“Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey”

Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey,” by MaryBeth Musumeci, Priya Chidambaram, and Molly O’Malley Watts, Kaiser Family Foundation

“Medicaid is an essential source of coverage for medical and long-term services and supports (LTSS) for many seniors and nonelderly adults and children with disabilities. Aside from the core group of SSI beneficiaries, pathways to full Medicaid eligibility based on old age or disability are provided at state option. This issue brief presents the latest state-level data on Medicaid financial eligibility criteria and adoption of key age and disability-related pathways (Figure 1). It also analyzes state choices about whether to adopt these optional age and disability-related pathways in light of states’ Affordable Care Act (ACA) expansion status. Findings are based on a survey of the 50 states and the District of Columbia. Appendix Tables contained detailed state-level data.”

LTC Comment (from Stephen A. Moses, President, Center for Long-Term Care Reform):

Definitely read this issue brief, but don’t expect to come away from it with an understanding of how Medicaid LTC eligibility actually works. For that you’d need to speak with state-level Medicaid eligibility workers who say things like this:

It is not at all unusual to encounter individuals and couples with resources exceeding a half million dollars, some with over one million. There is no attempt to hide that this money exists; there is no need. There are various legal means to prevent those funds from being used to pay for the applicant’s nursing home care. Wealthy applicants for Medicaid’s nursing home coverage consider that benefit to be their right, regardless of their ability to pay themselves. (Congressional testimony of a New York Medicaid eligibility supervisor)

The truth is that income rarely interferes with Medicaid eligibility because health and LTC expenditures are deducted from income before eligibility is determined. Bottom line, income below the cost of nursing home care is usually not disqualifying. Assets hardly count as most large assets, a home, car, business, etc. are exempt and non-exempt assets are easily converted. Read the KFF issue brief and see if you can discern how Medicaid LTC eligibility really works from reading it. One can’t help wondering whether the confusion is intentional to discourage responsible reform. The current eligibility system rewards irresponsibility and failure to plan for LTC risk and cost, but efforts to fix it fall on deaf ears partly because publications like this one disguise the truth.