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On June 27, 2013, the Federal Commission on Long-Term Care held its first meeting in Washington, DC.  The bi-partisan commission of 15 appointees, including Center for Medicare Advocacy Executive Director Judith Stein, was created by the American Taxpayer Relief Act of 2012 (the so-called "fiscal cliff" bill).[1]  The Commission is tasked with developing "a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals in need of such services and supports …"[2]   Under the current timeline outlined by statute, the Commission must complete its work in September 2013.

In the first of several public hearings the Commission plans to hold, the following invited witnesses testified on June 27, 2013, at a hearing entitled "The Current System for Providing Long-Term Services and Supports":

  • Anne Tumlinson, Avalere Health, discussed demographics of individuals who currently use long-term services and supports;
  • Kirsten Colello, Congressional Research Service, discussed eligibility for and current financing of long-term services and supports;
  • G. William Hoagland, Bipartisan Policy Center, discussed federal budget implications of long-term services and supports; and
  • Marc Cohen, LifePlans, Inc., discussed private long-term care insurance.

Judith Stein's Responses to Questions Posed to Commissioners

The bottom-line is we have no true system of Long-Term Services and Supports (LTSS).  We have various public and private components of coverage, but we do not have a comprehensive, reliable approach for people in need of long-term care. Yet, as people are living longer – and living longer with chronic conditions and disabilities – we need a logical, thorough system more than ever.

Currently the only way to obtain care over the long term is to be poor enough to qualify for Medicaid or wealthy enough to purchase long-term care insurance.  Neither of these options is certain to meet ones needs.  In many states individuals will not get what is needed through Medicaid and, even if one can afford long-term care insurance, it rarely provides enough coverage and premiums continue to rise exponentially.

Medicare is of limited value for nursing home care, only providing coverage for up to 100 days per benefit period, and only after a three-day inpatient hospital admission.  It can be more useful for longer term home health and hospice care, but this coverage is based on the need for skilled nursing or therapy, on being homebound, or on being terminally ill.  Individuals without such needs will not get coverage at all.

A true LTSS system would provide for a continuum of care from acute settings to community-based services for people of all ages who have significant functional limitations.

Strategies to Consider

  • Another public option, other than Medicaid, should be designed to cover LTC services and supports for people of all ages in the least restrictive setting.
  • Coverage for LTC should be based on defined functional limitations, not on an inability to leave home or the need for skilled care.
  • Eligibility for public funding should not be based on eligibility for Medicaid or other low-income trigger.
  • Private options can help meet the needs of some people, but should never be more expensive than public options and should always come with strong consumer protections.
  • All components of a LTC system should be subject to a consumer-friendly appeals system that will fairly enforce access to coverage.  

The Commission will soon launch a website along with guidance concerning how the public can submit information for the Commission's review.  In the meantime, individuals wishing to contact Commissioner Judith Stein can send information to


[1] American Taxpayer Relief Act of 2012, Pub. Law 112-240, Section 643; the text of the bill is available at:
[2] American Taxpayer Relief Act of 2012, §643(b)(1). 

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