LTC Bullet:  JBQ in Newsweek:  Use LTCI or RMs, Not Medicaid 

Tuesday, March 20, 2007 


LTC Comment:  Syndicated columnist and best-selling financial author Jane Bryant Quinn urges three million plus Newsweek readers to plan for LTC with insurance or use home equity so they don't end up gaming Medicaid.  


LTC Comment:  It doesn't get any better than this! 

Whether your professional mission in life is (1) to restore Medicaid as a quality long-term care safety net for the poor, (2) to protect seniors from the risk and cost of LTC with private insurance, or (3) to help the elderly "age in place" and maintain their standard of living with a reverse mortgage, nothing advances the cause like a positive article by an award-winning syndicated columnist in a leading mass-market magazine.  

That's exactly what we have to report today.  Here's the citation and a hyperlink to the whole story. 

Jane Bryant Quinn, "How You Can Pay for Costly Old-Age Care," Newsweek, March 26, 2007,  Sub-titled "Gaming the Medicaid system is legal, but I hate it. New rules, effective last year, make it harder for the rich to get on the rolls." 

So what?  A study of the news media (reported on at found that news magazines are holding up commercially better than other magazine genres; their readerships (and hence advertising targets) are getting older (44 years on average up from 41 in 1995) and more affluent ($65,000 up from $46,000).  All the major news magazines have lost circulation over the years, but "Newsweek has been the most stable of the three, experiencing a smaller drop of 3 percent in circulation since 1988."  Newsweek has a circulation of over three million and its readership is getting older and more affluent, exactly the right demographic for LTC insurance and reverse mortgages. 

Bottom line:  out of Newsweek's multi-million readership, we have every reason to believe that many thousands will take Ms. Quinn's sage advice and choose to plan responsibly for long-term care instead of ending up on public welfare by default. 

Next, some of my favorite clips from the column followed by comments on the painstaking process that created it and finally some quotes from nearly 20 years of Ms. Quinn's distinguished coverage of these issues.



"The majority of Americans can get Medicaid—maybe even you. . . .  It's a public-welfare program for those (mostly elderly) who need custodial care but can't afford it." 

"Not only are middle-class people accepted, some of the affluent have squeezed in, too, thanks to attorneys who use gifts, trusts, annuities and other strategies to disperse their wealth. Gaming the Medicaid system is legal, but I hate it. New rules, effective last year, make it harder for the rich to get on the rolls." 

"People with higher incomes and assets will have to take another tack. They never belonged in a welfare program in the first place and now will find it even harder to wiggle in." 

"The focus of planning continues to be the spouse at home. She (it's usually a she) may have a valuable house but a small income and shrinking assets, as her husband's nursing-home bills eat into their savings. But that doesn't mean that taxpayers should step in and help. Affluent couples can and should protect themselves." 

"There are at least three ways of ensuring the security of an at-home spouse . . .  

"1. Buy long-term-care insurance (LTCI). But hardly anyone does. Individual sales have been slipping since 2000. 'Why buy LTCI and take the risk you won't ever need the policy when a lawyer can get you onto Medicaid if you actually get sick?' asks Stephen Moses of the Center for Long-Term Care Reform. (The center lobbies for restricting Medicaid to the truly poor.) But Congress warned affluent people last year that they'd find Medicaid harder to get. Take the advice and apply early for LCTI. If you wait until 65 or 70, you might not be in good enough health . . . 

"2. Buy one of the newer 'combination' products-insurance packaged with benefits for long-term care, says insurance adviser Richard Sabo of Gibsonia, Pa. You might put a chunk of money into a cash-value policy, with the right to withdraw 2 percent of the death benefit each year, to cover nursing-home and home-care expenses. Your heirs get any remaining insurance proceeds tax-free. . . . 

"3. Tap your home equity, using a reverse mortgage. This is a loan against your home that doesn't have to be repaid until you sell or die. The older you are, the more you can borrow. Take it as a line of credit, which the spouse at home could use to pay bills." 

"To avoid these complications, a few couples divorce, says William Browning of Browning & Meyer in Columbus, Ohio. But that's a sad outcome, when you could have protected yourself with long-term-care insurance. It's expensive, but can save your marriage and your peace of mind." 


LTC Comment:  Jane Bryant Quinn goes to great lengths to make her columns succinct, accurate and fairly balanced.  On this particular piece, I first heard from Quinn's intrepid researcher Temma Ehrenfeld months ago.  She asked me a long series of questions by phone and email which I answered fully with links to the back-up documentation on the Center's website at

Last week, Ms. Quinn herself called.  She challenged me on a number of points mostly related to Medicaid long-term care eligibility.  She also talked with several elder law attorneys who made the seductive case (unsuccessfully) for Medicaid planning.  She hit me with their arguments, and vice versa, I'm sure.  With fewer than 1000 words to tell a complex story, Quinn is unequaled for making a story pithy, pointed and poignant. 

Wouldn't you know it though?  Click on one of the "sponsored links" at the end of the online version of Ms. Quinn's column and what do you get?  A long list of links to the websites of Medicaid estate planning attorneys!  When I clicked on one of those links, I was informed "Server is too busy."  Maybe that's why Jane Quinn told me once that she hates to write about Medicaid planning because, no matter how critical she is of the practice, her phone rings "off the hook" for months with calls from people who want to know where they can find one of those lawyers who can get you on Medicaid. 

And did you catch that reference to using divorce to qualify for Medicaid?  I debated the author of that quote, former NAELA president Bill Browning, at a long-term care insurance conference in 2002.  You can still hear us do verbal battle over the relative merits of Medicaid planning and private insurance.  Find a link to that "Great Debate" at  

Want to see some earlier examples of Jane Bryant Quinn's coverage of the Medicaid and long-term care financing issues?  Here are a bunch with quotes from my favorites. 


"One of America's great financial shell games is played, unseen, in the offices of lawyers and accountants who counsel the elderly.  One minute you see a pile of money.  Zip, zip, zip, the next minute it's gone."  (Jane Bryant Quinn, "Staying Ahead:  Dealing with the Medicaid Shell Game," San Francisco Chronicle, December 19, 1988) 


"On the matter of nursing-home costs, the law is quite clear.  The bills are your responsibility as long as your money lasts.  When you run out, you're rescued by the Medicaid program....  Thousands of older people resent that arrangement.  They'd rather get support from the taxpayer right from the start.  In this low endeavor, they're counseled by an army of "poverty makers"--law firms, accounting firms, legal-aid offices, social-service centers, nursing homes, even some Medicaid offices."  (Jane Bryant Quinn, "Do Only the Suckers Pay?," Newsweek, December 18, 1989) 


"Nationally syndicated financial columnist Jane Bryant Quinn called the attorney's artificial impoverishment techniques 'immoral, outrageous, unprincipled,'  (Summary of Frontline national TV special "Who Pays for Mom and Dad?," which aired April 30, 1991:  LTC News & Comment, June 1991) 


Jane Bryant Quinn, "How to Plan Ahead for the New Tax Hit," Newsweek, August 16, 1993, pps. 24-25.  Notes legislation to close Medicaid loopholes. 

Jane Bryant Quinn, "Paring Loopholes that Let the Well-Off into Medicaid," Washington Post, October 3, 1993.  First of two part series.  Also published as "10 Fewer Loopholes Now in Medicaid" in The Press Democrat, September 16, 1993. 

Jane Bryant Quinn, "States Work to Cut Abuse of Medicaid," Seattle Post-Intelligencer, September 21, 1993, p. B-6.  

Jane Bryant Quinn, "It's Middle Class Vs. Poor in Medicaid Fight," Seattle Post-Intelligencer, December 14, 1995, p. E1; JBQ's syndicated column for the Washington Post Writers Group derides Medicaid planning. 

Jane Bryant Quinn, "Congress Takes Aim at Abuse of Medicaid," Seattle Post-Intelligencer, September 10, 1996, p. B5. 

Jane Bryant Quinn, "Aging:  The Endgame, Why Pay for Nursing-Home Insurance, as Long as the Public Will Pick Up the Bill?," Newsweek, Vol. CXXVIII, No. 14, September 30, 1996, p. 53. 

Jane Bryant Quinn, "Time Has Come for Long-Term Care Insurance," Seattle Post-Intelligencer, October 10, 1996; article recommends long-term care insurance. 

Jane Bryant Quinn, "Long-Term Care:  Figure You're On Your Own," Seattle Post-Intelligencer, March 6, 1997, p. B4; Quinn's syndicated column for the Washington Post Writers Group encourages purchase of private long-term care insurance. 


In a 1999 interview with then-NAELA President Rebecca Morgan, was asked about Medicaid planning and answered thus: 

Q: (Morgan)  "You know some of our members do Medicaid planning for their clients and I know you have written on the issue of Medicaid planning and transfers.  Do you see a case where Medicaid planning would be appropriate?" 

A: (Quinn)  "I think that there is a legitimate concern, where there's a spouse at home.  However, there are already many protections for the spouse at home, which need to be examined before you do Medicaid planning.  I also think that if planning is done to protect the spouse at home, and the other spouse does indeed go into a nursing home, it would be proper for states to recover the Medicaid money from the estate, when the second spouse dies.  I believe very strongly that people ought to pay for themselves, instead of pushing the bill onto the taxpayers.  I think it's shocking that people with money still want the public to pay." 

Q:  (Morgan)  "Some have suggested that if we are going to change Medicare we ought to add a part D for long-term care.  Do you think people would be willing to accept more taxes for health care?" 

A:  (Quinn)  "I think we need to consider taxes for the basic medical system before we even begin to think about long-term care.  To me, long-term care is something people need to save for or cover with personal insurance. You save money all your life to take care of yourself in your old age.  Well, long-term care is taking care of yourself in your old age.  I think that should still be a private responsibility, unless you truly have no money.  I strongly support the Medicaid program.  I just don't support people going on Medicaid artificially." 

See "LTC Bullet:  Jane Bryant Quinn on Medicaid Planning, September 13, 1999" at


"As the population ages, Medicaid spending on nursing homes could easily get out of control. That is, unless it's limited to the people who really need it.  Medicaid is supposedly for the poor. But increasingly it's being exploited by the well-to-do. Instead of buying nursing-home insurance or using their savings, they're getting the government to cover their bills.  . . .  They're 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. . . .  In general, their gambits are legal. The state laws on who's eligible for Medicaid conceal many weak points that let moneyed people onto the rolls.  To me, exploiting these weaknesses is unethical. The question for families is whether money will always trump morals.  . . .  That turns Medicaid into an 'inheritance insurance plan for the middle class,' says Stephen Moses of the Center for Long-Term Care Financing in Bellevue, Wash. Parents go on welfare so they can leave their money to their kids. . . .  The bottom line: 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."  (Jane Bryant Quinn, “Shame of the Rich:  Making Themselves Poor,” Washington Post, June 3, 2001, P. H 2.  Online at; also discussed in "LTC Bullet:  JBQ Decries Exploitation of Medicaid," June 7, 2001, at 


"Whether to spring for LTC isn't an easy call.  People who earn enough to afford the premiums might gamble that they can pay their own way.  Others choose an unethical route:  they give their money to their kids, then claim poverty and apply for help from Medicaid, a welfare program that covers nursing-home care.  But as the boomers age, Medicaid will be overwhelmed. The reach and quality of welfare services will decline.  Even now, some nursing homes are reducing the number of Medicaid patients they'll take, and shuffling current residents into other facilities.  BELIEVE ME:  YOU'RE GOING TO WANT TO PAY PRIVATELY FOR CARE, AND LTC INSURANCE IS ONE WAY OF DOING IT."  (Emphasis added.)  (Jane Bryant Quinn, "Insurance:  Is Yours Safe," Newsweek, September 2, 2002, cited in "LTC Bullet--The New Retirees," Thursday, August 29, 2002,