Medicaid was actually something of an afterthought in the 1965 Medicare legislation. As Moore and Smith write, “There was so little comment that Medicaid did, indeed, seem like a casual add-on. A legislative draftsman said that he could scarcely recall working on Medicaid.” Since retirees receiving Social Security were covered by Medicare, Medicaid originally benefited only recipients of Aid to Families with Dependent Children, AFDC, the program generally known at that time as “welfare,” and the smaller categories of recipients of aid for the blind and disabled.
Although state participation in Medicaid was voluntary, the federal match was sufficiently generous, particularly for the less affluent states, that uptake of Medicaid happened fairly quickly. By 1970, 48 states plus the District of Columbia had established programs. (Alaska held out until 1972, and Arizona till 1982.)
The legislation required that states cover hospital services (except for mental health or tuberculosis, for some reason); physician services; X-rays and laboratory services; and skilled nursing home services for people over 21. However, it did not require coverage for medications; dental, hearing or vision services; or prostheses. States could choose whether to cover any of these, and also set income eligibility standards for AFDC, and hence Medicaid. This meant that the scope of coverage and generosity of the programs varied wildly from state to state, but in general, only people with very low incomes were eligible. This actually created a problem for people with disabilities, who couldn't accept employment without losing their Medicaid eligibility.
Little noticed in 1965 was the option for states to cover “medically indigent” people including not only beneficiaries of AFDC and disability, but also people over 65. "Medically indigent means that people's incomes aren't low enough to qualify for Medicaid ordinarily, but they have unaffordable medical expenses. As all people over age 65 were now to be covered by Medicare, perhaps it did not occur to people that this provision would be important. However, as people tended to live longer past age 65, and to develop costlier medical needs, including notably long-term care that Medicare does not pay for, states increasingly were compelled to provide Medicaid to Medicare beneficiaries with unaffordable medical and long-term care costs.
This “dual eligible” population now accounts for 19% of Medicare beneficiaries and 14% of Medicaid beneficiaries, but 30% of Medicaid spending. The median cost of a nursing home stay is about $8,000 per month nationally but in Connecticut, where my mother is currently in long-term care, it’s more than $13,000. As you can see very few retirees have incomes approaching this amount, and that is why they account for such a disproportionate amount of Medicaid spending.
However, the state takes as much as it can get from them. People who have savings don’t become “medically indigent” and eligible for Medicaid until they first spend nearly all of their savings on medical or supportive services they need. If they have a house or a car they can keep them as long as they’re alive, but they have to get rid of nearly all of their financial assets. (In Connecticut right now they can keep $1,600.) When my mother went into a nursing home, since my father was dead and none of her children wanted to live in the house, we sold it rather than pay taxes and maintenance. Actually we had to sell it anyway since she had a reverse mortgage and didn’t live there any more. But we were required to send the proceeds to the nursing home operator until they were gone. Now, out of her pension, she gets to keep $75 a month. The rest still goes to the nursing home, and the state pays the bulk of the bill that remains.
I wonder if people think this is the right way to address the problem?
2 comments:
Well, the right way to address the problem would be to wave a magic wand so that we live in a country that gives a shit about human life -- i.e., our elders and children, who will one day be elders.
But we don't.
We live in a country founded on genocide and violence. That's why some Republican pieces of shit -- like George Santos, for instance -- now respond to the dismembering of American schoolchildren with automatic weapons by sporting AR-15 lapel pins.
So why make sure people can end their lives in dignity and safety when you (i.e., Republican fascists) don't give a flying fuck whether they live or die in the first place? When the only factors that weigh in your political calculus are cutting your donors' taxes and making sure brown people are brutalized?
Salman Rushdie wrote, "Repression is a seamless garment." Our country is founded on repression -- of individuals (except their right to shoot people if they ring their doorbell), and of anything that isn't related to repression or generating income.
Another scam that's happening to our elders is financial abuse. I know of a man living by himself in Burbank, CA, who's been scammed for almost two years now by criminals who told him they were from "Publishers Clearing House." The primary offender claimed to be "Dave Sayer" (there is an actual website, but he is not this individual. This is a common scam).
We notified the proper authorities -- local law enforcement, FBI and other consumer-related agencies -- think about that: we're not individuals, we're "consumers" -- and nothing has been done. I think the scammers are viewed as practicing "private enterprise" who are "generating income" despite the fact that all they've done is steal over $1 million from this lonely, scattered old man.
Why is nothing done? Because it's viewed as his "individual right" to trust whom he wants to.
How fucking crazy is that? He'll soon be homeless and will need Medicaid to pay for some minimally adequate housing when his house, now valued at between $850,000 and $900,000, is sold. "Nobody can do anything" because the authorities are hamstrung and the FBI and other agencies don't give a shit.
This is happening all over America to mentally incapacitated elderly individuals.
This country cares not a whit for the sanctity of life. Perhaps that's why Repugnantcans focus on unborn fetuses so easily. 'Cause they sure as shit don't give a fuck about anyone or any creature who's actually alive.
This no doubt affects the legislation and practice of "healthcare."
There are several workarounds for the Medicaid rules.
First, if you have too much income to qualify for Medicaid, you can set up a "Miller's Trust", also known as a Qualified Income Trust, so that everything over the threshold goes into the trust and is not counted as income for qualification purposes.
To qualify with assets, individuals can put all of their assets into a non-revocable trust in advance with themselves as the beneficiaries. Each state has a look back period to decide if the transfers were a dissipation of assets and should be considered. I think California is either two or three years while Texas is five years. Set up the trust in advance and make it past the look back period and the assets are no longer yours and cannot be counted toward wealth.
This is for informational purposes and not to be relied on as every state is different and the rules are always changing.
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