Formation of trusts and spend down to Medicaid

To identify the proportion of community-dwelling elderly persons (70+) who could affect their eligibility for Medicaid financing of a nursing home stay through the use of a trust and to quantify the prevalence and predictors of trusts.

State-specific Medicaid eligibility regulations were used to determine eligibility and to identify those who could affect the same through the use of trusts. Multivariate logistic regression was used to identify correlates of having a trust. Wave 1 of the Assets and Health Dynamics of the Oldest Old (AHEAD) data base was used.

Four in 10 elderly community dwellers could potentially qualify for Medicaid by using a trust; however, less than 10% had a trust. On average, wealthier persons had trusts. Avoidance of probate and controlling assets after death appear to be stronger motivations for trust creation among the elderly than achieving Medicaid spend down.

The use of trusts was not common, and motives other than spend down were more important for those with trusts. Our results suggest little need for policy efforts to limit the use of trusts to achieve spend down.