Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: Educational opportunities for those interested in Long Term Care.

Description: Following recent SOA Research, we look at how climate scenarios will affect Long Term Care assumptions and business.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: Social Insurance & Public Finance Section council members provide a recap of sessions from the 2021 SOA Health Meeting, with a focus on sessions covering Medicare, Medicaid, the ACA, and public policy. The authors include a description of SIPF Section-sponsored sections, including a session on the ACA and a session on CMS's Direct Contracting Model.

Description: Family caregivers are a critical link in providing long-term services and supports (LTSS), but they have significant unmet needs. To better support family caregivers, Congress authorized the Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers Act in 2018 and created the RAISE Family Caregiving Advisory Council. The Council identified recommendations to serve as the backbone of a national strategy to improve the physical, emotional and financial well-being of family caregivers. A new report, "Asking Directions: Mapping a Course to Support Family Caregivers," identifies specific actions across a variety of players for meeting the Council’s recommendations. It summarizes insights from a year’s worth of strategy sessions and interviews with representatives of over 100 organizations. The report brings together thoughts on best practices and the most critical action steps from national and state organizations, county health providers, the direct care workforce, large and small employers, aging and disability organizations, faith-based groups, respite care providers and more. This article summarizes the research methods and key findings of the report and the work conducted by the Leading Age LTSS Center @UMass Boston and Community Catalyst’s Center for Consumer Engagement in Health Innovation.

Description: Congress authorized the creation of the RAISE Family Caregiving Advisory Council in 2018. The Council, comprised of family caregivers and experts from a wide variety of stakeholder organizations in both the private and public sector, have been engaged in an in-depth research effort over the last two years to develop recommendations and an implementation plan to address our national caregiving crisis. This article describes their work and the newly released Report to Congress.

Description: The article provides an overview of the federal tax treatment of long-term care insurance contracts, including a brief history of the tax treatment of long-term care insurance, the requirements that must be satisfied in order to be treated as qualified long-term care insurance under the Internal Revenue Code, and a brief discussion of qualified long-term care combination products and chronic and terminal illness accelerated death benefits offered under life insurance contracts.

Description: Description * Coinsurance has not been widely offered as a benefit reduction option to offset long-term care premium rate increases. This article uses an illustrative example to evaluate the potential impact coinsurance could have on an insurance carrier's future claim liabilities and a policyholder's premium rates. It also explores various considerations insurance carriers, regulators, and policyholders should think about when evaluating whether coinsurance is the right option.

Description: The summary and introduction of an SOA research paper that explores valuable insights and recommendations for insurance companies considering entering the market of commercial long-term care insurance (LTCI) in the Asia-Pacific, based on individual health status.