Elder Law FAX The December 4, 2006, issue of Elder Law FAX, a free newsletter published every other Monday by the Elder Law Practice of Timothy L. Takacs. Medicaid Commission Approves Final Recommendations on Long-Term Care The Medicaid Commission recommended in November ways to improve the long-term outlook of Medicaid, focusing largely on long-term care, the fastest growing part of the Medicaid budget. In May 2005, the Secretary of the U. S. Department of Health and Human Services, Michael O. Leavitt, established a Medicaid Commission under federal law to advise the Secretary on ways to modernize the Medicaid program so that it can provide high-quality health care to its beneficiaries in a financially sustainable way. The Commission was tasked to submit two reports to the Secretary for his consideration and submission to Congress. Last summer, the Commission submitted a report that provided recommendations on options to achieve $10 billion in Medicaid savings over five years while at the same time make progress toward meaningful longer-term program changes to better serve beneficiaries. Some of these changes were incorporated into the Deficit Reduction Act of 2005, which was enacted into law earlier this year. The Commission was also to consider specific performance goals for the Medicaid program, as a basis for long-term recommendations. By December 31, 2006, the Commission will submit a formal written report of its longer-term recommendations on the future of the Medicaid program that ensure the long-term sustainability of the program. Following its two-day meeting in Washington in November, the Commission issued several recommendations. The first recommendation states unequivocally that "1. Public policy should promote individual responsibility and planning for long-term care needs. Congress, the Administration, and states should implement measures that encourage individual planning for long-term care." Among the measures suggested include providing federal and state tax incentives to encourage the purchase of long-term care insurance and to encourage employers to offer such insurance to employees. Also included were tax deductions or credits to people who are caregivers, in order to encourage them to continue their efforts. The Commission also recommended that federal and state lawmakers promote the use of home equity by individuals to finance long-term care services needed to maintain the individual in his or her own residence and prevent or postpone Medicaid enrollment. According to the Medicaid Commission, "Federal and state initiatives to support the development of home equity programs, such as reverse mortgages, should increase consumer awareness and access, ensure consumer protections, and encourage industry innovation." In addition to the stress on personal responsibility, the Commission suggests that the federal government and the states promote increased education about the importance of planning for long-term care and increased flexibility for states to design their own Medicaid eligibility and benefit packages. "Changes in Medicaid long-term care policy should address institutional bias and reflect what most seniors and persons with disabilities say they want and need, which is to stay at home in their communities," said the Commission. AMNews reported that Rep. John Dingell (D, Mich.), the incoming chair of the House committee dealing with Medicaid, said "Certainly, this commission never recognized that the Medicaid program's first and foremost responsibility is to the beneficiaries. Our greatest concern should be that we ensure that health care is accessible to them." The recommendations can be viewed online at http://aspe.hhs.gov/medicaid/nov06/Recommendations.pdf.