The Federal Government Does Not Want to Pay...

For Your Long Term Care.

If you are between 45 and 65 and live in Michigan (or several other states) then you are about to receive a letter essentially BEGGING you to purchase long term care insurance. Georgia, Massachusetts, Nebraska, South Dakota and Texas are running similar campaigns.

Why this unprecedented focus on our seniors?

State Governments are being duped into paying for Nursing Home Coverage in tens of thousands of cases every year. The checks and balances for residents applying for state-funded Medicaid Nursing Home coverage have become so relaxed that the cost of caring for their most prominent population has spiraled out of control. Qualifying for Medicaid is sometimes as easy as buying mom a plasma screen television and a motorized wheelchair - or hiding her money soon enough that the government cannot recognize the true owner. You have to act sooner now - up to two years prior to placement, but it can still be done. I'm not sure why you would go this route. It's stealing from your State and wasting your own tax payer contributions. States have found no other way to deal with this "problem" than to defer the costs to other payors - either insurance companies, or, for the most part, the citizens themselves.

As I watch the daily long term care news, the number one post that I see is related to LTC insurance. I know two things about long term care insurance in 2006:

1. As a Nursing Home Administrator, I have seen the profits from Managed Care residents, and they CAN easily equal those of Medicare Part A residents.. With that being said, the amount of work that goes into qualifying an insurance resident for nursing home placement is still so complicated that many facilities will forgo the effort and fill the bed with a resident of a different payor type. Weekly faxing of therapy and nurses notes, daily communication with insurance regulators...

2. The whole concept is still so foreign that most Administrators and Admissions personnel do not even understand the benefits structures of LTC insurance residents enough to touch these types of cases. Therapy Managers are forced to manage these residents on a daily basis, and the likelihood of getting custodial care paid for is practically non-existent.

Long term care insurance is coming. State Governments along with the Federal Government are anxious to find a way to NOT pay for nursing home coverage - and who can blame them? The US Government sees an opportunity to defer a top ten cost to the states, and they have a winning argument due to fraudulent consumers. Not only are we about to see a movement away from Medicaid-based funding, but also away from Nursing Home-based care. You keep seeing the articles and debate on home health and community based care whether you want to believe it or not. Until we find a way to re-justify our widespread services as an industry as well as identify reliable source of revenue, we will continue to struggle against the uphill battle of consumer skepticism and government reluctance.

2 comments:

able-mart said...

Very informational blog.

The Nursing Home Administrator said...

Thanks! It's a work in progress, but a good chance to practice informative writing a flesh out my own opinions and arguments. I appreciate the comment.