Why Medicaid Planning Is 100 Percent Ethical

Q. My close friend, Paula, invited me to lunch the other day. We got to talking, and I asked her about her father who she told me was in a nursing home. She asked about my parents, and I explained how my mother’s dementia is getting worse, and we are exploring nursing home care for her, as well. I explained how I am worried about how expensive nursing homes are in this area and how quickly their assets will be depleted if they pay out of pocket for my mother’s care.

She told me how your firm helped her father get Medicaid and how it’s the only way they could have afforded the catastrophic cost of nursing homes in this area without going broke. Something doesn’t seem right to me, however. I live in a somewhat affluent neighborhood in Fairfax where houses go for $650,000-plus. I remember Paula’s parents worked most of their lives at decent jobs, raised two college-educated children, and have a beautiful labradoodle whose haircuts cost more than my entire family’s. There is no way they can be poor enough to qualify for Medicaid. Can you explain? And if they do qualify for Medicaid, how is it ethical? Also, don’t you get better care if you pay privately?


A. May is National Elder Law Month! Elder Law Attorneys across the country, including those at the Farr Law Firm, are taking the opportunity to educate seniors about their legal options in the communities we serve. Now is the perfect time to talk about one of our practice areas, Medicaid Planning, and why it and everything else we do is absolutely, unquestionably, 100 percent legal and ethical.

As an Elder Law attorney, I routinely help loved ones of those in need of long-term care to preserve assets while qualifying for Medicaid. As a professional, I have a duty to advocate for my clients. But as a taxpayer and citizen, I am often asked whether it’s ethical to help people shift the cost of long-term care to the taxpayers.

In most cases, these concerns disappear when people are actually faced with the enormous costs of long-term care. Also, it’s important to understand that Long-term care Medicaid was NOT designed for poor people; it is a different type of Medicaid — health insurance Medicaid— that was designed for poor people, meaning people with very low income. Long-term care Medicaid was designed for people who can qualify for it, which includes many middle- to upper-class seniors who rely on Long-term care Medicaid to cover the catastrophic costs of nursing homes so families similar to your neighbors don’t have to deplete the assets it took a lifetime for them to earn. With DC Metro area nursing homes often costing $12,000- $14,000 per month, even wealthy people and those who spend their lives saving can quickly lose everything they worked so hard to earn. Please read our web page on Why Medicaid Planning is ethical to learn more.

The ethics of Medicaid Planning was addressed in a New York Times article. Let’s take a look at a summary of what reporter Ron Lieber had to say and how the public reacted.

The Ethics of Medicaid Planning

In his personal finance column, “The Ethics of Adjusting Your Assets to Qualify for Medicaid,” and in a previous article about the same subject, “Plan on Growing Old? Then the Medicaid Debate Affects You,” New York Times reporter Ron Lieber explains how Medicaid has become the primary source of payment for long-term care services in the United States.

Lieber concurs with my description above on how “for most people who enter nursing homes or receive care at home or assisted living, if they pay for their care out-of-pocket, they’ll run out of money eventually and qualify for Medicaid coverage.” According to Lieber, “(w)e assume, incorrectly, that Medicaid is only for the younger poor or those with disabilities and that Medicare will pay for most nursing home care… When the first nursing home bills arrive, most people can’t pay… and certainly not for long, especially after 10 or 20 years of retirement spending. Ask around. Someone you know has quietly faced these facts and probably turned to Medicaid. Chances are, you, a family member or a close friend will someday, too.”

Also, according to Lieber, “Once properly impoverished under the law, then Medicaid, which gets funding both from your state and the federal government, picks up the tab.” He presented the question on whether this practice is ethical to his readers, and I will describe their responses below.

What New York Times Readers Had to Say

Lieber quotes responses to this question from a number of people, including Elder Law attorneys and children of seniors who received long-term care. Their responses are mostly favorable toward Medicaid Planning and include the following:

• It’s no different from tax planning for wealthy clients; both save money for taxpayers at the government’s expense.
• Only those who go to Elder Law attorneys know enough to plan, so this practice only helps those who are savvy enough or have enough funds to get the right advice.
• While it’s true that those who go to Elder Law attorneys are usually more sophisticated and on average more affluent than those who do not, they are rarely wealthy.
• I paid into this system as a taxpayer and now that I need care, it should be provided to me.
• The fact that I worked hard and saved while my neighbor spent profligately, shouldn’t mean that I lose everything if I become ill.
• The system is unfair in that Medicare will pay for acute needs, such as cancer care or heart surgery, but not chronic care for dementia or a long-term debilitating illness such as Parkinson’s.
• The luck of the draw as to what illness you get shouldn’t have such drastic implications on your wallet and the inheritance of your children.
• Forcing seniors to sell property or a small business to pay for their care takes away their dignity. They worked hard to create a legacy to pass on to their children and grandchildren. It shouldn’t be lost at the end.

Do You Get Better Care if You Pay Privately?

As you can see, most people understand why Medicaid planning is completely ethical and completely necessary. Many people, however, assume that you get better care if you pay privately. That is simply untrue. In fact, it is illegal to treat Medicaid patients differently than private pay patients, and it is illegal to discriminate against Medicaid patients. There may be no “Medicaid wing” and no public identification of a “Medicaid bed.” Typically, the staff does not know which patient is a Medicaid recipient. In actuality, the nursing home residents who get the best care are those who have done Medicaid Asset Protection, because a loving family member can then use those protected assets to provide a higher level of care for the nursing home resident. Elder Law, including Medicaid Planning and Medicaid Asset Protection, is all about preserving dignity and quality of life for elders.

Medicaid Laws Are the Most Complex and Confusing Laws in Existence

Medicaid laws are the most complex and confusing laws in existence, and impossible to understand without highly experienced legal assistance. Without proper planning and legal advice from an experienced Elder Law attorney, such as myself, many people spend much more than they should on long-term care, and unnecessarily jeopardize their future care and well-being, as well as the security of their family. Please read the Medicaid Complexity page on our website for more details.

It is extremely prudent to legally protect your assets in an effort to qualify for Medicaid nursing home benefits when needed. To reiterate, if you or a loved one become a client of the Farr Law Firm, you may rest assured that everything that we do is absolutely, unquestionably, 100 percent legal and ethical. Don’t ever hide your assets, and don’t make the mistake of attempting to protect your assets on your own. Make the wise choice, and call us to make an appointment for a no-cost introductory consultation:

Medicaid Asset Protection Attorney Fairfax: 703-691-1888
Medicaid Asset Protection Attorney Fredericksburg: 540-479-143
Medicaid Asset Protection Attorney Rockville: 301-519-8041
Medicaid Asset Protection Attorney DC: 202-587-2797

Print Friendly, PDF & Email
About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

Leave a comment

Thank you for your upload