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A model partnership.

After more than four years of critical examination of residents' needs for long-term care, program design, and coordination among private insurers and state and federal agencies, in December Connecticut launched a pilot project to offer affordable insurance coverage for long-term care. Sponsored in part by the Robert Wood Johnson Foundation, the Connecticut Partnership for Long-Term Care is the first project of its kind in the country and is designed to allow state residents to avoid impoverishing themselves to meet nursing home and home care costs.

Under the five-year pilot program, Connecticut residents will be able to purchase private insurance for long-term care that will protect their assets while allowing them to qualify for Medicaid. For every dollar paid out in benefits, that is, a matching dollar of an individual's assets will be protected. When patients are no longer able to meet the costs of care themselves they may still qualify for Medicaid, but with something left in the bank. The policies are geared to those who would enter nursing homes or home care as privately paying patients and would otherwise have to "spend down" into poverty before receiving Medicaid support - some 20 percent of nursing home applicants, the state Department of Aging estimates. Of the 18,000 nursing home or home care patients who now receive Medicaid assistance in Connecticut, some 40 percent started out paying for care themselves.

Connecticut obtained the necessary Medicaid waivers from the Health Care Financing Administration in August 1991. In mid-December Governor Lowell P. Weicker announced approval of the first three policies to be offered under the Partnership, from Blue Cross/Blue Shield of Connecticut, The Travelers Companies, and the AMEX Life Assurance Co.; approval of further policies from eight other insurers is pending.

The state has set strict minimum standards that long-term care policies must meet, including mandatory inflation protection. Importantly, policies cannot be limited to care in a nursing home but must cover home care (including assistance with activities of daily living), adult day care, and respite care as well.

The state standards leave considerable room for variation among different plans, however, both in the extent of coverage - home care need not be covered in full, for example - and in the type of coverage offered. Thus individuals may choose from daily benefit plants, like the group plan offered by The Travelers Companies, in which insureds may elect daily maximum benefits of $80 to $150 with a lifetime maximum of 500, 1,000, or 1,500 times the chosen daily benefits, according to James Ventrilio.

Other plans, like those offered by Blue Cross/Blue Shield, are assets-based, in which an insured purchases coverage in the amount of the assets he or she wishes to protect - savings, securities, a house, etc. - up to a maximum of $500,000. Under the various plans currently available from Blue Cross, said Karen Smith of the Connecticut Blue's product development office, the actual costs of care are covered in full up to the overall benefits maximum, regardless of whether they are for nursing home, home care, adult day care, or respite care, and regardless of the number of days of care.

Premiums, of course, will vary with the coverage selected. - B-JC
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Title Annotation:low-cost long-term care insurance
Author:Crigger, Bette-Jane
Publication:The Hastings Center Report
Date:Mar 1, 1992
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