Public-private collaboration is key to securing funding for long-term care for middle-income Americans

WASHINGTON–() – The Milken Institute today released a new report highlighting innovative public and private sector solutions that can expand access and delivery of long-term care for middle-income Americans. Published in collaboration with Genworth, “New approaches to accessing long-term care for middle-income householdsExamines the funding, technological and healthcare challenges of the current system and offers recommendations for overcoming these barriers.

Recent studies have found that more than half of middle-income seniors will not be able to afford the care they need. Meanwhile, while the pandemic has exposed glaring vulnerabilities in the long-term care system, it has also ushered in greater use of technology with telehealth and home care.

“Middle-income Americans are stuck between the inability to afford private long-term care and not being eligible for government-sponsored programs like Medicaid. This can lead to a gap in care for a significant portion of the population, ”said Nora Super, Senior Director of the Milken Institute Center for the Future of Aging.

The report follows a Financial Innovations Lab® that the Milken Institute hosted in fall 2020. The lab brought together an expert group of stakeholders from government, healthcare, long-term care delivery, insurance, finance and academia to develop solutions that can improve access to quality and affordable long-term care for middle-income households.

“The pandemic has raised awareness of the loopholes that exist in the current long-term care ecosystem. The concrete recommendations outlined in this report are essential in closing the gap in providing meaningful and much-needed long-term care solutions for millions of people. middle-income people, ”said Tom McInerney, President and CEO of Genworth. “It will take collaboration and innovative thinking between stakeholders at the federal and state levels, public and private sectors, to follow the roadmap set out in the report and effect the change that is so desperately needed. ”

Building on the lab and further research, the Milken Institute offers specific recommendations for public and private collaboration to successfully fund long-term care, including:

  • Design a large-scale demonstration project to better analyze the costs and benefits of various technological solutions that improve home care. There are many private sector pilot programs measuring the effectiveness of solutions such as telehealth and remote monitoring, but these programs do not use standardized data and evaluation frameworks. The report offers a roadmap for developing a cohesive demonstration project and describes specific parameters such as demographic profile, evaluation measures, and potential funding sources for successful program design.
  • Expand access to integrated care for middle-income Americans who cannot afford specialized private care programs and who are not eligible for Medicaid. The report recommends expanding promising integrated care programs that are already available in the market, such as Special Needs Plans (SNPs) and All Inclusive Care Programs for the Elderly (PACE). The proposed changes include offering a new community-based SNP or expanded access to CAPC through a tiered delivery structure, providing broader access to non-medical support services to a much larger cohort.
  • Develop new public-private complementary insurance solutions that offer transparent and affordable coverage and segment risk. Long-term care is too expensive for the private or public sector to deal with on its own. In order to mitigate the associated costs and risks, the Milken Institute has identified a new approach that allows the public sector to develop long-term care insurance programs that cover the first two years of long-term care costs, followed by complementary long-term care from the private sector. long-term care insurance products that provide coverage for additional years. For the longest and most expensive cases, Medicaid would continue to serve as a safety net. This is a more nuanced approach to risk segmentation than is typical in current models.

Caitlin maclean, Senior Director of Innovative Finance at the Milken Institute, added: “These innovative solutions can improve access to high-quality care for older people while reducing costs for public and private payers. ”

The Milken Institute will continue to leverage our network, engage policy makers, and provide a platform to advance these solutions. We encourage stakeholders in the long-term care ecosystem to heed these recommendations and advance access to quality care for Americans across the socio-economic spectrum.

“New Approaches to Access to Long-Term Care for Middle-Income Households” is co-authored by Jason davis and Caroline Servat. The full report can be downloaded here.

About the Milken Institute

The Milken Institute is a non-profit, non-partisan think tank that helps people build meaningful lives in which they can experience health and wellness, pursue effective education and gainful employment, and access resources. necessary to create ever-increasing opportunities for themselves and their larger communities. For more information visit

About the financial innovation laboratories®

The Financial Innovations Labs® bring together researchers, policymakers, and business, finance and professional practitioners to create market-based solutions to business and public policy challenges. Using real and simulated case studies, participants examine and design alternative capital structures, then apply appropriate financial technologies to them.

About the Milken Institute Center for the Future of Aging

The Milken Institute Center for the Future of Aging raises awareness, offers solutions and catalyzes action to promote healthy longevity and financial well-being. Through research, convening, advocacy and partnership with leaders from key sectors, the Center strives to improve lives and build a better future for all ages.

About Genworth Financial

Genworth Financial, Inc. (“Genworth”) is a leading Fortune 500 insurance holding company committed to helping families realize the dream of homeownership and meet the financial challenges of aging through its leadership positions. in mortgage loan insurance and long-term care insurance. Based in Richmond, Virginia, Genworth dates back to 1871 and became a public company in 2004.

Additional experts available to discuss long-term care

  • Marc Cohen, Co-Director, LeadingAge LTSS Center, UMass Boston
  • Richard Franck, Margaret T. Morris Professor of Health Economics, Department of Health Care Policy, Harvard Medical School
  • Jeff Huber, CEO, Home Place
  • Robert kramer, Founder and Strategic Advisor, National Investment Center for Housing and Elderly Care
  • Tom McInerney, President and CEO, Genworth Financial
  • Susan reinhard, Senior Vice President and Director, AARP Public Policy Institute
  • Katie smith sloan, President and CEO, LeadingAge
  • Anne Tumlinson, CEO, ATI Advisory

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