 LTC Bullet: Is Medicaid for the Poor and Vulnerable? Friday, August 22, 2025 Seattle— LTC Comment: Medicaid is nearly always described as a program for the poor and vulnerable. Is that true? Was it ever? Today, we explore some evidence that suggests it wasn’t and isn’t, after the ***news.*** *** TAKE ACTION: Compiling and reviewing the content of today’s Bullet brought to my mind these famous quotes.
"The only thing necessary for
the triumph of evil is for good men to do nothing". Standing by while Medicaid is converted from a safety net for the poor and disabled into a hammock for the financially comfortable is a case in point. If you want to be part of the movement to return Medicaid to those who need it most and to incentivize everyone else to take personal responsibility, especially for LTC planning, then join the Center for LTC Reform and help us fight the good fight.
You can join and contribute
here. Thanks for
your time and consideration. *** LTC BULLET: IS MEDICAID FOR THE POOR AND VULNERABLE? LTC Comment: How many articles have you read that explain how Medicaid benefits the affluent, often to the exclusion or disadvantage of the needy? Not many, I’ll bet, unless you follow these LTC Bullets. But there is plenty of evidence that, to whatever extent Medicaid was aimed at the poor and vulnerable originally, the program is undergoing a major change in the opposite direction. I’ll summarize some of that evidence below and use it as a base for a future article on the topic. Of course, the go-to source for evidence that Medicaid LTC benefits are easily and widely available to non-poor Americans is the Center for Long-Term Care Reform’s articles, speeches, reports and newsletters (LTC Bullets). Here are quotes from and links to a few recent examples “Medicaid should help the poor, but crushes them. The affluent should pay for their own LTC, but don’t. Then they take the best Medicaid offers. What’s wrong and what to do?” (“Medicaid Oversight,” July 11, 2025 “Is Medicaid LTC set up to hurt the poor, underprivileged, and marginalized while inordinately benefiting the affluent and middle class?,” (“Understanding Structural Long-Term Care Racism,” May 16, 2025) “Private wealth sits on the sidelines as Medicaid shifts from helping the poor and vulnerable to subsidizing the middle class and affluent. Facts and analysis follow.” (“How the Wealthy Stole Medicaid,” April 18, 2025) But Medicaid is not only available to the middle class and affluent in need of long-term care. It has also come to prioritize young, able-bodied people over the aged, poor, disabled, and most vulnerable. The Paragon Health Institute has identified a number of ways that Medicaid has transitioned from covering the poor and vulnerable to covering many more. “For more than a decade, the Affordable Care Act’s (ACA) Medicaid expansion has shifted resources away from the most vulnerable Americans – single moms, infants, and the disabled – in favor of able-bodied adults without dependents.” (“Losing Focus: How the ACA’s Medicaid Expansion Left Traditional Enrollees Behind,” by Liam Sigaud, February 10, 2025) “Since 2013, Medicaid rolls have swelled under the Affordable Care Act. More than 20 million able-bodied, working-age adults to Medicaid. These new enrollees, who now account for about 25 percent of Medicaid enrollees nationwide, have put additional strain on the health care system and diverted resources away from vulnerable Medicaid enrollees.(“Myth: The OBBB will harm the most vulnerable Medicaid enrollees,” by Liam Sigaud, August 5, 2025) “The Affordable Care Act (ACA) significantly expanded Medicaid over the past decade, worsening the program’s structural problems. The ACA created a new eligibility category for Medicaid—able-bodied, working-age adults—with a much higher federal reimbursement percentage for these enrollees. This has led to a host of problems, including: 1) a diversion of resources away from traditional Medicaid enrollees, particularly low-income children and people with disabilities, that has reduced their access to health care services; 2) a near quadrupling of Medicaid’s improper payments; and 3) a surge of spending that has significantly contributed to large and growing federal deficits.” (Medicaid Financing Reform: Stopping Discrimination Against the Most Vulnerable and Reducing Bias Favoring Wealthy States,” by Brian Blase and Drew Gonshorowski, July 2025) “States receive $9 in federal funds for every $1 of state spending on able-bodied, working-age adults compared to an average of only $1.33 in federal funds for every $1 of state spending on children, pregnant women, seniors, and people with disabilities. Thus, states receive nearly seven times more federal funding for every $1 of spending on expansion enrollees than traditional enrollees. This incentivizes states to prioritize expansion enrollees over traditional, more vulnerable populations and harms their access to care.” (“Consequences of Medicaid’s Discrimination Against the Most Vulnerable,” by Brian Blase, June 29, 2025) “The week’s Paragon Pic highlights the significant expansion in Medicaid enrollment over the last three decades, demonstrating that it is no longer solely a safety net for categories of just low-income Americans. … Paragon has written extensively on how Medicaid expansion has led to many problems, including a diversion of resources away from traditional Medicaid enrollees, a near quadrupling of Medicaid’s improper payments, and a surge of spending that has significantly contributed to ballooning federal deficits. Paragon also has written about how easy it is for people to qualify for Medicaid long-term care services, as the easy ability to artificially impoverish parents, aunts, and uncles has enabled heirs to protect their inheritances and pass costs to their fellow Americans.” (“Paragon Pic: Medicaid is No Longer for the Poor,” by Drew Gonshorowski) “Though Medicaid was intended to provide health care for the truly needy, the federal government provides an open-ended federal reimbursement of real state expenditures but also artificial state expenditures. As a result, states, insurers, and providers have used Medicaid to siphon hundreds of billions of dollars from federal taxpayers over the past decade and raise payments well above what can be considered ‘economical or efficient,’ as federal law requires.” (“Addressing Medicaid Money Laundering,” by Brian Blase and Niklas Kleinworth, March 2025) “Unrestricted Medicaid Expansion: California uses this influx of federal money to fund large-scale Medicaid expansions. The most significant of these are extending Medicaid coverage to illegal immigrants and eliminating the asset test so wealthy people can qualify for taxpayer-financed long-term care. Because the federal dollars are money laundered, the state circumvents restrictions on federal Medicaid funding for illegal immigrants.” (“California’s Insurance-Tax Shuffle: How Federal Money Ends Up Paying for Medicaid for Illegal Immigrants,” Paul Winfree and Brian Blase, March 12, 2025) “Medicaid, a vital program for indigent and disabled Americans who need long-term care, is facing a crisis of sustainability. The program, initially designed to assist those with insufficient means, is commonly exploited by loopholes in the system that allow basically anyone to gain eligibility for LTC services through financial planning. This trend not only stretches Medicaid’s resources thin but also raises questions about the program’s long-term viability and its impact on state and federal budgets.” (“Preserving long-term Medicaid for the poor,” Gary Alexander, January 15, 2024) “For decades, federal policymakers of both parties tried to ensure that scarce Medicaid LTC resources went solely to the needy. They failed, leaving Medicaid, including state and federal budgets, financially overwhelmed and most people, regardless of their economic condition, using public assistance if they incur catastrophic LTC costs.” (“Long-Term Care: The Solution,” Stephen Moses, October 2023) Closing LTC Comment: From 1965 until 1980, Medicaid allowed everyone to give away unlimited wealth without penalty to qualify for LTC benefits. Costs exploded, so measures were taken to discourage improper asset transfers and eventually to require recovery of exempt assets from estates. But none of those measures succeeded. Middle class and affluent people gained access to Medicaid after they confronted high LTC costs. Heirs benefited by Medicaid’s protecting their inheritances. Consumers responded by failing to plan for LTC. Private LTC insurance languished as a result. During Covid, Medicaid didn’t even enforce the existing lenient financial eligibility rules exacerbating all these problems. Since the Affordable Care Act, Medicaid has prioritized serving young, able-bodied people with huge subsidies for them to the detriment of aged, poor and disabled recipients. This whole house of cards is destined to collapse. When it does, America will be forced to adapt to an absence of huge, market distorting government transfers. Far better to move in the direction of market-based LTC by thoughtful policy than to wait for the economy to take us there by default. How to do that? For analysis and ideas on LTC reform, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. To find ample private funds for LTC, check out “Medicaid’s $100+ Billion Leak.” For what not to do, see “Medi-Cal-amity: California’s Reckless Expansion of Medicaid Long-Term Care to the Affluent.” Find much more on long-term care here. |