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Effective April 1, 2026, updates are being made to the Long-Term Care Personal Worksheet for all states except California and Florida. The only change to the worksheet is an update to the Rate Increase History Grid. These updates apply to both paper and electronic applications.
ICC23-470484_2026 (replaces ICC23-470484)
AL, AK, AR, CO, GA, ID, IL, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NM, NC, OH, OK, OR, PA, PR*, RI, TN, TX, UT, VT, VA, WA, WV, WI, WISE*, WY
ICC23-470484_SPPR_2026 (replaces ICC23-470484_SPPR)
PR Spanish*
470484_2026 (replaces 470484)
AZ, CT, DE, DC, HI, IN, MT, NJ, NY, ND, SD
470484_SC_2026 (replaces 470484_SC)
SC
The LTC Personal Worksheet cannot be ordered as a standalone form and is included within the LTC application packet. Application packet covers will be updated to show “_2026” instead of “_2025” (except CA and FL).
Forms recently replaced will no longer be accepted after April 30, 2026.
To read the full express report, click here.