LTC Bullet:  JBQ Decries Exploitation of Medicaid 

June 7, 2001 


Jane Bryant Quinn, one of this country’s most celebrated syndicated columnists, doesn’t mince words in her recent column titled “Shame of the Rich:  Making Themselves Poor.” Ms. Quinn goes right to the heart of our long-term care financing crisis in her column which you can read online at (The column has appeared across the country with different titles.  The Seattle Times, for example, used the heading, “Growing Numbers of the Well-off are Exploiting Medicaid.”)

According to Quinn, growing numbers of middle- and upper-middle class people are “willing to take care of themselves as long as they maintain their health.  If a nursing home looms, however, they decide to quit being responsible.  They look for ways of leaving their own money to their children, while forcing the taxpayer to provide their care.”  How?  Quinn explains that “so-called ‘Medicaid planners’ use the loopholes [in the Medicaid eligibility rules] to make you instantly ‘poor.’”  Several techniques promoted at a recent National Academy of Elder Law Attorneys (NAELA) conference in Vancouver, B.C. are given as examples of how Medicaid planners accomplish this artificial impoverishment for their clients.  (See the Center’s own review of this conference in a recent LTC Bullet at  “Bottom line,” says Quinn, “Medicaid is in serious trouble.  The government isn’t spending enough for quality care.  The more people with money exploit the system, by not paying for themselves, the worse the care is going to be for everyone.” 

CLTCF Comment:  LTC Bullets subscribers know the Center for Long-Term Care Financing takes a very dim view of Medicaid planning because of the dangers to vulnerable Medicaid planning clients and the corrosive effects on our long-term care service delivery and financing system.  Steve Moses, President of the Center, states in Ms. Quinn’s column that such legal maneuvering to qualify for public assistance “turns Medicaid into an ‘inheritance insurance plan for the middle class.’”  Why save, invest, or purchase insurance if you can wait to see if you ever need care, pass on the cost to taxpayers, and give your estate to your kids?  Of course, most people are not scheming years in advance to carry out such as plan.  Nor are most people aware of Medicaid’s notorious reputation for problems with access, quality, reimbursement, discrimination, and institutional bias absent first-hand experience.  Instead, the availability of Medicaid-financed care to nearly everyone regardless of income or assets has anesthetized the public from taking seriously the risk of catastrophic long-term care costs.  Thus, it comes as no surprise to us that most people surveyed give lip-service to the supposed need to plan for long-term care costs, but do nothing about it.  Eventually, a health crisis occurs and the only question becomes “how to” qualify for Medicaid (i.e., by actually spending down to eligibility levels or artificially impoverishing yourself with the help of a Medicaid planner) rather than “whether to” qualify for Medicaid.  As Ms. Quinn argues so clearly and cogently in her column, the Medicaid system is at risk of collapse unless exploitation of Medicaid is stopped. 

Source:  Jane Bryant Quinn, “Shame of the Rich:  Making Themselves Poor,” Washington Post, June 3, 2001, P. H 2.  Online at