You can download Gleckman’s paper here.  One idea he raises is totally eliminating Medicaid in long-term care and replacing it with universal or near-universal long-term care insurance. He also smartly points to the need to integrate long-term care and medical care.   If the Feds don’t make long-term care a significant part of health care reform this time around, it’s going to have to be states that forge the innovative solutions, because their budget expenditures are only growing on a parallel track with consumers who want something different.

Gleckman concludes:

The broader health reform debate now taking place in Washington creates a rare opportunity for policymakers to rethink the relationship between medical treatment and the long-term care needs of the chronically ill and those with disabilities.  It is, for instance, an ideal environment to better coordinate long-term care with medical treatment (ECUMEN COULDN’T AGREE MORE).  Broad health reform also presents an opportunity to review the bifurcated structure of Medicare and Medicaid that often works to the detriment of those eligible for both programs. It allows policymakers the chance to alter the balance between institutional and home- and community-based care.  And, as policymakers attempt to redesign health coverage, so should they be considering improved payment mechanisms for long-term care.  It is difficult to imagine a well-designed health reform that fails to address these issues.