FIA 2016
The Looming Impact of Long-Term Care on Medicaid

WOODSVILLE, NH – A new study, published by Federalism In Action, finds that America’s and New Hampshire’s long-term care service delivery and financing systems – as currently operating and likely to evolve – will not survive the coming demographic age wave.

Cassandra's Quandary (FIA, 2016)

View PDF of Cassandra’s Quandary.

According to the study, CASSANDRA’S QUANDARY: The Future of Long-Term Care in New Hampshire, radical changes in federal and state laws and regulations are needed to align consumer incentives with the need to finance future long-term care (LTC) adequately. To begin the public conversation and highlight this financial time bomb, Federalism In Action (FIA) partnered with the Center for Long-Term Care Reform and the New Hampshire Center for Economic Policy to perform a 30-year cost projection of NH’s Medicaid system.

“Long-term care financing is a time bomb about which experts and policy makers are too complacent,” said Stephen Moses, author of the study. “The soporific effect of moderate health and LTC cost inflation will end soon causing disastrous financial and care quality problems. Cassandra’s Quandary explains how and why this will happen in New Hampshire and the USA if nothing is done.”

Two federal programs—Social Security and Medicare—are notorious for their unfunded liabilities: $25 trillion and $43 trillion, respectively. However, another federal program—Medicaid—consumes a growing proportion of state and federal budgets but attracts less scrutiny of its long-term fiscal viability.

“While Obamacare is dominating the Medicaid discussion at the state level, it is long-term care for the aging that will dramatically increase Medicaid spending over the next several decades,” said J. Scott Moody, Federalism In Action CEO. “Yet, there is not a single state that is estimating these future costs, let alone preparing for them. New Hampshire, and New England in general, will be the first place where the fiscal pressure of the retirement of the baby-boomer generation will be felt.”

According to Moses, “the risk and cost of long-term care explodes at age 85.  The first baby-boomers turn 85 in 2031.  By then, it will be too late to avoid the collapse of America’s long-term care service delivery and financing system that will occur by 2050. The report explains why we’re in this mess and what to do about it—now!”

While common perceptions are that America’s aging population will strain Medicare resources, it will also adversely impact Medicaid and its long-term care coverage. Already a problem, three-fourths of Medicaid recipients are impoverished adults or children, but account for only one-third of the program’s expenditures, whereas only one-fourth of Medicaid recipients are aged or disabled, but consume two-thirds of the program’s costs. Just as alarming, Medicaid’s most expensive “dual eligible” recipients—those also receiving Medicare—comprise only 15% of total recipients but account for 39% of Medicaid spending, of which 70% is for their long-term care.

“Poor federal Medicaid policy caused America’s and New Hampshire’s LTC problems of impaired access, doubtful quality, inadequate reimbursement, and institutional bias,” explains Moses. “Our study explains what’s wrong with long-term care public policy and how shifting responsibility from the federal government to the states and the people can fix it.”

Stephen Moses is a senior policy fellow with Federalism In Action and the president of the Center for Long-Term Care Reform. He may be reached by email at or by phone at 432-364-2254. (View his bio here.)

Federalism In Action, a 501c(3), is an energetic, results-oriented public policy organization – promoting American federalism, liberty, and fresh ideas aimed at limiting government. We seek to restore the proper balance between the federal government and the states – focusing on ways states can truly act as independent sovereigns and come up with local solutions. To learn more, visit

The Center for Long-Term Care Reform, located in Seattle, Washington, promotes universal access to top-quality long-term care by encouraging private financing as an alternative to Medicaid dependency for most Americans. To learn more, visit

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Click here for PDF copy

Press Release in PDF.

One Response to Release: New Hampshire’s Financial Time Bomb

  1. Genial, formato de tu blog! ¿Cuanto tiempo llevas bloggeando? haces que leer en tu blog sea entretenido. El uso total de tu web es magnífico, al igual que el material contenido!

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