The Minnesota Cognitive Acuity Screen (MCAS) and LTCI

What do Coca Cola’s secret recipe, Colonel Sander’s 11 herbs and spices, and the Minnesota Cognitive Acuity Screen have in common?  Each has propelled its company to a position of industry dominance by virtue of a fiercely-protected patent.  The business of geriatric medicine has employed a battery of nearly 40 similar tests, where the quality of a cognitive screen can mean the difference between policy acceptance or denial, an insurer losing multimillion dollar bets, and of personalized treatment plans horribly miscalculated.

So imagine the LTCI industry’s readiness to adopt a screen that could deliver on this promise: “98.1% effectiveness in determining the presence or absence of mild to moderate cognitive impairment”.  That day occurred in the Summer of 2000, when the MCAS debuted.  A product developed and patented by Nation’s CareLink (today known as Univita), the Minnesota Cognitive Acuity Screen has been licensed for use by more than 33 LTCI insurers since its debut, and administered nearly 1/2 million times.

Agents find it difficult, if not impossible, to get their hands on the actual test questions or answer key questions.  Without too much sleuthing we find the Minnesota Cognitive Acuity Screen takes 15 – 20 minutes either in person or over the phone, and focuses on 9 key areas (Orientation, Attention, Delayed Word Recall, Comprehension, Repetition, Naming, Computation, Judgment, and Verbal Fluency).  Among the strengths of the MCAS are its speed of administration, sensitivity to even the earliest signs of mild impairment, and its ability to discern between the various sub-types of non-Alzheimer’s dementias which may comprise 20 – 25% of all cognitive impairments.

Surprisingly, the Alzheimer’s Association itself gives the MCAS only a lukewarm endorsement.  To understand the criticism, one must understand the critic: advocacy groups and researchers are most concerned with diagnosis, mitigation, and cure.  Underwriters and insurers are pre-occupied with risk assessment.  From these perspectives, each stakeholder views the Minnesota Cognitive Acuity Screen a bit differently.

Wary of home-testing in general, the Alzheimer’s Association labels the MCAS a “commercial” rather than “clinical” application, and seems equally leery over the maker’s recommendation for an annual re-test (at $95/each), when there is no scientific basis given for this claim.  On the other hand, with 40 other cognitive screens to choose from, the market seems to have settled the debate over the ubiquitous Minnesota Cognitive Acuity Screen to the satisfaction of the insurers, who have everything to lose by choosing this product.  Cognitive claims are among the industry’s lengthiest and most ruinous, so any underwriting tool which can successfully shape the risk pool, continually prove itself in the field, let alone pay for itself, will survive.

I’ve tried Coke, and Kentucky Fried Chicken, but it’s tempting to wonder how one might perform if given the chance to audit the MCAS?  Some producers have been old enough when they applied for their own LTCI that they can share their experiences.

In my case, I just had to be in the wrong place at the right time.

It was a foggy, cool Saturday afternoon, and I had the occasion to set-up a doctor’s appointment outside of normal business hours.  I pulled into the parking lot of the building and was immediately met by a flannel-clad fellow standing beside his beaten red pickup truck.  In one hand he held a cigarette, in the other the reins of two adorable chihuahuas.  Before I entered the building, I stopped to pet the shivering dogs and struck-up a light conversation with the guy.  Turns out he was trying to get them to gobble their medicine out of the bowls sitting on the pavement: I shared that I’m having the same problem with a cat of ours.  I say goodbye and run up the stairs into the building, where I’m forced to wait in a common area until my appointment begins.

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Stephen D. Forman

About Stephen D. Forman

A pioneer and leader in LTC insurance since 1974, LTCA has distinguished itself as one of the country's leading voices on this specialized topic. As Senior Vice-President, Stephen D. Forman has dedicated nearly two decades to this field, and is frequently sought for his expertise, appearing in such publications as "Kiplinger's Personal Finance", "Agents Sales Journal", and in the Congressional Research Service's confidential report to Congress on the CLASS Act. He can be reached at 800.742.9444 or

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