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Is Medicaid for the Middle Class? | Keystone Elder Law – Mechanicsburg, PA

There are many people who feel it is morally wrong for elder law attorneys to help individuals accelerate their eligibility for Medicaid benefits in a nursing home. Their feeling is that since the government is already in debt, people in nursing homes should expend all their own funds for care before receiving Medicaid benefits. While this sounds good, most people who feel this way have never considered the broader implications of this point of view.

Since Medicaid is considered a “welfare” program, it would be good to examine just what governmental welfare is. Looking at it in a broad sense, welfare is the “receipt of financial aid from a government agency or other source” (from the World English Dictionary by Collins). When you look at all the people and organizations that receive financial aid from the government, it becomes evident that the government’s view of welfare that is that it provides some public benefit that outweighs the expenditure/ loss of income. Consequently, when you and I claim mortgage interest and charitable donations as income tax deductions, we are receiving welfare in the form of paying less tax than others of comparable income who cannot claim these deductions. Could the government not use this lost income to lower the debt? Sure it could, but decisions have been made that the benefit to society outweighs the loss of revenue. When the government offers tax credits and subsidies to businesses that are already profitable, a decision has been made that the benefit to society as a whole outweighs the loss of income.

In the same way, Congress has set up specific regulations to allow middle class individuals to accelerate eligibility for Medicaid benefits in a nursing home. The policy at present is that this benefit to middle class individuals outweighs the cost to the Medicaid program. From the standpoint of the government, it is not a matter of morality, but it is a matter of public policy that in some way benefits society. Will it always be this way? Probably not. Congress is constantly changing the rules on program eligibility, tax deductions and tax credits. But unless you are willing to forgo the welfare you receive from the government (and there are some people who forgo their benefits because of this belief) it hardly seems fair to point a finger at those individuals who legally use the present Medicaid eligibility rules to their own benefit. A long time ago, a wise person told me to be careful about pointing fingers at others because when you do there are three fingers pointing back at you.

John Reese
Elder Care Coordinator