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Regulation and Compliance > State Regulation

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If you’re selling to consumers in Florida, Nevada or New York, they might need private long-term care insurance (LTCI) more than prospects living in Hawaii, Kansas or Connecticut.

Researchers at the AARP Public Policy Institute, Washington, tell the tale in a “long-term services and supports” state scorecard they created together with the SCAN Foundation, Long Beach, Calif., and the Commonwealth Fund, New York.

Dr. Bruce Chernoff, the president of the SCAN Foundation, presented a talk on the study recently at the Intercompany Long Term Care Insurance Conference in Las Vegas.

The researchers who created the scorecard spent two years designing the study and gathering the data. They looked for performance indicators in areas such as affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and organization of care and transitions from one level of care to another.

In some cases, the researchers came up with the results that health policy researchers usually come up with: Performance is terrible in the Southeast and Appalachia, and better in the Plains states.

But the researchers also came up with some surprises as they gathered the information they used to produce their Long-Term Services and Supports map.

New York ranks 41st in terms of performance, and just above Louisiana.

Florida, a state that often outshines other Southeastern states on acute-care measures, ranks 43rd. Just below Louisiana.

Nevada is ranked 40th, and Indiana, a state known for being a pioneer in the Long Term Care Partnership program, ranks 47th.

The top 5 states are Wisconsin, Hawaii, Oregon, Washington state and, in first place, Minnesota.

The groups that produced the scorecard want states, patient advocacy groups and others to push for improvements.

“Leading states do well in multiple dimensions, but all have far to go,” Chernoff said at the ILTCI Conference.

States’ performance on the indicators varied widely, and no state ranked in the top quarter in terms of all 25 indicators used to produce the scores, Chernoff said.

Alaska, for example, ranked 17th overall, and it ranked in the top quarter in terms of choice of setting and provider and in terms of quality of life and quality of care. But the state ranked in the bottom quarter in terms of  support for family caregivers and the cost of care. Compilers of nursing home cost survey reports usually find that Alaska has the most expensive nursing homes in the country.

One way states could improve their scores would be to spend more Medicaid LTC money on home care, rather than institutional care, and to make sure that a higher percentage of patients who end up in institutions start out seeing if they can get by at home, Chernoff said.

For producers, the message of the map may be that, whatever states and policymakers do in the future, consumers in the bottom-ranking states desperately need LTCI and comprehensive LTC plans today.

Some ideas for how LTCI producers might use the scorecard data in marketing and community relations efforts:

1. Click the “embed” button on the LTC scorecard Web page, at, to get the HTML code you need to share the map with consumers.

2. Organize and participate in panel discussions that focus on what the score says about the state of LTC services in your state.

3. Use the information about weaknesses in LTC services in your state to drive home the message that simply depending on Medicaid, the kids and fate to provide the right care at the right time may be a high-risk approach.


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