Authorized in 1987, the Program to Promote Long-Term Care Insurance for the Elderly (LTCI), a national program of the Robert Wood Johnson Foundation (RWJF), was charged with providing states with resources to plan and implement private/public partnerships (Partnership programs). The Partnership programs joined private, long-term care insurance with Medicaid to offer high-quality insurance protection against impoverishment from the costs of long-term care — including both nursing home care and/or home care.

Consumers who purchase such policies are insured for long-term care up to a pre-set dollar level through the private insurer. Once the private insurance is exhausted, they can continue their long-term care under Medicaid without spending their assets, as is usually required to meet the criteria for Medicaid eligibility.

Key Results

• By 2000, a total of 104,000 applications had been taken and more than 95,000 had been sold in the four program states — California, Connecticut, Indiana and New York.
• More than 25,000 new applications were received for Partnership policies in 1999.
• Program redesigns in Connecticut, Indiana and California have produced increases in applications received ranging from 324 percent to 540 percent, compared to similar time periods prior to those adjustments.
• In New York, where total sales have been the largest in number, updates to its program model are being explored to further program goals. This progress was accomplished despite restrictive language embedded in the Omnibus Budget Reconciliation Act (OBRA) of 1993 effectively curtailed one of the program's goals: replicating the partnerships in other states.

Evaluation Findings
Laguna Research Associates, Inc. of San Francisco conducted an evaluation of the program. Nelda McCall was the principal investigator.

• The evaluators found that the state regulations that had been developed for partnership products represented a more rigorous regulatory model — specifying higher quality policies — than previously existed in the states for long-term care insurance policies.
• More than 30 percent of those who purchased policies said they would not have purchased long-term care insurance without the partnership program.

Essential Features of the Policies

• Suitability for a broad income and age group among the elderly.
• Protection of beneficiaries' assets and income against catastrophic chronic care costs (with different levels of asset protection in each state).
• Coverage of a broad range of services, including home and community-based services and nursing home services.
• Case management and preadmission screening.

Program Management
The program operated under the leadership of a national program office at the University of Maryland Center on Aging.

Funding
RWJF's Board of Trustees originally authorized the program in December 1987 for $3.2 million. Implementation grants were authorized on an individual basis from 1989 to 1996 for $9.2 million.