What the world needs is another CLASS epitath

By Stephen D. Forman (LTCA)

Long Term Care Associates, Inc.


If there's one thing that saddens me the most about CLASS's zombie-fication, it's that I never got the chance to write about the loophole which the Department of Health and Human Services still had yet to find. Then again, why give them credit?

This is the group we tasked with establishing the framework for our nation's grand "voluntary long term care insurance program," yet who in public hearings were so out-of-touch with today's LTCI market that they were taken by surprise to learn of the existence of home-care only plans, of plans which pay cash benefits, and to learn that assisted living facilities are covered. Is it any wonder that the media has followed the government's lead by woefully repeating, "After CLASS, now what?"

Well sure ... only if you were completely ignorant of the private market and your experience of it consisted of a mental snapshot from 25 years ago, you too would stagger to your knees.

But I digress. Had CLASS survived, as a rough example it may have provided somewhere between $20 - $150 per day in coverage (it would've been based on functional disability, and averaged no less than $50 per day, with some getting more than average, some getting less than average).

A report recently came out with plan specifics (including a handful HHS was experimenting with which were “off-book” — i.e., outside the constrictions of legislation in the hopes of achieving actuarial soundness).

So one can easily imagine a CLASS beneficiary receiving as much as $4,500 per month. If this recipient were also on Medicaid HHC, then half goes to Medicaid ($2,250 per mo), and the CLASS beneficiary gets to keep the other half ($2,250 per mo). And you know what? That's a much better deal than original Medicaid HHC.

The sicker the individual, the more services they presumably would use, and the more money they get to pocket.

One caveat: this presumes Medicaid works like the books says it does. For a lesson in how Medicaid really works, please see anything written by my friend and colleague Steve Moses at the Center for Long Term Care Reform, or my upcoming article entitled "LTCI and Medicaid: Why 9 out of 10 Clients Make the Wrong Choice.”