"I find myself in a very conflicted position. I am 62 years old. I am a politically conservative person who has long believed that entitlement programs were a big part of this country's problems, and that Medicaid especially is responsible for creating a dependency on the government. Here's my situation: My 91 year old mother has depleted the savings that she and my dad worked to build, paying for care over the past five years. In five years, we have paid almost $400,000 between full-time sitters or nursing home care. Now she's out of money and the nursing home staff is telling me to apply for Medicaid for her. I could bring her home, but that would mean either me or my wife would have to quit our jobs or cut back on hours, and neither option is a good one. I can't afford to pay for her care out of my own pocket without severely impacting my own retirement, yet that's always been my belief - that families should take care of their own and not depend on the government. I'm in a real quandary as this goes directly against my beliefs, but I don't know what to do. I am an only child so there is no other family who can help."

Bill T.

First, you have my deepest respect for honestly confronting this clash of values that you have described. My personal opinion is that there may not be such a collision of values as you think. You seem to have taken personal responsibility for the care of your aging mother for the past five years, ensuring that the savings that your parents worked hard to accumulate have been used for her care in the best way possible. The fact that you feel conflicted about filing for Medicaid sounds less like a political view than a desire to continue that responsibility. You are certainly not alone as more aging parents from all political persuasions will likely need Medicaid’s assistance, and I want to gently challenge your belief that such programs only perpetuate government dependency.  

Medicaid's Founding and Purpose

Medicaid was established in 1965 as part of the Social Security Act, with the purpose of providing health coverage to low-income individuals and families. Initially targeted at families receiving cash assistance, the program has since expanded to cover a broader population, including pregnant women, children, elderly adults, and individuals with disabilities. As of 2023, Medicaid covers over 83 million Americans, making it the largest source of health coverage in the United States. Medicaid is jointly funded by the federal and state governments, with total spending exceeding $600 billion annually. The program plays a crucial role in ensuring access to healthcare for millions of Americans who might otherwise be unable to afford it. 

Criticisms of Medicaid

However, the cost and expansion of Medicaid have raised concerns among political conservatives. They argue that the rising expenditures place a significant burden on federal and state budgets, potentially diverting funds from other essential services. Additionally, some conservatives believe that the expansion of Medicaid encourages dependency on government assistance rather than promoting self-sufficiency.  

Furthermore, well-documented cases of Medicaid fraud and abuse have contributed to a negative perception of Medicaid among many, but especially among more conservative Americans.

Reconsider Your Conflict

When people with conservative beliefs about personal responsibility face the need for help, such as caring for an aging parent without savings, they may encounter a conflict. Their value of financial independence clashes with the necessity to use government programs like Medicaid, which they previously saw as fostering dependency.  

But is this really a moral and ideological dilemma that forces you to reconsider your beliefs in the light of your responsibilities and the stark financial realities you are confronting? The prevailing theme expressed by your beliefs seems to be taking responsibility, and you could consider that getting Medicaid support for your mother during what is likely the last remaining years of her life IS taking responsibility.   

Applying for Medicaid does not negate the commitment to caring for your aging mother. Instead, it acknowledges the practical realities of the high costs associated with long-term care. By securing financial assistance, you are ensuring that your mother receives the best possible care, which is a responsible and loving act. Rather than creating dependency and irresponsibility in you, here are three things getting Medicaid for your mother would allow you to do.

  1. Maintain Active Involvement: Even with Medicaid support, you can remain actively involved in your mother’s care. Regular visits, advocating for her needs, and staying informed about her health and well-being demonstrate your ongoing commitment and responsibility. 
  2. Focus on Quality of Life: By alleviating the financial burden through Medicaid, you can focus more on enhancing your mother’s quality of life. This might include spending more meaningful time with her, engaging in activities she enjoys, and ensuring she feels loved and supported. 
  3. Preserve Financial Stability: Seeking Medicaid assistance can help preserve your financial stability, allowing you to continue fulfilling other responsibilities and maintaining your independence. This approach ensures that you can care for your mother without compromising your own well-being and future. 

So let yourself off the hook. You haven’t compromised your values, but perhaps you can see others in a more compassionate way. How many other Medicaid recipients value personal responsibility, but circumstances gave them few options but to accept the safety net that Medicaid offers? It’s ok to support Medicaid reform in order to make it more fiscally sound and free from fraud and abuse while also acknowledging its value to those who need it most.