Medicaid planning, estate recovery, and alternatives for long-term care financing: identifying the ethical issues

In anticipation of the escalating costs of long-term care, consumers and the federal and state governments are engaging in a variety of strategies intended to preserve the financial solvency of the respective parties. For the consumer, this may mean planning in a way designed to maximize one's potential future eligibility for government support, whereas the federal government tries to limit those planning activities inspired by public benefits considerations and the states attempt to recover their long-term care expenses from the estates of deceased consumers whose long-term care needs the state had earlier supported. All of these strategies have important and controversial public policy implications. The public policy debate surrounding these strategies ought to be ethically informed. This article sets out to identify and outline some of the main ethical questions engendered by individual Medicaid planning on one hand, and state estate recovery efforts on the other. It concludes that neither of these approaches to the challenge of long-term care financing is very ethically palatable.