IPP Brief — LTC Insights · April 24, 2026 (v2)

This Week in LTC

The Caregiver Shortage Crosses Into Crisis Territory — 53 Million Family Members Now Filling the Gap

CNBC · Caregiving

A new Columbia University analysis finds nearly half of U.S. states sit at "critical" or "high risk" levels for unpaid family caregiving emergencies. There are now an estimated 53 million unpaid family caregivers in the U.S., contributing more than $870 billion in informal care annually. With professional home care wages running $33–$35/hour nationally — and $40–$50 in coastal cities — the supply gap is being closed by working adults stepping out of careers, not by new workers stepping in. Most projections see the shortage deepening into the early 2030s.

What This Means

For advisors: The "we'll just have family help" assumption is now a planning risk to surface explicitly. Cash-indemnity hybrid LTC policies that pay informal caregivers move from a nice-to-have to a structural answer.

For clients: Plan around who actually does the care, not just who pays for it. The next family caregiver may be you — or the cost of replacing one.

AI Underwriting Comes of Age — Pathwork and Waterlily Compress LTC Eligibility From Weeks to Seconds

Pathwork / Waterlily · InsurTech

Two AI platforms are quietly rewriting how Americans qualify for long-term care coverage. Pathwork's qualification tool produces instant eligibility insights across nine top carriers — including Lincoln Financial, Mutual of Omaha, OneAmerica, Nationwide, Securian, Thrivent, NGL, Aetna, and Manhattan Life. Waterlily's "Quote-and-Apply," backed by 500+ million data points and direct integrations with Nationwide, OneAmerica, and CareScout, runs hundreds of thousands of policy configurations to find a mathematically optimal match per applicant. The bigger shift: the underwriting bottleneck that historically killed conversions is now measured in minutes.

What This Means

For advisors: The "I have to think about it" stall after a quote is shrinking. Same-meeting eligibility is changing close rates and how follow-up is structured.

For clients: Getting a real answer on whether you qualify — and at what price — no longer requires weeks of back-and-forth with an underwriter.

Continental General Picks Up LTC Blocks From State Guaranty Associations — A Quiet Signal About Where Old Risk Is Going

Continental General · M&A

Continental General Insurance Company closed acquisitions of two blocks of life, health, and long-term care policies from state life and health insurance guaranty associations in February 2026. The deal sits inside a wider pattern: Manulife reinsuring $4.4 billion in LTC reserves to Global Atlantic and another $1.9 billion to RGA over the past 18 months; Unum closing a $3.4 billion LTC reinsurance transaction with Fortitude Re. The legacy LTC block is now an asset class — and private capital is buying.

What This Means

For advisors: When clients ask "is my carrier going to be around in 20 years," the answer increasingly involves who actually holds their reserves — which is often not the name on the policy.

For clients: A reinsurance transfer doesn't change your contract. It does change which balance sheet stands behind it. Worth a periodic check on your carrier's financial strength rating.

California's LTC Task Force Floats a 2.0–3.5% Payroll Tax — Roughly Five Times the Washington Rate

CA LTC Insurance Task Force · State Programs

The actuary on California's Long-Term Care Insurance Task Force has now estimated that the program design the Task Force prefers would require a payroll tax between 2.0% and 3.5% — significantly higher than Washington's 0.58% WA Cares rate. The Task Force is also recommending the state NOT allow an opt-out window, citing Washington's experience with pre-2021 private-policy exemptions. No legislation is moving yet, but the Oliver Wyman analysis underpinning the recommendations is the most detailed financial modeling of a California program to date.

What This Means

For advisors: California clients deserve a heads-up that the cost of inaction may include a permanent payroll tax with no off-ramp. The window for private LTC purchases ahead of any opt-out cutoff is the planning lever.

For clients: If California eventually adopts the Task Force model, owning private LTC coverage would not exempt you from the tax. Plan accordingly while the market is still voluntary.

Immigration Policy Becomes an LTC Issue — One in Three Home Care Workers Is an Immigrant

Johns Hopkins Bloomberg School of Public Health · Workforce

Roughly one in three home care workers in the United States is an immigrant, according to Johns Hopkins research. With increased immigration enforcement and policy uncertainty, a workforce that was already stretched thin is facing new instability — translating directly into longer waits, higher hourly rates, and reduced availability for in-home care across both private-pay and insurance-paid arrangements. The U.S. home care workforce is projected to generate over 6.1 million job openings between 2024 and 2034 — second among all U.S. occupations.

What This Means

For advisors: Cost-of-care projections in client plans should assume continued upward pressure on hourly home care rates. Reimbursement-style policies with daily caps will pinch first.

For clients: Even with a strong policy, finding a caregiver may become the constraint. Building a relationship with a home care agency early is increasingly part of a real plan.