Convergence Center For Policy Resolution

Long-Term Care Financing Collaborative

Transforming the financing and delivery of long-term supports and services for older adults and disabled people

Generously supported by:


Akin Gump Strauss Hauer & Feld LLP

American Health Care Association/ National Center for Assisted Living (AHCA/NCAL)

America’s Health Insurance Plans (AHIP)

Dennis Passis

Hedermand Consulting LLC

The Jewish Federations of North America (JFNA)

Jewish Healthcare Foundation

The John A. Hartford Foundation


Maja Kristin

Mt. Sinai Health Care Foundation

The SCAN Foundation

The Urban Institute

The Vision

The Convergence Collaborative’s vision is that consumers, providers, insurers, government, and others can work together to design a sustainable and affordable system that delivers and finances higher-quality Long Term Support and Services (LTSS). The current system underfunds the services and supports people need to live a meaningful life, and any solution should, as much as possible, shift from the current welfare-based model to an insurance-based system.

The Problem

At the time of the project, more than 6 million older adults needed a high level of care. That number was expected to increase to nearly 16 million within a half-century. Millions of middle-income Americans drain their financial resources, place enormous burdens on family caregivers, and eventually turn to Medicaid for assistance. We believe the United States can do far better. 

More than two-thirds of older adults will need some personal assistance before they die.

Nearly half of older adults will have a high enough level of need that they would be eligible for private long-term care insurance or Medicaid.

Unpaid family caregivers lose an estimated $3 trillion in lost lifetime wages and benefits.
Advancing States & AARP

Convergence Consensus Blueprint

Establish a universal catastrophic insurance program

This program should provide financial support to those with high levels of care needs over a long period of time. 

Create a series of private sector initiatives and public policies aimed at revitalizing the long-term care insurance market to help address non-catastrophic LTSS risk.

This includes efforts to encourage retirement savings and develop more efficient and innovative use of home equity to assist middle-and upper-income families finance LTSS needs for those risks that are not covered by catastrophic insurance benefits. 

A modernized Medicaid LTSS safety net

A modernized Medicaid LTSS safety net for those with limited lifetime incomes who are not able to save for these care needs, as well as for those who deplete their assets paying for medical and long-term care costs. This includes more flexible public programs that can deliver care in the setting most appropriate to the needs of individuals. 

Stronger support for families and communities

Families and communities that are the bedrock for people receiving care at home should receive stronger support and better integration of medical treatment and personal assistance.  

Project Outcomes

Foundational Principles

A list of foundational principles for designing a sustainable and affordable system of long-term services and supports.

Delivery of Care

Recommendations for the delivery of care that centered on enhancing the independence and choice of those receiving care and supporting the family members and communities that assist them.

Press Recap

Long-Term Care Financing Collaborative Press Recap

Play Video


In the News


Biden Takes On Sagging Safety Net With Plan To Fix Long-Term Care

“A couple of years ago, the Long-Term Care Financing Collaborative, a group formed to think through how to pay for long-term elder care, reported that half of adults would need “a high level of personal assistance” at some point, typically for two years, at an average cost of $140,000.”


Long-Term Care Needs A Long-Term Solution

“Five years ago, the Long-Term Care Financing Collaborative, a nongovernmental expert panel, offered a proposal to protect against catastrophic costs of long-term services and supports in the final years of life… Under the proposal, individual savings would buttress insurance benefits, and care would occur in the most appropriate home-based or institutional setting.”


Getting Old Is A Crisis More And More Americans Can’t Afford

Michelle Cottle on the impact of Convergence’s Long-Term Care Financing Collaborative: “In 2012, a broad cross-section of policy experts, consumer advocates and industry representatives formed the Long-Term Care Financing Collaborative to explore more sustainable funding models. Last month he introduced legislation that would establish such a program.”

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Long-Term Care Financing Collaborative

For the past three decades, policymakers have tried with little success to respond to the challenges of financing long-term services and supports (LTSS) to care for the millions of elderly and disabled Americans who need help. As our nation’s 78 million baby boomers age, demographic trends show declining availability of family caregivers and increasing reliance on paid care, either at home or in residential facilities. The out-of-pocket costs of such assistance can be catastrophic, and few people have the necessary resources, through savings or private long-term care insurance, to meet this need.

In 2012, a group of policy experts representing a wide range of interests and ideological views created The Long-Term Care Financing Collaborative to build a foundation for new thinking and innovation. They asked Convergence to convene and facilitate. In subsequent meetings, the group developed two interim sets of recommendations:

Long-Term Care

Financing Collaborative

Final Report

  • A list of foundational principles for designing a sustainable and affordable system of long-term services and supports.
  • Recommendations for the delivery of care that centered on enhancing the independence and choice of those receiving care and supporting the family members and communities that assist them.

The Collaborative was instrumental in helping build a unique research partnership between The Urban Institute and the actuarial firm Milliman that led to a common understanding of the actuarial and economic impacts of several long-term care financing options. As a result of these efforts, the Collaborative laid the groundwork for establishing a comprehensive, holistic set of recommendations for providing effective and efficient long-term care delivery and financing.

In February 2016, Convergence released the Collaborative’s final recommendations “A Consensus Framework for Long-Term Care Financing Reform.” In July 2021, legislation was introduced in Congress to create a universal catastrophic long-term care insurance program based on the ideas first put forth by the Collaborative. Several Collaborative members were members of the advisory group that provided input on the legislation. Recently, the Collaborative’s work has been featured in The New York Times and The Washington Post. Collaborative members also discussed how the Convergence process galvanized this groundbreaking idea on the podcast below.

Read the Collaborative’s final recommendations here.

The Collaborative in the News

Getting Old is a Crisis More and More Americans Can’t Afford,” The New York Times, August 9, 2021

The Middle Ground for Fixing Long-Term Care Costs: The WISH Act,” Health Affairs, August 9, 2021


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