LTSS Commission Recap – What’s Happening at WA Cares?

The details and implementation of Washington State's long term care program, WA Cares, are still being ironed out in the state legislature. Here is what we know so far.

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The LTSS Commission (overseeing WA Cares and providing recommendations to the legislature for changes to the law), met at the end of July. There are workgroups, offshoots of the Commission, that are working to create the specs for an LTCi supplemental product, exemption recertification, benefit eligibility, and portability. During the July meeting, the LTCi group presented to the Commission. The other workgroups will be presenting at the September 13th LTSS Commission meeting.

If you would like snippets of the July meeting, see our Meeting-at-a-Glance section below. Want to delve in deeper? You can watch the July meeting OnDemand and review the minutes, their presentation, or the Supplemental Private LTCi Workgroup Report.
 
Meeting At-A-Glance

Workgroup Reports (the first was presented in July; others will be presented on 9/13)

• Supplemental Private PTCi report
• Private LTC Exemption Recertification report
• Accountability and Self-Employment Income Reporting report
• Benefit Eligibility report and criteria summary
• Portability report

Items/issues reviewed

• Shared Savings Waiver for CMS services – The WA Cares program is expected to reduce Federal funding for Medicare and Medicaid, since WA Cares would pay primary to these programs. The Commission is expected to have a report by December this year regarding whether any of that savings will be passed onto WA state.

• Investment Plan – An update was provided, projecting a median 15-year return of 3.6%. Modeling projects the program will retain positive balances for at least 4 decades (this is lower than Milliman’s solvency recommendation of 75 years).
• The ESD outlined inconsistencies between PFML and WA Cares. They requested changes to the law, to add a collective bargaining agreement deadline and include the authority for the ESD to collect late premiums and levy penalties and interest.

Supplemental Private LTCi (SPLTCI) Workgroup Final Report
These are the main bullet points from this Workgroup’s report:

• Expand and leverage the Statewide Health Insurance Benefits Advisors (SHIBA) program.
• Create a new section of Title 48 to regulate SPLTCI, requiring disclosures to consumers.
• Require that a minimum 3% inflation protection provision be included in the SPLTCI plan.
• Lower the carriers’ time and cost required to develop, price, and support these new products.
• Apply the WA Cares benefit, automatically adjusted for inflation, as the “deductible” required under the SPLTCI coverage to eliminate a “donut hole” between the two plans. This would require the WA Cares statute to change to automatically adjust the lifetime benefit by an annual inflation factor.
• Remove the typical carrier requirement for the client to undergo a functional assessment or satisfy a benefit trigger in order to meet an SPLTCI’s elimination period; allow the carrier to also set a time component to the elimination period (such as 6 months), not to exceed 12 months.
• Allow carriers to set the elimination period for near-retirees at $36,500 or some other lower amount; plans offering a lower cap will reduce the potential of a donut hole for these consumers between the two programs’ benefit payments.
• SPLTCI policies must allow continuity of care from WA Cares, including family providers (unless there is a good-faith reason to believe a care setting or provider is not suitable). If a family provider is not deemed suitable, continuity of care must be provided under the SPLTCI policy for at least 90 days after the transition from WA Cares.
• Support a process of reciprocal administrative notification between WA Cares and SPLTCI carriers, with no health information or claim information being shared.
• Apply statutory changes to facilitate supplemental plans to only these SPLTCI plans, not the rest of the LTCi market.

 

The Bottom Line
Every agent who has clients with LTCi policies or riders should be paying attention to the LTSS Commission meetings and workgroup reports. As we saw last year, the legislature will typically enact most, if not all, of the recommendations that come out of the LTSS Commission. Each meeting has a public comment period, and I highly recommend adding your agent experience to the conversation, since there continue to be no agents, carrier representatives, or WA OIC employees on the LTSS Commission.
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Next meetings:

• 9/13/2022          1:00 – 4:00        
• 11/10/2022        8:30 – 11:30
• 12/9/2022          1:00 – 4:00

Access all meeting information, including links to the live webinars, here.