When the federal Commission on Long-term Care issued its report last month, there was a sense of déjà vu all over again. Sixteen years ago, in New York State, we were staff person and task force member, respectively, for New York’s Task Force on Long-Term Care Financing. Despite the passage of time, there were some interesting similarities between the federal commission and the New York State Task Force — these included the compressed time frame for deliberations and the issuance of dissenting reports.
There were important differences, however. New York’s Task Force included representation of private long term care insurers and elder law practitioners. This helped the Task Force make an important contribution to the policy debate about how a public-private partnership to finance long-term care could be accomplished, including a novel idea for a “defined contribution option” as a bridge between today’s reality that people do not tend to plan ahead for their long term care needs and a future vision where persons of means are incentivized to do so. The task force report also had important recommendations on reform of financing of Continuing Care Retirement Communities and growing interest in managed long-term care.
While it appears we are no closer to bridging the ideological gap between proponents of social insurance and private insurance, the good news is that we have moved from consensus to action on the issue of integrating acute, primary and long term care for persons dually eligible for Medicare and Medicaid. The federal commission, as did NY’s Task force, saw this as a means to improve quality of care and lower costs.
The New York Task Force spawned legislation that created a comprehensive statutory framework for managed long term care for the dually eligible, with a “walk before you run” approach. This spurred the development of plans that have voluntarily enrolled over 45,000 elderly and disabled persons, accounting for $1 billion in annual premiums. Now New York, with federal approval, is in the process of mandating participation in these plans. As a result of fiscal pressures on the states and incentives in the Affordable Care Act, long-term care integration is growing across the country. According to one study, approximately 26 states will have some form of managed long-term care by the end of 2014.
This, too, was once a controversial area, but with a systematic approach and open minds, many of the concerns were overcome. To be sure, long-term care financing reform is not an easy issue to tackle, but with a similar approach and all stakeholders at the table, much can be accomplished.
Brian Ellsworth is a health and long-term care policy expert, with a background representing providers and payers. Arthur Webb is a former Commissioner of several state agencies in New York and CEO of a LTC provider system and COO of a hospital.
