LongTerm Care Insurance Partnership Replication Next Steps

1
Long-Term Care Insurance Partnership Replication
Next Steps Mark R. Meiners Ph. D. Director,
Center for Health Policy Research and
Ethics George Mason University National
Association of Health Underwriters January 29,
2007
2
Partnership Features

• Balance cost/quality trade-off
• Inflation Protected Quality
• Consumer education campaigns.
• Uniform reporting for insurers.
• Asset Protection models
• -- Dollar for dollar
• -- Total assets
• -- Combo of these

3
Partnership Positives

• Efficient subsidy.
• Helps avoid Medicaid gaming.
• Helps avoid impoverishment.
• Improves important working relationships.
• Improves consumer confidence.
• Mitigates means testing concerns.

4
Partnership Problems

• Targeting challenges.
• Distribution channel reluctance.
• State-by-State filing burden.
• Reciprocity of asset incentive
• Medicaid unevenness and changes.

5
Sales Grow Fasterin Partnership States

• Normalized sales as of 1993
• Partnership states had 23 higher sales compared
  to other states in 2000-01

6
National Partnership Features

• Grand-fathers existing Partnership programs
• Allows only for dollar-for-dollar offsets for
  group and individual coverage
• Tax Qualified policies only
• The policy must meet NAIC 2000 model act
  requirements

7
National Partnership Features

• Inflation protection required
• Below age 61, undefined compound annual
  inflation protection
• For ages 61-76 some level of inflation
  protection
• Beyond age 76 no inflation protection required
• Agents and brokers must have Partnership training
  to be defined by states
•   

8
National Partnership Features

• No special Partnership policy features can be
  mandated, except for those above. 
• Any mandated provisions for non-Partnership
  policies can also apply to Partnership policies
•     

9
National Partnership Features

• DHHS must develop uniform data set reporting to
  central government repository
• DHHS must develop standards for uniform
  reciprocity among Partnership states (States
  could opt out)
• DHSS required to annually report on the
  Partnerships impact on a) access to LTC and
  Medicaid and b) Medicare and Medicaid expenditures

10
DHHS Uniform Reporting

• Goal Establish a uniform data set to be
  reported by insurers to HHS
• Steps
• Assess UDS currently in use in 4 states
• Conduct individual and group meetings
• Release Notice of Proposed Rulemaking (NPRM)
• Amend Medicaid Manual
• Issues
• Balance state interests in getting enough data to
  track program with insurer interest in
  streamlining process as much as possible

11
DHHS Reciprocity

• Goal Allow asset disregard to be used in any
  participating state
• Steps
• Assess existing reciprocity agreement
• Conduct individual and group meetings
• Amend Medicaid Manual (tentative)
• Issues
• Find a baseline that encourages states to
  participate in spite of program differences

12
DHHS Electronic Registry

• Goal To determine feasibility of a web-based
  tool for use by eligibility workers to certify
  client participation and determine asset
  disregard amount
• Steps
• Seek examples of similar look-up, web based data
  sets
• Develop technical specs and request informal
  vender response
• Coordinate with UDS

13
Status To Date

• State Plan Amendments
• Idaho approved effective 11/1/06
• Minnesota, Nebraska, Georgia, Florida filled
• Virginia soon
• Other States Considering
• AL, CO, DE, ID, IL, IA, KS, MD, ME, MA, MD, MT,
  MO, NJ, NC, ND, OH, OK, PA, RI, SC, SD, TX, WA,
  VT, WA, WI, WY

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DRA Partnership Time Tables

• Legislation Passed February 2006
• CMS Guidance Issued July, 2006
• DHHS Consultation with Stakeholders
• Individual meetings ongoing
• Group Meetings December
• Guidance on Reciprocity January, 2007
• Regulations on Data Requirements Early 2007

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Looking Forward

• Make It Simple to adopt, discuss, and
  promulgate
• Agents as Partners revisit strategies
• Comparability to Non-Partnership Policies
• Cost-effectiveness important to measure and track