(10) The National Association of Independent 
Financial Advisors. 
(11) The Center for Long-Term Care Reform. 
(12) Experts on the Federal budget, including 
experts currently or formerly employed by the Con-
gressional Budget Office or the Office of Manage-
ment and Budget. 
(13) Experts from relevant non-profit organiza-
tions and foundations, including the Brookings Insti-
tution, the Urban Institute, the Ethics and Public 
Policy Center, The Commonwealth Fund, the Herit-
age Foundation, the Cato Institute, and the Amer-
ican Enterprise Institute. 
(14) Any other appropriate stakeholders, as de-
termined by the Secretary. 
SEC. 7. CBO REPORT ON POLICY OPTIONS TO REDUCE RE-
LIANCE ON MEDICAID FOR LONG-TERM CARE 
SERVICES. 
(a) IN GENERAL.—Not later than January 1, 2014, 
the Director of the Congressional Budget Office shall sub-
mit to the Committees on the Budget of the House of Rep-
resentatives and the Senate a report containing the fol-
lowing: 
(1) PROJECTION OF NUMBER OF MIDDLE-IN-
COME PEOPLE WHO WILL RELY ON MEDICAID FOR 
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LONG-TERM CARE SERVICES.—A projection of the 
percentage of middle-income individuals in the 
United States who will rely, partially or completely, 
on Medicaid to finance their long-term care needs 
during the next 20 years and the percentage who 
will rely solely on other resources, including home 
equity, personal savings, or private long-term care 
coverage to finance such care. 
(2) ESTIMATE OF COST OF RELIANCE ON MED-
ICAID.—An estimate of the cost of such reliance on 
the Medicaid program to State and Federal govern-
ments. 
(3) ESTIMATE OF IMPACT OF SPECIFIC POLICY 
OPTIONS.—Subject to subsection (b), an estimate of 
the change in the cost estimated under paragraph 
(2) that would result from each of the following pol-
icy options: 
(A) REDUCTION IN HOME EQUITY EXEMP-
TION.—A reduction in the home equity exemp-
tion under section 1917(f) of the Social Secu-
rity Act (42 U.S.C. 1396p(f)) from the amount 
permitted under such subsection to— 
(i) $200,000; or 
(ii) $50,000. 
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(B) EXTENSION OF LOOK-BACK PERIOD.— 
Changing the look-back period for the transfer 
of assets under section 1917(c)(1) of such Act 
(42 U.S.C. 1396p(c)(1)) to a period of 10 
years. 
(C) 
ENCOURAGING
STATE
USE
OF 
LIENS.—Federal incentives for States to require 
the use of liens for the purpose of estate recov-
ery under the Medicaid program. 
(D) TAX
INCENTIVES
FOR
INSURANCE 
USE.—Tax incentives to assist middle-income 
individuals in the United States with the pur-
chase of long-term care insurance, including by 
amending section 125 of the Internal Revenue 
Code of 1986 to permit long-term care insur-
ance products to be included in employer cafe-
teria plans. 
(E) INCENTIVES FOR STATES TO INCREASE 
PURCHASES
OF
LONG-TERM
CARE
INSUR-
ANCE.—Provide 
States 
operating 
qualified 
State long-term care insurance partnerships (as 
defined in section 1917(b)(1)(C)(iii) of such Act 
(42 U.S.C. 1396p(b)(1)(C)(iii))) with incentives 
to increase the number of middle-income indi-
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viduals in the United States who are enrolled in 
long-term care insurance. 
(F) OTHER POLICY OPTIONS.—Any other 
policy options that the Director determines 
would reduce Federal and State spending on 
long-term care services under the Medicaid pro-
gram. 
(4) ESTIMATE OF IMPACT OF SPECIFIC POLICY 
OPTIONS
ON
SAVINGS
UNDER
MEDICAID
BLOCK 
GRANT.—An estimate, for each of the policy options 
under paragraph (3), of the change in cost estimate 
under paragraph (2), that would result if each such 
policy option were adopted and funding for long- 
term care services under Medicaid is provided to 
States through a block grant. 
(b) LIMITATION.—The Director may not evaluate any 
policy option under subsection (a)(3) if such policy op-
tion— 
(1) requires mandatory enrollment of individ-
uals in a program or insurance product; 
(2) requires employers to automatically enroll 
individuals in a program or insurance product, with-
out such individuals prior affirmative consent; or 
(3) requires that premiums collected for a long- 
term care program or insurance product be depos-
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ited in government securities or a Federal trust 
fund, such as the CLASS Independence Fund estab-
lished by section 3206 of the Public Health Service 
Act. 
Æ 
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