McCormack Speaks

February 22, 2018
by McCormack Speaks
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Gerontology Professor Marc Cohen Presents New “Policy Roadmap” for Future of LTSS Finance

This post originally appeared on the Gerontology Institute blog, written by Steven Syre.

What would a better way to finance long-term services and supports (LTSS) for older Americans really look like? Even more importantly: How would it perform?

Marc Cohen, co-director of the LeadingAge LTSS Center @UMass Boston, and two colleagues took up that challenge and developed a new “policy roadmap” combining public catastrophic insurance with gap-filling private LTSS insurance focused on middle-income people.

“The fundamental LTSS financing problem is the absence of an effective insurance mechanism to protect people against the cost of extensive LTSS they may require over the course of their lives,” said Cohen, also a professor at UMass Boston’s McCormack Graduate School.

Cohen and co-authors Judith Feder, a professor at Georgetown University’s McCourt School of Public Policy and a fellow at the Urban Institute, and Melissa Favreault, a senior fellow at the Urban Institute, said their plan would enhance benefits for people with long-duration impairments, reduce unmet LTSS needs and mitigate burdens facing family caregivers.

The authors said their plan would enhance LTSS spending by 14 percent, reduce out-of-pocket spending by 15 percent and cut Medicaid spending by 23 percent, compared to projected spending under current law.

The public-insurance element of the plan would be financed with a 1 percent Medicare tax surcharge paid by taxpayers over the age of 40.

The authors described their proposal as providing an “analytical foundation for demonstrating how a shift from an LTSS system dependent on impoverishment and last-resort public financing to a financially sound insurance system that can provide meaningful protection for people with catastrophic LTSS needs.”

Cohen and Feder presented their plan at a Jan. 31 discussion hosted by the Bipartisan Policy Center. They were joined on a panel by Gretchen E. Alkema, vice president of policy and communication at The SCAN foundation; Sheila Burke, a BPC fellow and strategic advisor at Baker Donelson; Cindy Mann, the former director of the Center for Medicaid and Anne Tumlinson, the founder of Daughterhood.

Under the plan, eligibility for public catastrophic coverage would be subject to waiting periods at age 65 ranging from one to four years, based on income. Higher earners would be subject to longer waiting periods.

Private insurance would offer a way to cover those up-front gap years. Based on the average cost of private policies on the individual market, the authors estimate gap-filling coverage would amount to 2-4 percent of income for all groups, except the lowest 20 percent of earners. Such costs are in the range of what people appear to be willing to spend for policies, according to the authors.

Individuals assessed with two or more limitations in activities of daily living or severe cognitive impairment expected to last longer than 90 days would qualify for public benefits once they satisfy the waiting period.

The model’s level of benefit payments is linked to direct service costs, excluding room and board. It would provide $110 per day, which was the average expense for five hours of service by home health aide in 2016 (though the benefit could be spent on nursing home care as well).

The authors said the 1 percent Medicare surcharge helping to finance the program would cost a worker earning the 2016 average covered wage of $48,642 about $41 per month, or when split evenly between employees and employers, about $21 in direct monthly costs to employees. They suggested the surcharge could be presented as a premium and taxpayers could be offered the opportunity to opt out of the plan.

Cohen and his co-authors acknowledged that the search for better ways to finance long-term services and supports is not high on America’s current political agenda. But they believe work on the issue now can pay dividends in the future.

“Research undertaken now on the design and challenges of specific proposals for LTSS financing reform will provide the necessary intellectual infrastructure and foundation for effective action when policymakers are inevitably forced to address the issue in the years ahead,” they wrote.

January 4, 2018
by McCormack Speaks
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How Housing Plus Services Addresses Senior Needs

This post originally appeared on the Gerontology Institute blog.

By Meghan Hendricksen

man with suitcase heading to nursing homeA shortage of affordable housing for seniors will pose a huge challenge for the United States in the years ahead. But finding homes for those elders is only part of the solution, according to Alisha Sanders.

Helping seniors deal with health issues locally and age in place in their homes should be an important element of any housing plan, she said.

Sanders, director of Housing & Services Policy Research at LeadingAge, was the final fall speaker series guest at McCormack Graduate School’s Department of Gerontology. Her talk, “Affordable Senior Housing Plus Services: Meeting the Needs of Low-Income Seniors,” stressed the value of providing housing and services together. Continue reading.

December 15, 2017
by McCormack Speaks
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Marc Cohen Co-Chairs National Panel Examining State-Based LTSS Programs

The post originally appeared on the Gerontology Institute blog.

image of Marc CohenMarc Cohen, co-director of the LeadingAge LTSS Center @UMass Boston, has been named co-chair of a study panel organized by the National Academy of Social Insurance to help states design new programs to address challenges facing many of their citizens.

The study panel is part of a new academy project called “Designing State-based Social Insurance Programs for Paid Leave, Affordable Child Care and Long-Term Services and Supports.”

The academy noted some states are in the process of developing social insurance programs to meet those needs. The study panel was organized to inform those debates by researching options for funding and administering such programs. Continue reading.

October 11, 2017
by McCormack Speaks
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Robyn Stone Named “Influencer in Aging” by Next Avenue

By Geralyn Maga, Gerontology Institute

picture of Robyn StoneRobyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston, has been named an Influencer in Aging by Next Avenue. The Influencers in Aging list recognizes 50 advocates, researchers, thought leaders, innovators, writers and experts “at the forefront of changing how we age and think about aging.”

“Stone brings decades of research experience and senior-level policy expertise to LeadingAge’s mission to inspire, serve and advocate for older Americans,” reads the Next Avenue description of Stone’s accomplishments. “She has leveraged her expertise into advocacy for better long-term care policy, with a particular emphasis on lower income older adults.”

Candidates for the Influencers in Aging designation are nominated by Next Avenue readers, editors, and contributors, as well as past Influencers in Aging.

“We searched for a diverse and broad list of people whose work to improve the lives of older adults in the areas of health, money, work, living and caregiving was especially impressive over the past year,” writes Shayla Stern, director of editorial content for Next Avenue. Read more.

This post originally appeared in the Gerontology Institute blog.

July 12, 2017
by McCormack Speaks
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How to Measure Real Potential Cost of New Health Care Legislation for Elders

by Marc Cohen and Kris Wiitala

This post originally appeared on McCormack’s Gerontology Institute blog.

US capitol buildingBoth the House-passed version of ACA repeal legislation, the American Health Care Act (AHCA), and the Senate’s version currently under deliberation – the Better Care Reconciliation Act (BCRA) – include a particularly debilitating change: a per capita cap system of funding for Medicaid. This change would dramatically cut federal Medicaid funding to states. It would force states to make difficult decisions between benefit cuts, provider payment cuts, and changes to eligibility requirements – or all of these in varying measure – in order to balance their budgets. Analyses have pointed out how a per capita cap system would lead to significant underfunding of long-term services and supports (LTSS), penalize adults and children with disabilities, lead to significant shortfalls in state funding, and cause financial challenges for providers.  Continue reading.

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