Everything that is wrong with LTC services and financing today has its roots in well-intentioned public policy decisions made many years ago that went terribly awry.
It started with the addition of Medicaid to the Social Security Act in 1965. The Act authorized Medicaid to provide LTC to individuals “whose income and resources are insufficient to meet the costs of necessary medical services … .”
This open-ended mandate to fund LTC for everyone who cannot afford it set the stage for everything that followed in six critical policy areas.
Policy area #1: Eligibility
Under the law everyone who cannot afford LTC would be eligible for Medicaid. But what does it mean to be unable to afford LTC? Objective criteria were needed. A reasonable principle would have been “help the neediest first.”
Instead, Medicaid financial eligibility rules allow high-income people to qualify if their private medical or LTC expenses are commensurately high as they usually are for elders in need of high-cost LTC. High-asset people also qualify if they hold their wealth in exempt forms, such as home equity, a business, a vehicle, an IRA in payout status, prepaid burial expenses, etc. Countable assets are easily sheltered by using them to purchase exempt resources.
The full article can be found in McKnight’s Long-Term Care News.
