Medicaid And Long-Term Care: An Unsustainable Union

This Kaiser Family Foundation brief about the nation’s ballooning spending on long-term care insurance is particularly pertinent in the aftermath of the administration’s decision to abandon the Affordable Care Act’s CLASS program. To be clear, CLASS was never designed as an alternative to comprehensive insurance — it offered only a modest benefit, but advocates hoped that the program could serve as a first step towards a more serious (and sustainable) government investment in long-term care. As former CAP fellow Judy Feder put it during a recent interview with NPR, “What a government program, even a limited one offers, is an opportunity to put government behind an education, a marketing effort. It can actually support the purchase of private long-term care insurance alongside a modest public benefit.”

Most importantly, the program offered some sort of an answer to the nation’s current reliance on Medicaid for long-term needs, which as Kaiser explains, is simply unsustainable. Consider:

– Medicaid has evolved to become our nation’s primary payer for long-term services and supports, financing nearly half (43 percent) of all spending on long-term care services.

– Among those using long-term services and supports, the average annual spending per Medicaid beneficiary was $43,296 compared to just $3,694 for Medicaid beneficiaries who did not use long-term care services.

– Sixteen percent of Medicaid beneficiaries with disabilities used long-term services and supports, but they accounted for fifty-eight percent of all Medicaid spending on people with disabilities.


Democrats may not be very interested in investing in CLASS and Republicans are eager to peel off another layer of the Affordable Care Act, but the reality is that government spending on long-term care will only increase if lawmakers don’t deal with it. Financing long-term care through a self-sustaining insurance program, rather than Medicaid, is concept both parties should be able to agree on and as Rep. Frank Pallone (D-NJ) has suggested, Democrats should be promoting.