Verification Protocol V3(2): every claim in elder-care/docs/, elder-care/research/ and elder-care/baseline/ that does not already appear on the public pages. Claims that do appear there are carried at their P/S numbers in ledger-public.md and are not re-numbered here; where a record file states the same fact differently from the public page, it is numbered here, because the divergence is itself the finding.
264 rows (R001–R264). Verdicts per V7; CONFIRMED-INTERNAL = reproducible from the committed record with no external referent.
docs/research-inquiry.md — protocol, hypotheses, anchor priors (R001–R052)
| # | Claim | Verdict |
|---|---|---|
| R001 | Status line: Phase 0 executed 2026-08-03, verdict GO, anchors 7 and 11 broken/reframed | CONFIRMED-INTERNAL |
| R002 | §2 seed H2.1: unpaid family caregiving accounts for the majority of LTSS hours delivered nationally | UNVERIFIABLE — never tested; superseded by the valuation kill condition |
| R003 | §2 seed H2.2: Medicaid, not Medicare, is the primary public LTSS payer | CONFIRMED |
| R004 | §2 seed H2.3: no unified national HCBS waiting-list count exists; incompatible waiver definitions, unknown duplicate rates | CONFIRMED (KFF states the series is not comparable across states or over time) |
| R005 | §2: the 85+ band is the load-bearing denominator for LTSS need | CONFIRMED (ASPE: 40% of 85+ had severe LTSS needs vs 8% of 65–74) |
| R006 | §3 framing: treat workforce as the primary binding constraint, per the childcare/housing rhyme | CONFIRMED-INTERNAL — a prior, correctly labelled |
| R007 | §3 seed H3.1 (turnover/vacancy binds more tightly than waiver funding) | CONFIRMED-INTERNAL as stated; verdict INDETERMINATE |
| R008 | §3 seed H3.2 (immigration restriction as first-order supply constraint) | CONFIRMED-INTERNAL |
| R009 | §3: direct-care turnover is among the highest of any major occupation group | UNVERIFIABLE at primary tier |
| R010 | §4: CLASS failed at the design stage, not the implementation stage | CONFIRMED |
| R011 | §4 seed H4.1: private LTC insurance is not viable at a price point most households will pay | UNVERIFIABLE — never adjudicated in any findings file |
| R012 | §4 seed H4.2: WA Cares is the load-bearing precedent for a payroll-tax design surviving a real legislature | CONFIRMED-INTERNAL |
| R013 | §5: nursing home care is a mandatory Medicaid entitlement; HCBS mostly optional capped waivers | CONFIRMED at statutory tier (see P094/P095) |
| R014 | §5: Money Follows the Person history of lapses and reauthorizations | UNVERIFIABLE — never researched |
| R015 | §5: Olmstead's ADA integration mandate as the legal lever forcing state rebalancing | UNVERIFIABLE — named, never reached; no citation anywhere in the record |
| R016 | §5 seed H5.1: largest waiting lists correlate with institutionally-biased spending mix, not low spending | CONFIRMED-INTERNAL — verdict "consistent with (n=1)" |
| R017 | §6: CMS Care Compare and the Special Focus Facility program as quality instruments | UNVERIFIABLE — named, never researched |
| R018 | §6 seed H6.1: PE-owned facilities show a measurable staffing/outcome delta | CONFIRMED |
| R019 | §7: assisted living has no federal Conditions of Participation, no Care Compare equivalent, no uniform staffing or incident-reporting requirement | CONFIRMED at secondary tier (V5 negative; consistent with GAO-18-179) |
| R020 | §7: state licensure-category proliferation is a first-order measurement problem | CONFIRMED (GAO-26-107884: AL "aren't uniformly defined across federal claims systems") |
| R021 | §7: NIC MAP is a private, subscription, investor-facing source and should be flagged as such | CONFIRMED-INTERNAL |
| R022 | §7 seed H7.1 (incidents systematically undercounted) | CONFIRMED |
| R023 | §7 seed H7.2 (Medicaid AL footprint growing) | CONFIRMED-INTERNAL — verdict: data gap |
| R024 | §8: OAA Title III-E and Title III-C predate every current caregiver proposal by decades and are the baseline | CONFIRMED |
| R025 | §8 seed H8.1 (imputed value exceeds total paid LTSS spending) | CONFIRMED-INTERNAL — superseded by the kill condition |
| R026 | §8 seed H8.2 (NFCSP orders of magnitude below caregiver value and HCBS spending) | CONFIRMED in direction; see S083 on the exponent |
| R027 | §9: Medicaid waiver architecture §1915(c)/(i)/(k), §1115 demonstrations | CONFIRMED at statutory tier (42 U.S.C. §1396n) |
| R028 | §9 seed H9.1: is the binding lever federal or state? | CONFIRMED-INTERNAL |
| R029 | §11 seed list of nine candidate architectures | CONFIRMED-INTERNAL |
| R030 | §11 seed H11.1: demand-side money without workforce capacity inflates wages/prices without adding care hours | UNVERIFIABLE — never adjudicated; ws13 finds the opposite for BIP-style packages |
| R031 | Anchor 1 definition: 56% = 2+ ADLs/90+ days or severe cognitive impairment | CONFIRMED at agency-primary tier (ASPE 2022, HIPAA-style trigger) |
| R032 | Anchor 1: ASPE 2019 also reports 48% receive paid LTSS lifetime | CONFIRMED at agency-primary tier |
| R033 | Anchor 1: Kemper/Komisar/Alecxih 2005 is a Brookings-ICF model of independent lineage | CONFIRMED (ASPE 2019 cites it as an independent projection) |
| R034 | Anchor 1: "the current ASPE figure is materially lower (56%)" and 70% is a "citation trap" | OVERSTATED — see S018; the two use different models and different definitions |
| R035 | Anchor 2: PHI's figure is BLS-derived, not an independent second source | CONFIRMED-INTERNAL — an M1 two-source disclosure, correctly made |
| R036 | Anchor 3: must specify "standalone individual" to avoid understating participation | CONFIRMED-INTERNAL |
| R037 | Anchor 4: AARP's 2026 update is replacement-cost, blended wage by task type | CONFIRMED at secondary tier |
| R038 | Anchor 4: the 350B→600B→$1.01T move is "partly from methodology revision, not just growth" | CONFIRMED-INTERNAL — and the qualifier the whitepaper drops (see P141) |
| R039 | Anchor 4: CBO 2013 used HRS data; RAND 2014 used ATUS | UNVERIFIABLE at primary tier (cbo.gov blocked; RAND PDF 404) |
| R040 | Anchor 5: left blank, queued | CONFIRMED-INTERNAL |
| R041 | Anchor 6: premiums delayed by HB 1732/1733 | UNVERIFIABLE at primary tier |
| R042 | Anchor 6: private-insurance opt-out window Oct 2021–Dec 2022 | UNVERIFIABLE at primary tier |
| R043 | Anchor 6: SB 5291 (May 2025, eff. Jan 2026) loosened vesting (10yr, breaks allowed, or 3-of-last-6) and added opt-outs; no rate/cap change | UNVERIFIABLE at primary tier — and see R044 |
| R044 | Anchor 6: rate "unchanged since enactment", cap "auto-inflation-adjusted" | OVERSTATED — RCW 50B.04.080(1) moves rate-setting to the Pension Funding Council from 2026-01-01, capped at .58% |
| R045 | Anchor 6: benefits payable July 1, 2026, "confirmed independently (AARP, DSHS, KOMO)" | CONFIRMED at statutory tier, one tier deeper than the record reached |
| R046 | Anchor 7: "CMS's own repeal cites the moratorium as running to 2035, one law-firm summary said 2034; not reconciled" | CORRECTED — the repeal rule (90 FR 55687) says "September 30, 2034" / "before October 1, 2034" throughout, as does Pub. L. 119-21 §71111 |
| R047 | Anchor 7: rural hardship-waiver terms are moot | CONFIRMED |
| R048 | Anchor 10: "not RFS, not JPE — the seed didn't specify venue" (venue now on record) | CONFIRMED |
| R049 | Anchor 10: "No direct econometric rebuttal found" | CONFIRMED-INTERNAL — the honest version of P121 |
| R050 | Anchor 10: two independent systematic reviews (BMJ 2023, 55 studies; ScienceDirect 2025, US-specific) reinforce the direction | UNVERIFIABLE at primary tier |
| R051 | Anchor 11: "since SNF census is flat-to-declining while AL is the growing setting, a same-year comparison could narrow or reverse the gap" | CONFIRMED-INTERNAL |
| R052 | Anchor 12: Medicaid HCBS ≈ $116B (FY2020, KFF) to $162B (CY2020 combined fed/state) | UNVERIFIABLE at primary tier |
docs/phase0-findings.md (R053–R084)
| # | Claim | Verdict |
|---|---|---|
| R053 | No kill condition fires as a stop | CONFIRMED-INTERNAL |
| R054 | §12's first named kill condition fires exactly as specified | CONFIRMED-INTERNAL |
| R055 | The second kill condition (§3) was not testable within Phase 0 scope; left open | CONFIRMED-INTERNAL |
| R056 | Three independent knobs explain the valuation spread: population scope, wage-rate assumption, hours source | OVERSTATED — elapsed time is a fourth, unnamed driver (R038 concedes it) |
| R057 | "None of the three studies is wrong; they are answering different questions" | CONFIRMED-INTERNAL |
| R058 | §8 must report a conditional range by scope and method | CONFIRMED-INTERNAL |
| R059 | Rule vacated on statutory-authority grounds in both courts | OVERSTATED — 90 FR 55687 records a major-questions holding for N.D. Tex. only; the N.D. Iowa ground is not stated by CMS, and neither opinion has been read |
| R060 | The N.D. Iowa case was a 20-state AG suit | UNVERIFIABLE — the repeal rule names Kansas v. Kennedy without a party count |
| R061 | "HHS withdrew its own appeals of both losses in fall 2025" | UNVERIFIABLE — 90 FR 55687 records the N.D. Tex. case as "appealed June 2, 2025 to the Fifth Circuit" and says nothing about withdrawal |
| R062 | Congress's moratorium is "a belt-and-suspenders legislative kill shot on top of the court losses" | CONFIRMED-INTERNAL |
| R063 | Independently confirmed via AHA, Federal Register, CANHR, Center for Medicare Advocacy, Duane Morris, Skilled Nursing News | CONFIRMED-INTERNAL |
| R064 | The rule was "modeled to save 13,000 lives/year" | UNVERIFIABLE — appears nowhere in 89 FR 40876's fetched text; no citation in the record |
| R065 | §11's federalism hypothesis gets a strong empirical answer: state-level laws are the more durable lever | OVERSTATED — one reversal is not a durability comparison; the record's own patchwork finding cuts against it |
| R066 | AL ~1.016M (NPALS 2022) vs SNF ~1.24M (CASPER July 2025); SNF ~20% larger | UNVERIFIABLE at primary tier |
| R067 | The claim is right in order of magnitude, wrong on direction | CONFIRMED-INTERNAL |
| R068 | NIC MAP resident count was paywalled and unobtainable | CONFIRMED-INTERNAL |
| R069 | CLASS was a pure adverse-selection failure, not a funding or political one | OVERSTATED — repeal came in a fiscal-cliff deal; political causation is not excluded by the actuarial record |
| R070 | HHS tried employer auto-enrollment, tiered/phased benefits, and an 80% benefit cutback after 5 years; all left "high uncertainty about long-run solvency" | CONFIRMED at secondary tier |
| R071 | Sebelius, Oct 2011: "I do not see a viable path forward for CLASS implementation" | CONFIRMED at secondary tier |
| R072 | ATRA 2012 simultaneously created a Commission on Long-Term Care | CONFIRMED at statutory tier (Pub. L. 112-240 §643) |
| R073 | CBO independently projected the same structural problem (growing deficits post-2030) | UNVERIFIABLE (cbo.gov blocked) |
| R074 | Texas is one of six states (with FL, IA, OK, OR, SC) that don't screen for eligibility before adding to an interest list | OVERSTATED — KFF's current brief reports eight such states, of which Texas is the one with interest lists only |
| R075 | Texas 2015: 198,538 raw entries → 101,948 unduplicated (~95% inflation) | CONFIRMED at secondary tier |
| R076 | 55,009 people on the Texas list were already receiving other Medicaid LTSS | CONFIRMED at secondary tier |
| R077 | Texas STAR+PLUS HCBS headcount ~15,850 against ~24,000 slots, secondary-aggregator only | CONFIRMED-INTERNAL (self-disclosed gap) |
| R078 | Texas did not report FY2020 LTSS expenditures to CMS's Mathematica rebalancing study | CONFIRMED at secondary tier |
| R079 | Florida was rejected as a case (non-responsive to KFF's 2025 survey); Illinois disqualified (no waitlist) | CORRECTED — KFF's brief records Illinois waiting lists that grew from 14,444 to 15,905 between 2023 and 2024 |
| R080 | ACS 2024 1-year table-based Summary File, B01001, gives population 65+ and 85+ by state | CONFIRMED-INTERNAL (pipeline committed) |
| R081 | Two pipeline bugs caught by inline identity checks, recorded in the incompatibility log | CONFIRMED-INTERNAL |
| R082 | LTSS spending by payer vs utilization by setting was not pulled; needs NHEA + CMS-64 | CONFIRMED-INTERNAL |
| R083 | Re-ranking for full execution: §8 rises, §6/§9 change shape, §5 gets a sharper opening, §11 gains a clean test case, §3 holds | CONFIRMED-INTERNAL |
| R084 | WA Cares payouts are weeks old; any performance analysis works with essentially no outcome data | CONFIRMED |
research/ws02-spending-findings.md (R085–R094)
| # | Claim | Verdict |
|---|---|---|
| R085 | NHEA "nursing care facilities & CCRCs" mixes short-stay Medicare rehab with long-stay Medicaid custodial care | CONFIRMED (KFF describes the same methodology issue) |
| R086 | Medicaid shows as only 30.4% of that NHEA line — an artifact of the mixing | UNVERIFIABLE at primary tier |
| R087 | "home health" mixes skilled Medicare home health with Medicaid personal-care HCBS | CONFIRMED |
| R088 | Medicaid's $253B splits ~47pts HCBS / 14pts institutional | UNVERIFIABLE at primary tier |
| R089 | Up from a 52% split of 29/23 in 2000 | UNVERIFIABLE at primary tier |
| R090 | Urban DYNASIM split: Medicare 9.9%, Medicaid 34.3%, OOP 52.3%, private insurance 2.7% | UNVERIFIABLE at primary tier |
| R091 | A Health Affairs critique found DYNASIM diverges substantially from NHEA accounting for the same period | UNVERIFIABLE at primary tier |
| R092 | DYNASIM is a projection model, not current-spending accounting — treat as a modeling exercise | CONFIRMED-INTERNAL |
| R093 | CBO's 2013 report used a third, broader Medicare-inclusive definition | UNVERIFIABLE (cbo.gov blocked) |
| R094 | Confidence: medium-high on the headline range because "multiple KFF compilations converge" | OVERSTATED — red team #6 already found these share upstream NHEA assumptions; the tier line was not updated |
research/ws03-findings.md (R095–R110)
| # | Claim | Verdict |
|---|---|---|
| R095 | ARPA §9817 was a temporary 10-point FMAP increase earmarked for HCBS | CONFIRMED at agency-primary tier (MACPAC) |
| R096 | Only 5% ($1.7B) targeted waiting-list reduction directly | CONFIRMED (MACPAC Fig. 1: $1.7B) — the fact that most undercuts P064, and it is absent from the public pages |
| R097 | Only three states (CA, NM, TX) specifically targeted that category | CONFIRMED at secondary tier |
| R098 | National median home care worker wage rose $13.07 (2014, infl-adj.) → $16.77 (2024) | UNVERIFIABLE at primary tier |
| R099 | Pennsylvania direct-care turnover held at 44–65%, projected 37,000-worker shortfall by 2026 | UNVERIFIABLE at primary tier |
| R100 | No source tracks hours of care delivered per enrollee comparably across states | CONFIRMED (MACPAC's own measurement-gap finding) |
| R101 | §9817 carried no evaluation requirement; states kept no mandated common baseline | CONFIRMED at agency-primary tier (MACPAC: "Section 9817 did not include a requirement to evaluate") |
| R102 | States running concurrent initiatives "encountered difficulty isolating the impact of each initiative" | CONFIRMED — verbatim in MACPAC |
| R103 | A GSA/American Institutes for Research national evaluation was still pending | CONFIRMED (MACPAC: "A report is anticipated in 2026") |
| R104 | Foreign-born share 28% of the direct-care workforce nationally (PHI, ACS-based, up from 21% in 2011) | UNVERIFIABLE at primary tier |
| R105 | 36.5% for home health aides (MPI/AIC, 2019 ACS), vs 17% for the overall US workforce, 6.9% undocumented | CONFIRMED at secondary tier; STALE as a present-tense claim (2024 base is 19.2%) |
| R106 | ~69–74% of NYC's home health/personal care aide workforce is immigrant; CA health workforce ~35% | UNVERIFIABLE at primary tier |
| R107 | DHS terminated the healthcare "sensitive locations" enforcement exemption (Jan 21, 2025) | UNVERIFIABLE at primary tier |
| R108 | An executive order (Feb 19, 2025) threatens federal payments to sanctuary-facilitating entities | UNVERIFIABLE at primary tier |
| R109 | Justice in Aging's Feb 2026 fact sheet found no documented data on actual staffing disruptions | CONFIRMED-INTERNAL (V5 negative, correctly labelled) |
| R110 | EPI's "400,000 jobs threatened" is a modeled projection, not an observed loss | CONFIRMED-INTERNAL |
research/ws04-insurance-reform-findings.md (R111–R120)
| # | Claim | Verdict |
|---|---|---|
| R111 | The 2015 study was legislature-mandated, by Milliman via DSHS/ALTSA | CONFIRMED at secondary tier |
| R112 | "the original study has not yet been read in this record" | CONFIRMED-INTERNAL — and this pass did not reach it either |
| R113 | The public-benefit option modeled alongside it became WA Cares | CONFIRMED at secondary tier |
| R114 | The adverse-selection bridge is "the researcher's inference," not a Milliman finding | CONFIRMED-INTERNAL |
| R115 | Braun & Kopecky (Cleveland Fed) point to tying private LTC insurance to Medicaid asset-test offsets | UNVERIFIABLE — abstract-level only, self-disclosed |
| R116 | No named federal reinsurance-for-LTC bill or Academy-endorsed reinsurance mechanism was found | UNVERIFIABLE (V5 negative) |
| R117 | The Bipartisan Policy Center proposal leans on auto-enrollment with opt-out, not reinsurance | CONFIRMED at secondary tier |
| R118 | That is equally explained by upfront cost asymmetry as by mechanism efficacy | CONFIRMED-INTERNAL (red team #10) |
| R119 | Scorecard effect: CC 2, IQ/WS 1, CR 1, AA 2 for the private-LTC row | CONFIRMED-INTERNAL — superseded by the pass-3 board |
| R120 | "The result is real but scope-limited negative evidence, not 'tested and rejected'" | CONFIRMED-INTERNAL — contradicts the §4 digest headline at S100 |
research/ws05-findings.md (R121–R128)
| # | Claim | Verdict |
|---|---|---|
| R121 | Header corrected on red-team review from SUPPORTED to CONSISTENT WITH (n=1, correlational, confounded) | CONFIRMED-INTERNAL |
| R122 | Indiana split its Aged & Disabled Waiver in July 2024 into PathWays (60+) and Health & Wellness (under 60) | CONFIRMED at secondary tier |
| R123 | Both new waivers hit approved capacity almost immediately | CONFIRMED at secondary tier |
| R124 | Combined waitlist ≈12,800 (July 2024) → over 17,000 (February 2026) | CONFIRMED at secondary tier — 19 months, not the whitepaper's eighteen (P098) |
| R125 | Confirmed independently by FSSA/DDARS, KFF's national survey, and state-level journalism | CONFIRMED-INTERNAL |
| R126 | Top HCBS-heavy states reach 83.2% | UNVERIFIABLE at primary tier |
| R127 | Indiana's 2024 waiver restructuring may itself be a confounder | CONFIRMED-INTERNAL |
| R128 | Meta-finding: states useful for testing H5.1 tend to be those with poor spending data — flagged as speculation | CONFIRMED-INTERNAL |
research/ws06-09-findings.md (R129–R145)
| # | Claim | Verdict |
|---|---|---|
| R129 | 38 states + DC had standards exceeding "the old, pre-2024 federal floor (0.3 HPRD)" | CORRECTED — 42 CFR 483.35 contains no numeric HPRD floor, before or after the repeal; the restored text requires "sufficient" staff plus an RN 8 consecutive hours/day, 7 days/week |
| R130 | California 3.5, New York 3.5, DC 4.1 (highest), Florida 3.6, Arkansas 3.36 HPRD | UNVERIFIABLE at primary tier (secondary aggregator; deviations #11 discloses this) |
| R131 | New York's 2021 law requires 40% of revenue go to resident-facing staffing | UNVERIFIABLE at primary tier |
| R132 | 29 states require under 3.5 HPRD, 15 under 2.5 | UNVERIFIABLE at primary tier — and the counterweight the public pages omit (see P108/P114) |
| R133 | "state law is a genuinely uneven patchwork, not a uniform substitute for the dead federal floor" | CONFIRMED-INTERNAL — omitted from both public pages |
| R134 | No state staffing mandate has been struck down or repealed | UNVERIFIABLE (V5 negative) |
| R135 | A fourth industry lawsuit targeting NY's funding/staffing provisions is ongoing; $2,000/day fines recently reaching ~20 facilities | UNVERIFIABLE at primary tier |
| R136 | No state legislation specifically reacting to the 2026 rescission is yet visible; a ~6-month window is too short to read as declining to respond | CONFIRMED-INTERNAL (red team #12) |
| R137 | Federal replacement bills S.3886 and H.R.8100 have not passed | UNVERIFIABLE at primary tier |
| R138 | Health Affairs panel: 2010–2023, mandates raised staffing ~5% (CNAs +5.7%, LPNs +7.5%, no RN change) | CONFIRMED at author-institution tier; the publication year is 2026, not 2025 (see S114) |
| R139 | Labor costs rose less than revenue; margins statistically unchanged; no closure effect | CONFIRMED at author-institution tier (+273Klaborvs+546K net patient revenue) |
| R140 | Scoped to mandates studied (up to ~4.1 HPRD), not to ratio mandates in general | CONFIRMED-INTERNAL (red team #13) |
| R141 | The IV estimate is "notably larger than the naive OLS estimate (+10%)" | CORRECTED — the OLS effect is 0.3 pp, "about 2% of the mean"; the direction holds, the magnitude does not |
| R142 | The authors' interpretation is that correlation understates the effect because PE homes selectively admit healthier patients | CONFIRMED — verbatim in the paper |
| R143 | Also +19% billed spending, ~50% higher antipsychotic use | CORRECTED — IV spending effects are +8% (per stay) and +6% (stay + 90 days); the paper reports no antipsychotic result at all |
| R144 | A JAMA COVID-era comparison prevents a claim that the evidence is uncontested | CONFIRMED-INTERNAL |
| R145 | PE-ownership disclosure/oversight is a candidate architecture independent of the staffing-ratio question | CONFIRMED-INTERNAL — never added to the board (re-score log records the same gap) |
research/ws07-findings.md (R146–R155)
| # | Claim | Verdict |
|---|---|---|
| R146 | GAO-18-179: only 22 of 48 studied states could report critical-incident counts | CONFIRMED (GAO: "Twenty-six state Medicaid agencies could not report…") |
| R147 | Incident types covered: abuse, neglect, medication errors, unexplained deaths | CONFIRMED (GAO highlights name the same categories) |
| R148 | Only 34 of 48 made any incident data public | CONFIRMED — verbatim in GAO |
| R149 | GAO-26-107884 (2026) "confirms the gap persists" | CORRECTED — the 2026 report is Assisted Living Facilities: Information on Federal Spending and Medicaid Coverage (June 2, 2026) and makes no incident-reporting finding |
| R150 | Medicare+Medicaid spent at least $12B on AL services in 2024, "likely an undercount" | CONFIRMED — verbatim in GAO ($3.5B Medicaid + $8.5B traditional Medicare) |
| R151 | CMS finalised a rule (May 2024) requiring annual state critical-incident reporting, effective 2027 at the earliest | CONFIRMED at secondary tier |
| R152 | Washington Post: 2,000+ elopement incidents since 2018, ~100 deaths | UNVERIFIABLE — paywalled, secondhand, self-disclosed |
| R153 | No rigorous state-by-state AL-vs-SNF per-resident incident-rate comparison exists | CONFIRMED-INTERNAL (V5 negative, correctly labelled) |
| R154 | Sources disagree on Medicaid AL-waiver state count (41–46) — a measurement-consistency issue, not a conflict | CONFIRMED-INTERNAL |
| R155 | NCAL/AHCA: ~18–20% of AL residents Medicaid-supported, services only, never room-and-board | UNVERIFIABLE at primary tier |
research/ws08-findings.md (R156–R170)
| # | Claim | Verdict |
|---|---|---|
| R156 | Cash & Counseling ran 1998–2003 in AR/FL/NJ, RWJF/ASPE-funded, Mathematica-evaluated | CONFIRMED (ASPE hosts the evaluation reports) |
| R157 | Satisfaction: AR 60.8% vs 42.7% "very satisfied" | UNVERIFIABLE at primary tier this pass |
| R158 | Treatment caregivers reported less physical strain and better self-rated health across all three states | CONFIRMED at secondary tier |
| R159 | Control-group members frequently didn't receive services they were authorized for | CONFIRMED at secondary tier |
| R160 | Costs higher in year 1 in most states (AR elderly +17%, FL nonelderly +14%, both significant) | UNVERIFIABLE at primary tier |
| R161 | Narrowing to non-significant in Arkansas by year 2 but persisting in FL/NJ | UNVERIFIABLE at primary tier |
| R162 | Self-direction is available in all 50 states + DC via 1915(c)/(i)/(j)/(k) and 1115 | CONFIRMED at statutory tier for the authorities; state coverage UNVERIFIABLE |
| R163 | ~1.5M people self-directed Medicaid HCBS in 2023 | UNVERIFIABLE at primary tier |
| R164 | Usage among 65+ dual-eligibles ranges 0.1% to 99.6% by state | UNVERIFIABLE at primary tier |
| R165 | The self-direction/agency-workforce interaction is explicitly untested (PMC12605748) | CONFIRMED-INTERNAL |
| R166 | Credit for Caring reintroduced as S.925 / H.R.2036 (March 2025, bipartisan) | UNVERIFIABLE at primary tier |
| R167 | Parameters: nonrefundable, 30% of expenses above a $2,000 floor, capped $5,000; earned-income floor $7,500; phase-out above 75K/150K MAGI | UNVERIFIABLE at primary tier |
| R168 | No CBO/JCT score exists; JCT typically scores only at markup | CONFIRMED-INTERNAL (V5 negative, correctly labelled as a finding) |
| R169 | MetLife 2011 lifetime cost: $324,044 (women), $283,716 (men) — dated, no successor found | CONFIRMED-INTERNAL as dated; figures UNVERIFIABLE at primary tier |
| R170 | BRFSS 2021: 19.6% vs 12.9% poor mental health, plus elevated depression, obesity, smoking | UNVERIFIABLE at primary tier (cdc.gov 403 to every method tried) |
research/ws10-international-findings.md (R171–R186)
| # | Claim | Verdict |
|---|---|---|
| R171 | Germany: payroll social insurance, 3.6% of wages (4.2% childless 23+), ~2.5% of GDP | UNVERIFIABLE at primary tier |
| R172 | By design covers only about half of actual LTC cost — a partial-insurance model | CONFIRMED at peer-reviewed tier (NBER w31870: privately financed share ~60% including informal care) |
| R173 | German contribution rate rose again for 2025; federal loans needed to hold 2026 rates steady | UNVERIFIABLE — sourced to a German consumer-finance blog |
| R174 | German direct-care vacancies rose 110% in a decade against 45% demand growth and 13% workforce growth, attributed to "NBER/Geyer" | CORRECTED (citation) — NBER w31870 (Long-term Care in Germany, Nov 2023) contains no vacancy, demand-growth, or workforce-growth series; its only 13% is the 2021 foreign-national share of the LTC workforce |
| R175 | Most transferable German piece is the partial-coverage design itself | CONFIRMED-INTERNAL |
| R176 | Japan: 50% enrollee premiums (age 40+) + 50% general revenue, ~1.8% of GDP, in-kind benefits only | UNVERIFIABLE at primary tier |
| R177 | The favorable "Japan succeeded" narrative clusters around Campbell, Ikegami and Gibson | CONFIRMED-INTERNAL, with completeness disclaimed (red team #20) |
| R178 | Geyer (PMC7054649) argues cross-country LTC comparisons are undermined by definitional heterogeneity and excluded informal-care costs | CONFIRMED-INTERNAL — recorded as the critique's claim, not adopted |
| R179 | Japan projects a 570,000-worker shortfall by 2040 at flat service levels | UNVERIFIABLE at primary tier (MHLW not reached) |
| R180 | Copay increases toward 30% "are already being proposed" | CONFIRMED-INTERNAL — and the correct wording the whitepaper overstates (P161) |
| R181 | Transferable Japanese fragment is the age-40 pre-funding logic | CONFIRMED-INTERNAL |
| R182 | Netherlands: flat 9.65% income-related contribution; Wlz funds the most severe/institutional cases after 2015 | UNVERIFIABLE at primary tier |
| R183 | Highest LTC spend in the OECD (4.4% of GDP, 2021, projected toward 6% by 2070) | UNVERIFIABLE at primary tier |
| R184 | Municipalities and insurers benefit from pushing people into the nationally-funded Wlz | CONFIRMED at peer-reviewed tier (PMC11984009 cited) |
| R185 | Dutch workforce shortage projected at 266,000 by 2035 (already 44,000 short) | UNVERIFIABLE at primary tier |
| R186 | No non-strained counterexample was sought in this pass | CONFIRMED-INTERNAL (red team #21) |
research/ws11-scorecard.md (R187–R204)
| # | Claim | Verdict |
|---|---|---|
| R187 | Three scoring passes, not one; pass 2 was instruction-blinded with filesystem access throughout | CONFIRMED-INTERNAL |
| R188 | 25 of 40 ranked cells moved; the blind scorer differed on 26; one kept as a logged judgment split | CONFIRMED-INTERNAL |
| R189 | Anchored scale as authored (passes 1–2), preserved alongside the amendment | CONFIRMED-INTERNAL |
| R190 | Anchor 3 widened to cover "no evidence either way"; anchor 1 narrowed to require documented adverse effect | CONFIRMED-INTERNAL |
| R191 | The original scale is asymmetric: 4 and 5 require evidence, 1 and 2 accept its absence | CONFIRMED-INTERNAL |
| R192 | The same defect the housing re-score named on 2026-08-06 | CONFIRMED-INTERNAL |
| R193 | ~two thirds of pass 3's corrected cells are below-neutral unevidenced cells returning to neutral | CONFIRMED-INTERNAL (20 of 25 = 80%; "two thirds" understates) |
| R194 | Federal LTC insurance basis: German vacancies 110% against 13% workforce growth | CORRECTED (citation) — see R174 |
| R195 | Federal AL standards basis: "GAO-18-179 and GAO-26-107884 document a persistent government-verified incident-reporting gap" | CORRECTED — see R149 |
| R196 | Federal AL standards basis: ~10-year congressional moratorium | CORRECTED — see R046 |
| R197 | OAA/NFCSP row is now entirely unevidenced; CR held at 3 by both scorers independently | CONFIRMED-INTERNAL |
| R198 | Rankings under three weightings (corrected scale) | CONFIRMED-INTERNAL — all 24 sums independently recomputed and reproduce exactly |
| R199 | Sensitivity under the original scale: private LTC reform still last; HCBS de-capping leads WS and CC; C&C leads CR; wage floor leads nothing | CONFIRMED-INTERNAL — all 24 sums independently recomputed and reproduce exactly |
| R200 | "Do not cite a ranking from this file without also citing which scale it came from" | CONFIRMED-INTERNAL |
| R201 | The private-LTC row scored 2/1/1/1/2 with exactly one evidenced cell | CONFIRMED-INTERNAL |
| R202 | "Cash & Counseling ties or trails nationalized WA Cares insurance and the wage floor" is withdrawn | CONFIRMED-INTERNAL |
| R203 | Federal LTC social insurance now ranks last under all three weightings, on evidence | CONFIRMED-INTERNAL — but its two "evidenced" cells rest on R173/R174 |
| R204 | A three-way tie at 21 under every weighting between wage floor, OAA/NFCSP and unstructured cash | CONFIRMED-INTERNAL |
research/ws11-rescore-log.md and ws11-blind-scores-2026-08-10.md (R205–R226)
| # | Claim | Verdict |
|---|---|---|
| R205 | Structural blinding via scripts/batch-rescore.py: one tool-less request, evidence inlined |
CONFIRMED-INTERNAL |
| R206 | Supersedes the 2026-08-03 pass-2 re-score as the filing's independence claim | CONFIRMED-INTERNAL |
| R207 | Elder care was excluded from the 2026-08-06 cross-filing pass at commit 40b7372 |
CONFIRMED-INTERNAL |
| R208 | Section A: five corrections that hold regardless of the scale change | CONFIRMED-INTERNAL |
| R209 | A2 HCBS-WS 2→4 on ws13's BIP stacked DID (+13.24% HCBS workforce, no institutional offset) | CONFIRMED at peer-reviewed tier (PMID 40845205 cited) |
| R210 | A7 AL-WS 3→4 on the Health Affairs panel; pass 2 stopped one step short | CONFIRMED-INTERNAL |
| R211 | A7 AL-IQ 2→3 as an evidenced wash under the published anchor 3 | CONFIRMED-INTERNAL |
| R212 | A1 CR and AA 4→3; under the published scale they would fall to 2 | CONFIRMED-INTERNAL |
| R213 | "These two above-neutral cells are the only unevidenced cells the published board scored up" | CONFIRMED-INTERNAL |
| R214 | Section B: exactly twenty below-neutral unevidenced cells returned to neutral | CONFIRMED-INTERNAL (counted: 20) |
| R215 | "Not one was corrected because new evidence arrived" | CONFIRMED-INTERNAL |
| R216 | Section C: five cells where reasoning was replaced and the score held | CONFIRMED-INTERNAL |
| R217 | A3 WS=3's published basis wrongly used the Health Affairs staffing-mandate panel; moved to A7 | CONFIRMED-INTERNAL |
| R218 | A4 C&C-CC kept at 1; the blind scorer called it "my most aggressive score" | CONFIRMED-INTERNAL |
| R219 | Section D: A4 AA judgment split kept at 4 against a blind 5 | CONFIRMED-INTERNAL |
| R220 | Section E: fourteen cells matched outright, enumerated | CONFIRMED-INTERNAL (counted: 14; 26 + 14 = 40) |
| R221 | The PE-mortality finding attaches to no row; blind scorer: "if PE oversight were row A11, it would be the only row with a 5 on IQ" | CONFIRMED-INTERNAL |
| R222 | PACE blind row corroborated ws12 on 4 of 5 cells; IQ contested downward 4→3 | CONFIRMED-INTERNAL |
| R223 | Credit for Caring has a full blind row (3/3/3/2/3) that is not entered | CONFIRMED-INTERNAL |
| R224 | Three passages leaking prior cell values were redacted, each with a visible marker | CONFIRMED-INTERNAL |
| R225 | Residual un-redacted risks itemised (dangling links; ws13's directional phrasing) | CONFIRMED-INTERNAL |
| R226 | "This is a re-score, not a fact-check … Whether the underlying findings are true is Phase 1" | CONFIRMED-INTERNAL — this pass is that Phase 1, and it found the underlying findings are not uniformly true |
research/ws12-pace-sequencing.md (R227–R246)
| # | Claim | Verdict |
|---|---|---|
| R227 | PACE is a Medicare program and Medicaid state-plan option for adults meeting the state NH level-of-care standard | CONFIRMED at agency tier (CMS) |
| R228 | The organization accepts prospective Medicare and Medicaid capitation and must provide the full covered-service package | CONFIRMED at agency tier |
| R229 | CMS requires services at a PACE center, the home, and inpatient facilities; new organizations face federal application and state-readiness review | CONFIRMED at agency tier |
| R230 | CMS's PACE manual specifies eleven interdisciplinary-team roles | CONFIRMED at agency tier (manual cited with page numbers) |
| R231 | Expanding PACE creates demand for the same direct-care labor the filing has not shown can expand | CONFIRMED-INTERNAL — labelled a design fact, not a scalability claim |
| R232 | CMS/Abt evaluation: lower hospital admissions and fewer NH days at six months, more community days, higher initial life satisfaction | CONFIRMED at agency tier (report cited with page numbers) |
| R233 | Differences narrowed at later follow-up; the report flags selection bias and small late samples | CONFIRMED at agency tier |
| R234 | 2024 JAMA Health Forum systematic review: PACE subset found reduced long-term NH stays in three of four studies | CONFIRMED at peer-reviewed tier (PMID 39028653) |
| R235 | ASPE/Mathematica matched evaluation (8 states, 2006–2008 enrollees, followed to 2011): Medicaid capitation exceeded predicted Medicaid spending in every reported interval | CONFIRMED at agency tier |
| R236 | ASPE's literature review reached the same guarded bottom line; the two are not independent | CONFIRMED-INTERNAL |
| R237 | CMS July 2026 directory: 206 active National PACE contracts | CONFIRMED-INTERNAL (extraction method published and reproducible) |
| R238 | 201 report visible enrollment totaling 79,758; five blank because CMS masks values ≤10 | CONFIRMED-INTERNAL (deviations #27 records the correction) |
| R239 | Contract mailing addresses fall in 34 states; address state ≠ service-area state | CONFIRMED-INTERNAL |
| R240 | 52 listed contracts became effective 2024–2026 (eight in 2026); this does not measure net growth | CONFIRMED-INTERNAL |
| R241 | "historically hard to scale" remains NOT MEASURED as a causal claim; retire the shorthand | CONFIRMED-INTERNAL |
| R242 | Provisional PACE row: CC 2, IQ 4, WS 3, CR 3, AA 4 — not entered | CONFIRMED-INTERNAL |
| R243 | Sequencing: build the workforce before treating PACE as capacity expansion | CONFIRMED-INTERNAL |
| R244 | Sequencing: do not sell PACE as a cost-containment first move | CONFIRMED-INTERNAL |
| R245 | Four prospective M3 criteria, all returning Indeterminate on the 2026-08-06 follow-up | CONFIRMED-INTERNAL |
| R246 | The protocol's prior order (workforce first, HCBS de-capping second, caregiver payment last) "remains directionally sound" | OVERSTATED — the pass-3 board withdraws the scorecard's support for it under both scale readings; ws12 was not updated |
research/ws13-rebalancing-evidence.md (R247–R253)
| # | Claim | Verdict |
|---|---|---|
| R247 | 2026 Health Services Research stacked DID (ACS 2005–21): BIP adoption raised HCBS workforce 13.24%, no significant institutional-workforce effect | CONFIRMED at peer-reviewed tier (PMID 40845205) |
| R248 | 2025 BMJ Open generalized DID: ~5 pp fewer long NH stays for Medicaid beneficiaries living alone in BIP completer states | CONFIRMED at peer-reviewed tier (DOI cited) |
| R249 | HRS does not directly observe HCBS use; concurrent MLTSS adoption remains a confound | CONFIRMED-INTERNAL |
| R250 | 2025 state-year study found no significant wage association with HCBS spending | CONFIRMED at peer-reviewed tier (PMID 39425476) |
| R251 | 2023 DID: each added HCBS dollar associated with $0.74 of added total LTSS spending; the self-financing claim is not supported | CONFIRMED at peer-reviewed tier (PMID 37326313) |
| R252 | 2026 IV/border study: HCBS use reduced Medicare community-initiated home-health use by 1.02 pp — substitution, not total savings | CONFIRMED at peer-reviewed tier (PMID 41919377) |
| R253 | MACPAC's 2025 rate-setting review: states use inconsistent compensation inputs; no public wage series is required | CONFIRMED at agency tier |
research/deviations-log.md, red-team-log.md, baseline/ (R254–R264)
| # | Claim | Verdict |
|---|---|---|
| R254 | Deviations log freeze point: research-inquiry.md as committed at 3d1785b (2026-08-03) |
CONFIRMED-INTERNAL |
| R255 | 31 numbered deviation entries | CONFIRMED-INTERNAL (counted) |
| R256 | Deviation #2: the moratorium end-year is unreconciled between CMS (2035) and a law-firm summary (2034) | CORRECTED — resolved at statutory and agency-primary tier as 2034 |
| R257 | Deviation #19: red-team corrections were not line-edited into six findings files | CONFIRMED-INTERNAL |
| R258 | Deviation #23: that line-edit pass was completed 2026-08-06 | OVERSTATED — ws02's confidence tier (R094) and ws04's §4 headline (S100/R120) still read pre-red-team |
| R259 | Deviation #30: the blind matrix differed on 26 of 40; 25 corrected, 1 judgment split; 14 matched | CONFIRMED-INTERNAL |
| R260 | Deviation #31: three redactions, each left a visible marker; PACE scored from an evidence-only extract | CONFIRMED-INTERNAL |
| R261 | Red-team log: 22 attacks, 4 "partially lands", 2 "answered, no change", 1 "answered, minor addition", rest absorbed | CONFIRMED-INTERNAL |
| R262 | Baseline incompatibility #1: ACS .dat estimate E_n sits at field 2n-1; the off-by-one pulled the MOE jam value -555555555 |
CONFIRMED-INTERNAL |
| R263 | Baseline incompatibility #2: a SUMLEVEL-only join admitted ~550 extra geographies (603 vs the correct 53) |
CONFIRMED-INTERNAL |
| R264 | Baseline population pipeline (ACS 2024 1-year SF, B01001) is committed and auditable | CONFIRMED-INTERNAL |
Record coverage: 264 extracted · 264 verdicts · 0 unaddressed.