Among the many byproducts of the aging baby boomer generation will be increased need for prolonged health care. As they age, baby boomers will stretch and test the system’s ability to provide — and pay for — long-term care.
Along with that demographic shift of unprecedented proportions, other major changes are coming with national health care reform. How those two large evolutionary cycles mesh will determine, in large part, what California’s health care system looks like a generation from now.
In California, long-term care insurance is expensive and often not included in employer-based purchasing agreements, leaving it up to individuals to arrange for coverage.
Some observers contend that Californians routinely transfer assets or otherwise manipulate their financial status to qualify for government-subsidized long-term coverage. Critics of the system, some of whom have ties to the long-term insurance industry, say California officials are not diligent enough in tracing financial histories of individuals before they qualify for subsidized coverage.
The Affordable Care Act in 2014 will bring more Californians into the Medi-Cal program, many of whom will be eligible for long-term care.
Medi-Cal, California’s federally subsidized Medicaid program, is already by far the largest provider of long-term care in the state. Long-term Medi-Cal coverage pays for more than 60% of all nursing home days in the state and accounts for almost 50% of total nursing home expenditures. In addition to paying for nursing home care, Medi-Cal also provides a range of services for the elderly and people with disabilities who need long-term care due to chronic conditions.
Federal guidelines call for states to establish asset levels and standard “look-back periods” into a potential Medicaid beneficiary’s financial history. California officials are working on setting levels of financial responsibility for new beneficiaries of Med-Cal long-term coverage.
Getting eligibility questions clearly answered and qualifying procedures clearly established before 2014 would help California deal with its aging population.
Is asset transferring to qualify for Medi-Cal indeed a problem? How big a problem is it? What steps should state policymakers — especially those forming California’s new Health Benefits Exchange — take to address the issue?
We got responses from:
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