Question

Conclusion for project file consumer protection

Answer 1

This research project examined provisions for protecting the rights and meeting the needs of elderly consumers who purchase long-term care insurance through the California Partnership for Long Term Care (CPLTC), a public-private partnership between long-term care insurance carriers and Medi-Cal (California’s Medicaid program). In particular, this project: (1) investigated the experiences of policyholders in light of existing regulations and standard practices in long-term-care case management, (2) examined the adequacy of existing quality assurance procedures, and (3) developed recommendations for assessing consumer satisfaction and enhancing consumer protection with services provided under long-term care insurance. The research methodology involved in-depth process analysis of the experiences of 33 long-term care insurance policyholders. The analysis included longitudinal case studies involving detailed case record reviews, multiple interviews with 19 policyholders, as well as information gathered from family members, care managers, care management provider agency personnel, and insurance company representatives. We found that policyholders were generally satisfied with the services they received, both from care managers and from direct service providers. Policyholders’ basic service needs appeared to be met in most cases, although there were a few cases in which inadequate services or insufficient care management may have contributed to deleterious policyholder outcomes.