As you know, I have been hitting the books as part of my Gerontology masters work with the University of North Carolina Greensboro. What is likely snoozy subject matter to most is a real page-turner for me. Gerontology studies (that aren’t Theories of Aging…too hard and too sciency!) rev me up and get my blood pumping, especially all the stuff I’m learning in my Elder Law class. It’s really salacious material to me. Not only is Elder Law at the core of how and why we must Grand Plan for our Golden Years, it’s also healing and helpful and super hope-instilling to know the law long before you need to lean on it. And in case you didn’t hear the verdict, we’ll all have to lean on this kind of law one day — it is our geris-prudence!

So, this week we were learning about all the government programs available to older adults, how these benefits can support or cover long term care costs and why it’s important to MEET WITH AN ELDER LAW ATTORNEY NOW before the sh** hits the fan. Of course, one of those topics includes Medicaid. According to my new friend, Copilot, and confirmed by my course instruction, Medicaid is a joint federal and state program that provides health care coverage to individuals with limited income and resources. Eligibility is primarily based on income, which is compared to the federal poverty level. Each state has its own income thresholds and additional criteria.

Here are some key points about Medicaid:

• Eligibility: Medicaid is designed to assist low-income adults, children, pregnant women, elderly adults, and people with disabilities¹.
• Administration: While the federal government sets general guidelines, each state administers its own Medicaid program, which means eligibility and benefits can vary from state to state².
• Funding: The program is funded jointly by the federal government and the states

Bottom line is, Medicaid will help pay for your costly and ongoing long-term care needs. But you have to qualify for it, and most importantly, know HOW to qualify for it. Unfortunately, Medicaid is a program most people don’t — won’t! –learn about until it’s go-time and they’re trying to figure out how to pay for 24-7 in-home care or an assisted living facility for a loved one with dwindling assets. And according to my studies, planning for it can also be an ethical issue of epic proportion.

Let’s unpack that ethics and planning stuff real quick because it kind of flies in the face of Grand Planning. While Medicaid planning with an elder law attorney is totally within the scope of all things smart and legal, it also begs the question: is planning for it gaming the system? To be more blunt, is a person who has the resources to pay for long term care but protects it in an irrevocable trust or spends it down through careful gifting or asset transfer, a total shmuck?

This story in The New York Times lays it all out pretty succinctly.

What do you think? It’s my opinion that as long as you’re abiding by the five-year lookback rules and parameters set forth by the government, it is a-ok to make a plan to access government benefits that are available to all of us as citizens of the United States of America. To me it’s not only ethical, it’s dang smart! Plus, the way our caregiving provisions and costs are structured, it’s hard to manage these crazy a** expenses any other way! And plus, plus… we’re living a lot longer than we used to! And plus, plus, plus, we can’t depend on our communities and families like we may have been able to in the past. Unless you have enough money in your coffers to self-pay for decades of 24-7 caregiving or have a bussin’ old school long-term care insurance policy, you are going to have to consider the implications of Medicaid resources. Is that unethical? Hard to see how it could be, but it’s something to know about as you make your own Grand Plans for the future.