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Takin' it to the streets

October 1, 2008
by Maureen Hrehocik, Executive Editor
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Steve Moses, a modern-day road warrior, sets out to change LTC funding—one mile at a time

Stephen A. Moses likens the current status of long-term care to the blind men and the elephant allegory. Each blind man felt different parts of the elephant without “seeing” the whole animal. Without seeing the whole, the beast was described as everything from a wall to a spear, depending on where each man touched the creature.

“How can anyone describe the whole until they have learned the total of its parts?” Moses asks rhetorically. And therein lies the mandate Moses has given himself for educating everyone who is a long-term care (LTC) stakeholder from politicians to the public through his Center for Long-Term Care Reform's National Long-Term Care Consciousness Tour (LTCCT)—a one-year, 35,000 mile sojourn across the United States in a 16-ft. Airstream trailer (dubbed “The Silver Bullet” and sporting the tour's sponsors' logos). He is proselytizing on the need to save Medicaid as a long-term care safety net for the neediest in the country, restrain its rising tax burden, and improve the program in the process. The key to accomplishing this, Moses says, is long-term care insurance for people not requiring public assistance.

“In order to avoid the catastrophic risk of a long-term stay without adequate funding, the public needs to look through the windshield, rather than the rearview mirror,” Moses says. “In the rearview mirror is government-financed nursing home care. Through the windshield is the brick wall of fiscal reality that will end government long-term care financing and force personal responsibility.”

The LTCCT began in Florida in January. Moses, a modern-day crusader for social change, has been in the Southwest, Southeast, Central, East, Mid-Atlantic, and was scheduled to be in the Northeast and Midwest in September and October, and work his way back toward his home base in Seattle during November and December. Moses speaks to anyone who will listen. He has been interviewed by countless local television stations, newspaper reporters, magazine editors, and radio talk show hosts; done podcasts; and appeared as a speaker at state capitols and for insurance groups, financial professionals, national associations such as the American Medical Association, and the general public. He chronicles his travels with a daily “LTC Bullet: Livin’ in Aluminum” e-mailed to his supporters.

Why would anyone subject himself to life on the road for a year, spending much of his own money, enduring the rigors of road rage, traffic congestion, malfunctioning GPS equipment, campground living, and meeting after meeting explaining the same thing? One word: passion. And Steve Moses has it in spades.

How it began

From the late ′70s through the late ′80s, Moses worked for the U.S. Department of Health and Human Services (HHS) as a Medicaid state representative for the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services [CMS]), and a senior analyst for the Office of Inspector General of the HHS. It was during this time that he was exposed to the scams involved in getting Medicaid. “Here I was, a government employee in a little regional office in Seattle and I came across a report that showed the state of Oregon recovered $5 million a year out of the estates of deceased Medicaid recipients who lived in nursing homes! I thought Medicaid was welfare! How do you qualify for public welfare, spend years in a nursing home at enormous cost to the state and federal government, and you die, and a state like Oregon collects $5 million a year?”

Moses explains the conventional wisdom says the only way to get Medicaid is if you have no or a low income, have assets less than $2,000, and need nursing home care. “The idea you have to be low income to qualify for Medicaid long-term care is preposterous. Why this doesn't sink into the minds of the academics and policymakers is beyond me. If you're over age 65 and have a nursing home-level of medical need, practically everyone qualifies for Medicaid,” he says. (Moses now specializes in correcting problems associated with “Medicaid estate planning,” a practice of artificially impoverishing affluent people to qualify them for public assistance. He has had an impact on passage of several national statutes, including the Deficit Reduction Act of 2005, which discouraged Medicaid planning abuses and supported the LTC Partnership programs involving state governments and private insurors.)

After doing some studies for the Health Care Financing Administration to confirm his original analyses of the scope of the problem, the studies were picked up by the General Accounting Office. That resulted in legislation being passed to make transfer of assets penalties longer and to make estate recovery mandatory, Moses says. “The principle was, Medicaid should not be free long-term care insurance,” he explains, “but should be a loan. Either pay for your LTC up front, or, if you expect the government to pay for it and (you) shelter all your assets and wealth, then you pay for it out of your estate. These types of abuses were even more egregious 20 years ago,” Moses says. “Subsequently, there has been no incentive for a privately financed home services infrastructure to develop. This explains why we're in the mess we're in. The United States has a nursing home-based, welfare-financed long-term care system.”