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The high costs of long-term care (LTC) -- medical and nonmedical services for those who cannot care for themselves -- place a growing burden on the elderly and disabled, on their families, and on state and federal budgets. At an AEI event on Friday morning, a panel of experts discussed how to protect Americans from the rising costs of long-term care.
Mark Warshawsky of the Long Term Care Commission kick-started the discussion with some questions, specifically asking whether Americans, in an attempt to finance long-term care costs, spend down their assets to become eligible for Medicaid.
Joshua Weiner of RTI international confirmed the pervasiveness of the "Medicaid spend-down" phenomenon; according to his research, 10 percent of the non-Medicaid population over the age of 50 spent down their assets over a 10- to 12-year period.
Steve Moses of the Center for Long Term Care Reform disagreed with Weiner's assessment of Medicaid spend-down. Moses argued that, according to Medicaid eligibility policy specialists across the country, Medicaid eligibility requirements are easy to circumvent, such that many people -- particularly those with the means to hire eligibility lawyers and specialists -- can qualify without spending down significant wealth.
Matt Salo of the National Association of Medicaid Directors emphasized that regardless of whether people spend down to become eligible, LTC spending constitutes the majority of Medicaid spending, and the rise in LTC costs will increasingly strain state budgets.
To protect Americans from the costs of long-term health care for the elderly and disabled, President Obama’s health law established the Community Living Assistance Services and Supports Act (CLASS). Less than two years later, the Obama administration announced that CLASS could not operate without large and growing deficits, and the program was terminated. In its wake, the Commission on Long-Term Care — created by the fiscal cliff legislation — is charged with developing a new way to finance long-term care services and supports. The commission’s report is due in September 2013.
At this event, Mark Warshawsky, a well-known expert in retirement finance and a newly appointed commissioner, will explain the implications of another publicly funded long-term care insurance program. A panel will then debate whether another government program is the best way to ensure that families can afford to provide the necessary services for their aging loved ones.
If you are unable to attend, we welcome you to watch the event live on this page. Full video will be posted within 24 hours.
Howard Gleckman, Urban Institute
Stephen Moses, Center for Long-Term Care Reform
Matt Salo, National Association of Medicaid Directors
Mark Warshawsky, Commission on Long-Term Care
Joshua Wiener, RTI International
Joseph Antos, AEI
For more information, please contact Catherine Griffin at firstname.lastname@example.org, 202.862.5920.
For media inquiries, please contact MediaServices@aei.org, 202.862.5829.
Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI. He is also a member of the Panel of Health Advisers for the Congressional Budget Office and recently completed two terms as a commissioner of the Maryland Health Services Cost Review Commission. His research focuses on the economics of health policy, including Medicare and broader health system reform, health care financing and the budget, health insurance regulation, and the uninsured.
Howard Gleckman is a resident fellow at the Urban Institute and is affiliated with its Tax Policy Center and Program on Retirement Policy. He is the author of “Caring for Our Parents” (St. Martin’s Press, 2009) and writes regularly on long-term care for Forbes.com. Gleckman was a 2006–07 media fellow at the Kaiser Family Foundation and a 2006–08 visiting fellow at the Center for Retirement Research at Boston College. He was senior correspondent in the Washington, DC, bureau of Business Week, where he covered health and elder care as well as tax and budget issues for nearly 20 years.
Stephen Moses is president of the Center for Long-Term Care Reform in Seattle, Washington. The center promotes universal access to top-quality long-term care by encouraging private financing and discouraging welfare dependency for most Americans. Previously, Moses was director of research for LTC Inc., a Medicaid state representative for the Health Care Financing Administration. He was also previously a senior analyst for the inspector general of the US Department of Health and Human Services. He frequently addresses professional conferences in the fields of law, aging, and insurance.
Matt Salo was named the first executive director of the National Association of Medicaid Directors (NAMD) in February 2011. Salo formerly spent 12 years at the National Governors Association. While there, he worked on the Governors’ health care and human services reform agendas and was responsible for securing the entire tobacco settlement for the states, getting more than $100 billion in state fiscal relief, and modernizing the Medicaid program. Salo also worked for the NAMD from 1994 to 1999 and taught high school for two years at T.C. Williams High in Alexandria, VA.
Mark Warshawsky is director of retirement research at Towers Watson, a global human capital consulting firm, where he oversees a small data, survey, and analysis team and conducts research. He is a coauthor of “Fundamentals of Private Pensions” ( Oxford University Press , 2010, Ninth Edition) and author of “Retirement Income: Risks and Strategies” (MIT Press, 2012). He was a member of the Social Security Advisory Board from 2006 to 2012 and is now a member of the federal Commission on Long-Term Care. From 2004 to 2006, Warshawsky served as assistant secretary for economic policy at the US Department of the Treasury, playing a key role in the development of the Pension Protection Act of 2006. He has also held senior-level economic research positions at the Federal Reserve Board in Washington, DC; the Internal Revenue Service; and TIAA-CREF.
Joshua Wiener is a distinguished fellow and program director for aging, disability, and long-term care at RTI International. Wiener directed the development of the Brookings-ICF Long-Term Care Financing Model, the first comprehensive microsimulation model for long-term care in the United States. He is co-director of the Administration on Aging-funded Alzheimer’s Disease Supportive Services Program National Resource Center. Before coming to RTI International, Wiener did policy analysis and research for the Urban Institute, the Brookings Institution, the Health Care Financing Administration, the Massachusetts Department of Public Health, the Congressional Budget Office, the New York State Moreland Act Commission on Nursing Homes and Residential Facilities, and the New York City Department of Health.