Building a Roadmap for Financing Long-Term Services & Supports

Melding Private Insurance, a Contribution Program & Medicaid into a Cohesive Proposal 

						
Long-Term Care Financing Advisory Committee
						
November 12, 2009

Presentation
•	Refined Strawman Proposal
•	LTC Partnership
•	Contribution Program
•	Combined Approach
•	Impact on Medicaid

•	Future Medicaid analysis

•	Appendix

Section 1
Refined Strawman Proposal

Refinements to Strawman proposal since last month
•	LTC Partnership/Private LTC Insurance
•	Identified affordable benefit package models
•	Targeted middle income people who are at risk to spend down

•	Contribution Program
•	Modeled a mandatory plan
•	Analyzed premiums required to ensure solvency

•	Medicaid Program
•	Assessed effect of LTC Partnership and Contribution on Medicaid
•	Status quo eligibility rules for purposes of modeling Medicaid baseline

Preview: “Take-away” points

LTC Partnership:
•	Private LTC insurance with good benefits can be made affordable to younger middle income adults
•	Group coverage with conversion requirement would increase take-up rate

Contribution Program:
•	$75 daily benefit covers a significant amount of care and needs
•	High uncertainty on how high to set premium rates in order to guarantee solvency (because of uncertainty in disability/death rates, among other factors)

Medicaid Savings:  
•	Difficult to calculate, requires many assumptions

Comprehensive and cohesive approach begins to emerge (assumes mandatory Contribution Program)

% FPL	100%	200%	300%	400%	500%	600%	1000%	2000%	
FPL (1) 	 $10,836 	 $21,672 	 $32,508 	 $43,344 	 $54,180 	 $65,016 	 $108,360 	 $216,720 	
Age	 	
25	 	 	 	 	 	 	 	 	
35	 	 	 	 	 	 	 	 	
45	 	 	 	 	 	 	 	 	
55	 	 	 	 	 	 	 	 	
65	 	 	 	 	 	 	 	 	
75	 	 	 	 	 	 	 	 	
85	 	 	 	 	 	 	 	 	

 	  Continue to rely on Medicaid	
 	  LTC Insurance may be affordable, but most will continue to rely on Medicaid	
 	  Contribution program is affordable with subsidy	
 	  Contribution program is affordable 	
 	  Can afford to participate in Contribution program and purchase supplementary LTC Insurance	

Framework for Evaluation &
Key Assumptions

Key questions for evaluating the proposal

•	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 LTS coverage does it provide?

•	Costs (Costs and Savings Impact Analysis)
•	Who bears the costs?
•	Is it cost effective?

Assumptions and limitations of analysis
•	Assumptions
•	Affordability:  Target of 2%
•	Modeled mandatory enrollment for Contribution Program
•	5% compound inflation (e.g. Premiums, LTS costs, Medicaid)
•	Modeled individual policies, did not look at couples policies
•	No assumptions made about tax treatment of the premiums/costs 

•	Limitations of work
•	Projection stops at 20 years
•	Population subgroups by age & income (e.g. people who are disabled)
•	Disability & death probabilities are critical
•	No Return on Investment assumptions made
•	Microsimulation model is highly recommended in order to develop legislation

								
LTC Partnership/Private Insurance

LTC Partnership is worth considering

•	Comparison grid highlights key differences between MA asset protection provision (quasi-Partnership) and LTC Partnership

•	Important things to be gained from a LTC Partnership:
•	Asset protection provided when purchase LTC insurance policy (in MA: asset protection provided when individual enters nursing facility)
•	Policies must cover community-based benefits (in MA: no requirement)

•	Choice is between existing MA asset protection rules or full LTC Partnership
•	Federal law “grandfathered” MA quasi-Partnership rules, but do not provide a way to amend these rules, except by implementing full LTC Partnership
•	Any new Program must protect people who bought LTC insurance policies under the quasi-Partnership rules

LTC Partnership: Where did we leave off last month?

•	Last month, we looked at the Connecticut Partnership model.  

•	We wanted to improve that model by:
•	Creating an affordable LTC insurance benefit package
•	Targeting middle income people who are at risk to spend down

•	In this section, we identify and model the features of two affordable LTC insurance benefit packages 
•	CalPERS
•	Federal Long-term Care Insurance Program (FLTCIP)

Elements of the improved model

•	Who participates (target population)?  
•	People over the age of 25 years
•	Incomes over $25,000 for under 65
•	Incomes over $30,000 for elderly people
•	People who can pass health screen; excludes people with disabilities
•	Assumed 15 percent of population over 25 would take up private insurance

•	What is the benefit?
•	Daily benefit of up to $100 or $150 toward comprehensive LTS for up to 2 years

•	What is the cost?  annual premiums vary by age, examples:
•	$410 at age 25
•	$967 at age 55
•	$4,905 at age 85

Two affordable models – benefit details

STRAWMAN PROPOSAL:  INSURANCE PARTNERSHIP	
 	 	 	
 	CalPERS Design	FLTCIP Design (no Partnership yet)	
 	 	 	
Features 	Self Funded	Insurance Carrier	
Enrollment	Offered	Offered	
Daily Benefit Amount (DBA)	$150 	$100 	
Health Screen	Yes	Yes	
Elimination Period	30 days	90 days	
Vested	n/a	n/a	
Eligibility - Benefit Trigger	2 ADLs	2 ADLs	
Plan Type	Comprehensive	Comprehensive	
Benefit Period	2 years	2 years 	
Inflation Protection	5%	5%	
Lifetime Maximum	 -----$109,500----- 	 -----$73,000----- 	

Who benefits: 69% of the population over age 25 would be eligible* to purchase a LTC insurance policy (estimate that only 15% will purchase)

THE INSURANCE PARTNERSHIP						
									
			Who benefits from the Program?		Who does not?		
 	 	 	 	 	 	 	 	 	
			                     Insurance Partnership				
	MA Pop		Eligibles	Take Up Rate	Take Up Rate		Ineligible	Percent	
									
25-35	     818,744 		      594,736 	           123,668 	21%		             224,008 	27%	
35-44	     955,201 		      693,858 	           144,279 	21%		             261,343 	27%	
45-54	  1,000,687 		      726,899 	           175,773 	24%		             273,788 	27%	
55-64	     747,266 		      542,814 	           131,259 	24%		             204,452 	27%	
65-74	     428,866 		      240,851 	             40,811 	17%		             188,015 	44%	
75 and Older	     441,862 		      248,150 	             42,048 	17%		             193,712 	44%	
Total 	  4,392,626 		   3,047,307 	           657,838 	22%		          1,345,318 	31%	
				15%					
									
Total Population, all ages except for under 18					
Under 65	  4,191,189 		   2,558,307 	           574,979 	22%		             963,591 	23%	
65+, including 85+	     870,728 		      489,001 	             82,858 	17%		             381,727 	44%	
Total Population	  5,061,916 		   3,047,307 	           657,838 	22%		        1,345,318 	27%	
									
Total MA Population	  6,497,967 		47%	10%			          3,450,660 	53%	

* Assumes low-income people and people who cannot pass health screen are not eligible to purchase an LTC insurance policy

Benefits covered: Both models cover substantial home care, most assisted living, and some nursing facility care

HOW DOES THE INSURANCE PARTNERSHIP ADDRESS LTS NEEDS?			
 	 	 	 	 	 	
		                         CalPERS	                           FLTCIP	
2009 Dollars	Costs	2 Years	1 Year	2 Years	1 Year	
Coverage	 	 $   109,500.00 	 $ 54,750.00 	 $ 73,000.00 	 $36,500.00 	
Daily Benefit Amount	 	 $          150.00 	 	 $      100.00 	 	

Long-Term Supports & Services at Home	 	 	 	 	 	
3 hours day/3 days week	 $  10,296 	 	100.0%	 	100.0%	
5 hours day/5 days week	 $  28,600 	 	100.0%	 	100.0%	
 	 	 	 	 	 	
Assisted Living 	 $  51,480 	 	100.0%	 	70.9%	
 	 	 	 	 	 	
Nursing Home Costs 	 $105,485 	 	51.9%	 	34.6%	

Slide from last month: Connecticut premiums unaffordable for middle income 
•	Higher income people buy LTC insurance in CT (green)
•	We need to make LTC insurance affordable for middle income (yellow)

A	 	% FPL	100%	200%	300%	400%	500%	600%	1000%	2000%	
	 	FPL (1) 	 $ 10,836 	 $  21,672 	 $ 32,508 	 $ 43,344 	 $   54,180 	 $   65,016 	 $ 108,360 	 $ 216,720 	
 	 	FPL (2) 	 $ 21,672 	 $  43,344 	 $ 65,016 	 $ 86,688 	 $ 108,360 	 $ 130,032 	 $ 216,720 	 $ 433,440 	
											
B	Age	FLTCIP	                                        Annual Premium as a Percentage of Annual Household Income:  	 	 	 	 	 	 	 	
	25	 $    410 	3.8%	1.9%	1.3%	0.9%	0.8%	0.6%	0.4%	0.2%	
	35	 $    472 	4.4%	2.2%	1.5%	1.1%	0.9%	0.7%	0.4%	0.2%	
	45	 $    661 	6.1%	3.1%	2.0%	1.5%	1.2%	1.0%	0.6%	0.3%	
	55	 $    968 	8.9%	4.5%	3.0%	2.2%	1.8%	1.5%	0.9%	0.4%	
	65	 $ 1,518 	14.0%	7.0%	4.7%	3.5%	2.8%	2.3%	1.4%	0.7%	
	75	 $ 2,522 	23.3%	11.6%	7.8%	5.8%	4.7%	3.9%	2.3%	1.2%	
	85	 $ 4,905 	45.3%	22.6%	15.1%	11.3%	9.1%	7.5%	4.5%	2.3%	
											
	What if premiums were subsidized and limited to 2% of income?				
	 	 	 	 	 	 	 	 			
	 	 	 	 	 	 $ 43,344 	 $   54,180 	 $   65,016 			
	 	 	 	 	 	2.0%	2.0%	2.0%			
	 	 	 	 	 	 $      867 	 $     1,084 	 $     1,300 			
	25	 $    410 	 	 	 	 	 	 			
	35	 $    472 	 	 	 	 	 	 			
	45	 $    661 	 	 	 	 	 	 			
	55	 $    968 	 	Annual subsidy ========>	 	 $      101 	 	 			
	65	 $ 1,518 	 	Annual subsidy ========>	 	 $      652 	 $        435 	 $        218 			
	75	 $ 2,522 	 	Annual subsidy ========>	 	 $   1,655 	 $     1,438 	 $     1,221 			
	85	 $ 4,905 	 	Annual subsidy ========>	 	 $   4,038 	 $     3,822 	 $     3,605 			

Costs to the individual: Improved model is more affordable, particularly for younger middle income

A	 	% FPL	100%	200%	300%	400%	500%	600%	1000%	2000%	
	 	FPL (1) 	#######	#######	#######	#######	#######	#######	#######	#######	
 	
B	Age	FLTCIP	Annual Premium as a Percentage of Annual Household Income:  	
	25	 $    410 	3.8%	1.9%	1.3%	0.9%	0.8%	0.6%	0.4%	0.2%	
	35	 $    472 	4.4%	2.2%	1.5%	1.1%	0.9%	0.7%	0.4%	0.2%	
	45	 $    661 	6.1%	3.1%	2.0%	1.5%	1.2%	1.0%	0.6%	0.3%	
	55	 $    968 	8.9%	4.5%	3.0%	2.2%	1.8%	1.5%	0.9%	0.4%	
	65	 $ 1,518 	14.0%	7.0%	4.7%	3.5%	2.8%	2.3%	1.4%	0.7%	
	75	 $ 2,522 	23.3%	11.6%	7.8%	5.8%	4.7%	3.9%	2.3%	1.2%	
	85	 $ 4,905 	45.3%	22.6%	15.1%	11.3%	9.1%	7.5%	4.5%	2.3%	

Additional cost if program provides subsidies: Older middle income would need subsidy in order to afford policy

Age	FLTCIP Premium	 	Annual Subsidy Required to Limit Premium to 2% of Income

 	 
                           %FPL	400%	500%	600%	
55	 $     968.00 	 	 $   101.00 	 - 	 - 	
65	 $  1,518.00 	 	 $   652.00 	 $   435.00 	 $   218.00 	
75	 $  2,522.00 	 	 $1,655.00 	 $1,438.00 	 $1,221.00 	
85	 $  4,905.00 	 	 $4,038.00 	 $3,822.00 	 $3,605.00 	

Group insurance could increase take up rate
•	What does a Group offer?
•	Affinity, Simplicity to a large base
•	No agent fees, but regulated in the same way as the individual market
•	Would need to require rollover to retirement with no changes (group conversion)

•	Other State Models:  All state employees
•	State of Minnesota
•	State of Michigan

•	CalPERS:  
•	12-14% of eligible population
•	Self-funded (no insurance company) to all active workers, retirees, & families
•	More risky, if program does not perform well

•	The Federal Long-Term Care Insurance Program (FLTCIP)
•	6 percent of eligible population
•	John Hancock is the Insurance Carrier
•	Rate increase = Lapse in Mortality Rates (and decline in Rate of Return, ROR)

LTC Partnership:  Effect on Medicaid
•	Potential savings to Medicaid
•	If new middle income people buy LTC Insurance, then fewer people would spend-down to Medicaid

•	Potential costs to Medicaid
•	Helping people keep their assets could reduce Medicaid revenue:
	If people were already buying LTC Insurance and would have spent down and Medicaid would have recovered their assets, then Medicaid would recover fewer assets

Outstanding questions and considerations

•	Are we ready to recommend a LTC Partnership with these parameters?

•	Do we want to explore subsidizing older middle income people who are close to the affordability threshold?

•	Do we want to consider ways to increase participation?
•	Target people at younger ages
•	Encourage group coverage
•	Provide financial incentives

•	Do we want to consider other mechanisms (e.g., LTC riders to life insurance policies) for promoting insurance for LTS?

								
A Contribution Program

Contribution Program:  Where did we leave off last month?
Elements of the improved model

•	Last month, we looked at the CLASS model.  

•	We wanted to improve that model by:
•	Ensuring solvency over many years
•	Ensuring high participation levels

•	In this section, we:
•	Analyze the premiums required to ensure solvency
•	Model a mandatory plan 

Elements of the improved model

•	Who participates (target population)?  
•	People over the age of 25 years 
•	People of low to middle income
•	Incomes over $25,000 for under 65
•	Incomes over $30,000 (roughly) for elderly people
•	Nobody is excluded due to disability status
•	79% of population is eligible to participate, assumes 100% participate (mandatory program)

•	What is the benefit?
•	$75 cash daily benefit for LTS ($50 cash daily if 2 ADLS, $100 if 4 ADLs)
•	Lifetime

•	What is the cost?
•	$92 monthly premium, or $1,095 annual premium (derived from analysis)
•	Premiums same for everyone regardless of age and income
•	Premiums paid until person receives benefit (includes retirees)

Contribution Program – benefit details

STRAWMAN PROPOSAL:  CONTRIBUTION PROGRAM	
 	 	
 	Option Base	
 	 	
Features 	 	
Enrollment	Mandatory	
Daily Benefit Amount (DBA)	$75 	
Health Screen	No	
Elimination Period	None	
Vested - Before Eligible	5 Years	
Eligibility - Benefit Trigger	2 ADLs	
Plan Type	Cash Benefit	
Benefit Period	Lifetime	
Inflation Protection	5%	
Lifetime Maximum	No	

Who benefits: 79% of population over age 25 would be eligible to participate (modeled mandatory program - 100% take-up)

 	Contribution Program	
 	MA Pop	 	Eligible	Participate	Take Up Rate	
 	 	 	 	 	 	
25-35	          818,744 	 	        694,354 	          694,354 	100%	
35-44	          955,201 	 	        810,079 	          810,079 	100%	
45-54	       1,000,687 	 	        848,655 	          848,655 	100%	
55-64	          747,266 	 	        633,736 	          633,736 	100%	
65-74	          428,866 	 	        240,851 	          240,851 	100%	
75 and Older	          441,862 	 	        248,150 	          248,150 	100%	
Total 	       4,392,626 	 	     3,475,824 	       3,475,824 	100%	
 	 	 	 	 	 	
% of Total Population	 	 	79%	79%	 	

 
Benefits covered: A $75 daily benefit amount would cover most home care needs, but is insufficient for institutional care

HOW DOES THE CONTRIBUTION PROGRAM ADDRESS LTS NEEDS?	
 	 	 	 	 	
2009 Dollars	 	1	2	3	
Cash Daily	 	 $       50.00 	 $       75.00 	 $     150.00 	
Cash Yearly	 	 $18,250.00 	 $27,375.00 	 $54,750.00 	
 	 	 	 	 	
 	 	                          Percentage of Needs Met	 	 	
Long-Term Supports & Services at Home	 	 	 	 	
3 hours day/3 days week	 	100%	100%	100%	
5 hours day/5 days week	 	64%	96%	100%	
 	 	 	 	 	
Assisted Living 	 	35%	53%	100%	
 	 	 	 	 	
Nursing Home Costs 	 	17%	26%	52%	

Costs to the individual:

Affordable for people at or above 500% FPL (green)
People 400-500% FPL would require subsidies (yellow)
People below 400% would continue to rely on Medicaid (red)

A	 	% FPL	100%	200%	300%	400%	500%	600%	1000%	2000%	
	 	FPL (1) 	 $10,836 	 $ 21,672 	 $ 32,508 	 $ 43,344 	 $ 54,180 	 $ 65,016 	 $ 108,360 	 $ 216,720 	
 	 	FPL (2) 	 $  21,672 	 $   43,344 	 $   65,016 	 $   86,688 	 $ 108,360 	 $ 130,032 	 $   216,720 	 $   433,440 	
											
B	Age	Contribution	Annual Premium as a Percentage of Annual Household Income:	
	25	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	
	35	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	
	45	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	
	55	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	
	65	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	
	75	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	
	85	 $  1,095 	10.1%	5.1%	3.4%	2.5%	2.0%	1.7%	1.0%	0.5%	

An individual with income = 400% FPL would require a subsidy of $228/year to limit spending to 2% of income

Uncertainty as to how high to set premiums to ensure solvency: 

Premiums are very sensitive to assumptions, particularly disability and death rates, and population projections

 	Death & Disability Rate	Monthly Premium	

Higher Range (Conservative)	Higher probabilities applied to population over age 65	
$91.21	

Lower Range (Optimistic)	Same probabilities applied to all age groups 	

$65.55	

Requires diligent oversight over revenues and expenses to ensure solvency

A graphic illustrates the cyclical relationship between enrollee risk and benefit coverage, actuarial accuracy, revenue and expenditures, and period evaluation of Medicaid obligations and consumer.

Contribution Program:  Effect on Medicaid
•	Potential savings to Medicaid
•	Fewer people would spend-down to Medicaid, especially if mandatory
•	If Contribution program pays before MassHealth for MassHealth-covered services, then there would be direct savings to Medicaid

•	Potential costs to Medicaid
•	If include asset protection for Contribution benefits (like Partnership), then Medicaid would recover fewer assets

Outstanding questions and considerations

•	Are we ready to recommend a Contribution Program with these parameters?

•	Relationship to CommonHealth?
•	For people with disabilities, does a Contribution Program pay first (direct savings to Medicaid) or cover services that CommonHealth doesn’t cover?

•	Mandatory or auto-enrollment with voluntary opt-out?
•	Consider various mechanisms for universal participation?

•	Consider ways to increase voluntary participation?
•	Incentivize with Medicaid asset protection (like Partnership)?
•	Conduct sensitivity analysis of lower participation rates?

The Big Picture

Public & Private Insurance Options
How do they fit together?

Some people may wish to purchase both: people with higher assets who can afford both premiums

HOW DOES THE INSURANCE PARTNERSHIP ADDRESS LTS NEEDS?		
 	 	 	 	 	 	
		                         CalPERS	                           FLTCIP	
2009 Dollars	Costs	2 Years	1 Year	2 Years	1 Year	
Coverage	 	 $109,500.00 	 $ 54,750.00 	 $73,000.00 	 $36,500.00 	
Daily Benefit Amount	 	 $       150.00 	 	 $     100.00 	 	

Long-Term Supports & Services at Home	 	 	 	 	 	
3 hours day/3 days week	 $  10,296 	 	100.0%	 	100.0%	
5 hours day/5 days week	 $  28,600 	 	100.0%	 	100.0%	
 	 	 	 	 	 	
Assisted Living 	 $  51,480 	 	100.0%	 	70.9%	
 	 	 	 	 	 	
Nursing Home Costs 	 $105,485 	 	51.9%	 	34.6%	

Does the refined Strawman proposal meet our principles?

•	Meets All Principles

•	Strengthens the safety net for low income (by deferring Medicaid spend-down)
•	Provides affordable options for middle income
•	Supports stay-at-home preferences
•	Increases private financing
•	Limits pressure on state programs

Changes necessary to implement Strawman proposal
•	Contribution Program
•	State legislation with design specifications to support Committee’s goals

•	Insurance reforms
•	NAIC model act & regulations
•	State LTC Partnership legislation with design specifications to meet Committee’s goals
•	Other insurance market reforms?  e.g. group conversion policies
•	Develop FDIC-like mechanism to insure policies against risk of insurer insolvency?

								
Medicaid

Steps in Medicaid analysis

1.	Establish Medicaid spending baseline

2.	Quantify effects on Medicaid baseline of proposals

3.	Identify gaps in participation/coverage

4.	Identify and assess Medicaid improvements or expansions to fill gaps

5.	Cost out Medicaid improvements/expansions

Assessing the impact on Medicaid

•	Key Features
•	Status quo eligibility rules for purposes of modeling Medicaid baseline
•	Uses Medicaid state plan LTS spending to model potential impact on Medicaid  (impact could be greater because excludes HCBS waiver spending and expenditures made on behalf of Medicaid members by other state agencies)

									

•	Methodology 
•	Calculate Medicaid baseline ($2.8 b)
•	Focus on the baseline for elderly ($1.8 b.)
•	Focus on the baseline for people with disabilities ($911 m.)
•	Calculate the impact of each program and for each population on the baseline
•	The Contribution Program
•	The LTC Partnership 
•	And, then Together

Baseline Facts about Medicaid -
State plan spending used for modeling purposes
•	Big role for Medicaid:
•	Medicaid represents 37 percent of all long-term care spending on the elderly, including all source

•	Elderly big spenders:
•	Medicaid spending on the elderly represents 66 percent of total LTC spending on elders and people with disabilities

•	Institutional bias:  
•	Spending on Nursing homes represents 77 percent of all spending on the elderly
•	Spending on Nursing homes represents a SMALL percent of all $ on people who are disabled

•	Total budget bigger than $2.7 billion:
•	$3.4 billion is spent on LTS when include community-based waiver services for people who are elderly and those who are disabled (ages 18-64) 

[Placeholder]
The Big Picture:  A Global Shift in Roles

 	2010
 	2015
 	2020
	
 	$	% of total	$	% of total	$	% of total	
If we do nothing:	 	 	 	 	 	 	
private health insurance	 	 	 	 	 	 	
personal resources	 	 	 	 	 	 	
medicaid	 	 	 	 	 	 	
Total	 	 	 	 	 	 	
 	 	 	 	 	 	 	
with Partnership:	 	 	 	 	 	 	
private health insurance	 	 	 	 	 	 	
medicaid	 	 	 	 	 	 	
Total	 	 	 	 	 	 	
 	 	 	 	 	 	 	
with Contribution and Partnership:	 	 	 	 	 	 	
Contribution Program	 	 	 	 	 	 	
private health insurance	 	 	 	 	 	 	
personal resources	 	 	 	 	 	 	
medicaid	 	 	 	 	 	 	
Total	 	 	 	 	 	 	
 	 	 	 	 	 	 	
with MassHealth expansion	 	 	 	 	 	 	
Contribution Program	 	 	 	 	 	 	
private health insurance	 	 	 	 	 	 	
personal resources	 	 	 	 	 	 	
medicaid	 	 	 	 	 	 	
Total	 	 	 	 	 	 	

Conceptual example - How will the financing of LTS change under the Contribution Program for the elderly? 

The Impact of New Approaches on the Financing of Long-Term Care

 	Baseline/Elderly	Do Nothing	Contribution	Insurance Partnership	
 	 	 	 	 	
Public	 $   698,198,003.00 	14.50%	Might decrease	Might decrease	
Medicare	 $ 1,802,098,087.00 	37.30%	Projected Decrease	Projected Decrease	
Medicaid	 $   225,706,895.00 	4.70%	Not sure	Not sure	
Other Public	 $ 2,726,002,984.00 	56.50%	 	 	
Total Public	 $   923,904,897.00 	19.10%	 	 	
Total Public less Medicaid	 	 	 	 	
 	 	 	 	 	
Private	 	 	 	 	
Out of pocket	 $ 1,976,434,070.00 	40.90%	Projected Increase	Projected Increase	
Private LTC Membership	 $   125,369,859.00 	2.60%	No change	Projected Increase	
The Contribution Program	 - 	0.00%	Projected Increase	 	
Total Private	 $ 2,101,803,929.00 	43.50%	 	 	
 	 	 	 	 	
TOTAL 1, w/o Unpaid Care	 $ 4,827,806,914.00 	100%	Projected Decrease of Unpaid	Projected Decrease of Unpaid	
Unpaid/Informal Care	 $ 3,510,996,137.00 	 	 	 	
TOTAL 2, w/ Unpaid Care	 $ 8,338,803,051.00 	 	 	 	

Next steps re: Medicaid

•	Continue to quantify effects on Medicaid baseline of proposals

•	Clarify resulting gaps in participation/coverage

•	Identify and assess Medicaid improvements or expansions to fill gaps

•	Cost out Medicaid improvements/expansions

								
Committee Business

Committee Business

•	Public input process
•	New Dates (confirmed):
•	Friday, December 11th from 1 PM – 3:30 PM, Needham Sheraton
•	Thursday, December 17th from 5:30 PM – 7:30 PM, Northampton COA

•	Next meeting:
•	Date:  Thursday, December 10th, 2009 from 9:00 -11:30am
•	Location:  AARP - One Beacon Street, 23rd Floor 

•	Future meeting reminder
•	Additional meeting scheduled for either Thursday, February 11th  or February 25th