The Deficit Reduction Act of 2005 is not part of a natural evolution of the Medicaid program. That program was created along with Medicare and the Older Americans Act in 1965 to prevent the elderly from living their final years in poverty.
Instead, the DRA is an unnatural partisan product of those determined to scare boomers and their parents into purchasing long term care insurance. It contains the most regressive and punitive changes to the Medicaid program since its creation. These new rules will hurt seniors and the nursing home industry. It remains to be seen whether they will drive boomers to purchase LTC insurance out of fear of what their parents are about to experience.
Certainly, the ethical question of denying care to chronically ill older Americans and people with disabilities to strengthen the demand for a private-sector product must be evaluated by policy-makers and the American people in the years ahead.
In the United States, we discriminate in our delivery of health care based on the type of illness a senior has. If one has an illness like heart disease or cancer, Medicare provides comprehensive care. If one has a chronic illness like Alzheimer's, Parkinson's, ALS (otherwise known as Lou Gehrig's disease) or multiple sclerosis, the government doesn't help with most of the cost of care unless the individual is impoverished and qualifies for Medicaid.
However, until we have a comprehensive LTC system for all Americans, it is essential for Medicaid to maintain its role as a federal-state program and continue to help pay for the LTC needs of low- and middle-income older individuals and of individuals with disabilities. It is in this context that families needing LTC services engage in financial planning to pay for those services.
Most families needing LTC feel defeated by having to apply for a "welfare" program after years of working and saving. A colleague of mine from Illinois has stated that most middle-income seniors who turn to Medicaid for nursing home care are "people who are up against a wall because of a serious illness, who have never depended on a government handout in their lives."
Many are children of the Great Depression and World War II veterans–our so-called "Greatest Generation." Most are women, who, after losing their husbands to the devastation of chronic illness, have to suffer the indignity of impoverishment and financial dependence on family or the government.
The result is that our health care system penalizes people who have pursued the American dream, saved for retirement and then get the wrong disease.
When seniors meet with me for LTC planning, it is always a part of a larger planning process that examines the full range of LTC options, issues and costs relevant to a client's circumstances. For these clients, many elder law attorneys recommend LTC insurance as an option.
Most often, the attorney's help is sought when the need for LTC already has arrived and the senior is uninsurable. It usually involves spouses and children of a loved one needing nursing home care who already have been heavily invested in providing care to that person for an extended period. My clients' goals typically include finding the best quality health care for their loved one, supplementing the Medicaid personal needs allowance (typically $30 to $50 per month), and paying for non-covered Medicaid services and needs (e.g., dental care, hearing aides, eyeglasses, private duty nurse, clothing, books and flowers).
