Better Care for Billions Less: Fixing Medicaid’s Long-Term Care Incentives

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Cato Institute

Politics, Unknown, News Commentary, 424708, Libertarian, Markets, Cato, News, Immigration, Peace, Policy, Government, Defense

4.6 • 949 Ratings

🗓️ 11 December 2025

⏱️ 45 minutes

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Summary

Cato's Michael Cannon and the Center for Long-Term Care Reform's Stephen Moses examine how Medicaid’s long-term-care eligibility rules let middle- and upper-middle-class households shelter assets and shift costs onto taxpayers, driving up spending and lowering quality for the poor. Drawing on Moses’s new Cato paper Better Long-Term Care for Billions Less, they explain how perverse incentives, generous exemptions, and weak estate recovery undermine private planning and inflate a program already consuming one-third of Medicaid’s budget.

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Transcript

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0:00.0	Hello and welcome to the Cato podcast.
0:07.0	My name is Michael Cannon.
0:08.0	I'm the Director of Health Policy Studies at the Cato Institute.
0:11.0	I'm very glad to be here with a longtime friend of mine and of the Cato Institute,
0:17.0	Stephen A. Moses, who is the founder and president of the Center for Long-Term Care Reform,
0:22.5	and a visiting fellow with the Paragon Health Institute. Welcome, Stephen.
0:27.1	Thank you so much for having me.
0:28.7	Stephen, and I say a longtime friend, you and I have known each other for probably 20 years at this point.
0:34.7	More than 20, yes. 20 years ago, we did some things together.
0:38.7	And for even longer than that, you have been the president of the Center for Long-Term Care Reform,
0:45.6	and you wrote a paper for the Cato Institute, probably 20 years ago, on this topic. And you have a new one out for the Cato Institute on that topic again.
0:55.3	The title is Better Long-Term Care for Billions Less. And that came out just a couple of weeks ago.
1:03.6	And we wanted to talk to you about that today. But before we get into that, I find your story so
1:09.6	interesting. And I think our listeners would too. We started
1:13.1	working together because we have common views and common interest when it comes to long-term care
1:20.2	and long-term care services and supports. These are the types of care that people need
1:26.3	to help them with activities of daily living when they
1:30.1	get older or suffer a disability and can't do those activities themselves.
1:34.1	So we've had a lot in common on policy grounds.
1:37.1	And it really fascinated me when I learned that you are a libertarian who has made his career
1:43.6	in long-term care advocacy and policy reform.
1:48.1	So tell me, how did you come to libertarianism and how did you come to working in long-term care policy?
	...

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