Medicaid planning


Provide ethical factors that your peers may not have presented. Discuss possible policy solutions to overcome challenges presented by your peers.  should be 100 to 150 words, with a minimum of one supporting reference included.

Response 1

Medicaid planning refers to the process of transferring or converting assets of a long-term care consumer to create Medicaid eligibility (Payne, 2013). As many older adults who require long term care via a nursing home, they face financial difficulties in not meeting the requirements for Medicaid eligibility. What Medicaid planning ideally looks to achieve is creating Medicaid eligibility without draining a person’s estate finances for their children. Medicaid planners assist clients in structuring their financial resources, through creating trusts, managing asset transfers, and convert countable assets into exempt assets to ensure Medicaid eligibility as well as preserve family resources (Iversen, 2020). Additionally, Medicaid planners manage finances to ensure the client’s healthy spouse has adequate income and resources to continue living independently during the time when their partner is receiving care assistance via Medicaid (Iversen, 2020).

Medicaid beneficiaries are poorer and have a poorer health profile compared with privately insured (Paradise & Garfield, 2013). Medicaid planning raises ethical and moral concerns as on method requires applicants must spend down their assets to qualify. Payne (2013) explains that individuals requiring nursing home support who do not qualify for Medicaid initially privately pay thousands and thousands of dollars in order to stay in the nursing home until they ultimately drain through their assets. Once they have spent down their assets, they are at the point to qualify for Medicaid. Unfortunately, this means that their family suffers as they spend through everything they had in order to afford nursing home care for the loved one. Payne (2013) states that while there is an emotional appeal that Medicaid is only for the true needy, more than half the senior population would be financially devastated by two years of private pay in a nursing home, thus meeting Medicaid eligibility. Medicaid planning and spend down to access Medicaid has drastic consequences on the healthcare industry as it will increase costs and diminish quality of care. With an increased demand for relief from Medicaid, there are not enough resources for necessities such as adequately staffing facilities and provided updated equipment.

As many older adults do not qualify for Medicaid, elderly individuals are desperately trying to stay in the community and see a nursing home as a last resort. Payne (2013) found a recent increase in the number of elderly individuals with family caregivers in the community and a decline in formal care delivery. Reliance on family care has increased dramatically, which could be heavily influenced by formal care costs. Payne (2013) explains that elderly adults go into a nursing home when they lack assets and family support, which explains why Medicaid-eligible patient predominate there.

Response 2

I order to qualify for Medicaid the aging adult must be below a certain income bracket.  Medicaid planning is when they sell or give away some assets to fall under this level, so they qualify for Medicaid.  Once eligible Medicaid will pay for a portion of their long-term care facility.  The argument is whether the aging adult that performs Medicaid planning is “truly needy”, or are they simply playing the system to protect their assets.  (Pabar-paynerevoct2013, 2013) On the other is the State or Commonwealth, which seeks to advance budgetary restraint by limiting Medicaid to as few impoverished citizens as possible.   Medicaid recipients are not given a free ride. They are required to pay the resident’s responsibility share.  This can equate to their entire income.  (n.d.) The resident is left with a $35 for their personal use per month.  That being said, Medicaid is a government program that the aging adult has paid into for decades.  Why should the funds be taken from them simply because they are now in the elderly population?  For most of those that need to be in a long-term care facility, Medicaid is the only financial option.  Long-term care insurance is out of reach or obtainable and paying privately is not doable for the middle-class population.  With more aging adults entering the Medicare system there is a greater burden on the funds.  When aging adults can “spend down” their access making them eligible for Medicare it is making the funds stretch further.   The consequences of more individuals enrolling in Medicaid have therefore increased costs to both state and federal governments. (Financial Stress and Risk for Entry into Medicaid Among Older Adults, n.d.) With the funds being stretched long-term facilities are reimbursed less.  This trickles down to having less staff employed and fewer resources for the facility and residence. This proves to be a decrease in quality care for the residences.  This is also evident in how providers are paid for their services.  To be reimbursed and make living providers have to expand their treatments.  This might involve doing extra tests or procedures, so they make a profit.  So, just because they can get into the facility are, they receiving the level of care they desire?

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