Medicaid

We went this morning to see a lawyer specializing in legal issues of the elderly.  Although it feels almost ridiculously early to be thinking about it, Marja and I have some radical financial decisions to make.  The most important is thinking about long-term nursing-home care.  Most (an estimated 75% according to one source) Alzheimer’s patients end up in nursing homes at tremendous cost.  And that brings up the question of protecting our IRAs and the inheritance we have from Marja’s mom.  Nursing homes for people with Alzheimer’s can cost $80,000 a year.  Medicare does not cover the care, and—as I understand it—Medicaid will pay for nursing home care only after the person (or family) has spent down most of their savings.

And to prevent the wealthy from making legal arrangements give the money away but keep control over it, Medicaid has a five-year “look-back” and would not cover nursing home care if we’d given our money away during that period.  I’m not yet clear how it all works, but I’ve been told that it’s perfectly legal divest ourselves of money prior to the 5-year look back.  Given my stage in the disease, there’s a good chance I won’t need the nursing home care for five years.  If that’s the case, then it makes sense to give most of our money away now.

There is the important question of the ethics of such manipulation to stick the government with the cost when we could pay at least much of it ourselves?  But I feel no ethical qualms.  First of all, Marja and I have spent our adult lives volunteering or working at wages much lower than possible in order to serve the poor.  Since the US, alone among Western industrialized countries, does not protect its residents from destitution, we (and many others, of course) have been doing the job our government should have been doing. 

Furthermore, when Marja and I received her inheritance, we made the decision to give away the vast majority of it to continue to work for justice in our country, which we have been doing.  It would be possible to spend the money immediately by giving it all to charitable organizations, and we are doing some of that.  But we have also felt it important to give directly to support individual poor people.  Someone has said that what the poor need is not more programs but more money.  That’s an oversimplification but we’ve decided to give certain poor people we know, (and we’ve known quite a few after my years as a doctor and Marja’s years as a teacher.) 

The problem is that, if we want to be responsible about giving the money away directly to poor people, it takes a while.  We want to make sure the money is used well, so we only support people we know personally.[1]  And if we don’t want to encourage an unhealthy dependency in those to whom we give, it’s a slow process.  Giving our money directly to poor people (and organizations supporting peace and justice) corrects a small part of the injustice of our country.  The real responsibility for correcting that injustice lies within our society through government, but society has chosen not to do that.  So we feel no qualms about having government pay for whatever nursing home expenses we need as long as we can do it legally and with transparency. 

So we have to think about how best to sequester our money and that’s where the lawyer comes in.  There are lots of other similar decisions that we should be making pretty quickly. The financial consequences of such decisions will be enormous.

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[1] Just to be clear, we are not a foundation or charity and do not accept or pay attention to requests from strangers.