Helping Families Navigate the Financial Challenges of Age Transitions

Tag: medicaid

When political values collide with Mom’s Need for Care: One Reader’s Crisis of Conscience. 

"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."

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. 

Free Lunch and ‘Free’ Care Likely Too Good to be True!

I take care of my 88 year old mother. Last month I attended a free lunch seminar offered by a company I'd never heard of, about Medicaid planning. It sounded like they could make arrangements so that all of mom's assets would be protected for me and my brother, and that Medicaid would pay for all of her nursing home expenses should we decide to move her to one. It sounded too good to be true. The company is not a law firm but they said they had lawyers working for them. They charge $5,000 to file all the paperwork for Mom to get qualified. Is this a fair price to pay and should I even get Mom on Medicaid?

There’s an old saying that if you take your problem to a carpenter whose only tool is a hammer, don’t be surprised if the solution requires a nail. As the caregiver for your 88-year-old mother, it’s completely understandable that you’re seeking the best options to protect her assets while also considering her healthcare needs. Unfortunately, some believe there is only one solution to the problem of paying for care. The situation becomes more complex, especially with the maze of options surrounding Medicaid and long-term care.

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Four Ways to Pay for Long Term Care with Home Equity

My wife and I are in our mid-seventies and concerned with how we will pay for care as we age. We do not have long term care insurance and likely could not qualify due to health reasons. We own our $700,000 home debt-free but have modest liquid assets. Can we use our home equity to pay for care without having to sell it or go into debt? We would like to stay in our home as long as possible.

As we age, the need for long-term care becomes a critical consideration for many families. For older adults who have not purchased long-term care insurance or do not have sufficient liquid assets to cover extensive care costs, their primary asset—the family home—often becomes a focal point for financial planning. Many individuals feel that their home is the one asset they’ll be able to leave to family members. However, most polls show that children don’t really want mom and dad’s home. Inheriting the home also means inheriting taxes, maintenance, insurance, and squabbles over division. Most homes are sold at a discount with the cash divided among heirs.

It makes sense then that the home should be an available resource for long term care expenses. Your wishes to stay in your home as you age and move from independence to dependence is also typical. Most people would prefer to “age in place.”

Let’s look at four less-traditional ways to use your home equity to pay for long-term care.

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Too much trustee discretion prevents elderly beneficiary from Medicaid eligibility.

A New York Appeals court recently affirmed the State’s Medicaid division’s decision to deny Medicaid eligibility to the beneficiary of a trust, arguing that the trust gave the trustee too much discretionary authority. The case underscores the need to have an experienced attorney familiar with local Medicaid rules, draft trust documents where protecting Medicaid eligibility is a major concern.

In this instance, the applicant’s son was trustee of a living trust established for the benefit of the applicant. As trustee, the son took out a home equity loan using trust assets as collateral, and used the loan proceeds to pay for his father’s living and caregiving expenses. Once the trust assets were depleted, the father applied for Medicaid benefits but was denied because the State ruled that the trust assets were available to the applicant, and imposed the required “look-back rule” in denying eligibility.

In upholding the State’s determination, the Appeals Court stated:

Because the trust instrument gave the trustees broad discretion in the distribution of the trust principal, including for petitioner’s benefit, the agency did not err in concluding that the principal is an available resource for purposes of petitioner’s Medicaid eligibility determination

For the full text of the ruling, click here.

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