors.

Bob Pearson, CEO, LTCGS
rlpearson@CareQuestPlus.com
CareQuest National Work & Family Life Programs


Reproduced from National Underwriter Life & Health/Financial Services Edition, July 29, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.