Long-term care, Medicaid, and impoverishment of the elderly

The 1989 Long Term Care Survey was used to assess the extent to which entry of disabled elderly into nursing homes depletes personal wealth ("spenddown"); the effect of state eligibility rules on this process, on incentives to shield assets for Medicaid eligibility, and on out-of-pocket prices for nursing-home care; and whether the disabled elderly's housing wealth represents potential revenue for Medicaid. Most disabled elderly in the community were either Medicaid eligible, or would have been soon after entering a nursing home. Variations in state Medicaid eligibility rules do not explain differences in the spenddown process: the amount of nonhousing wealth of most disabled elderly seldom warranted its transfer to relatives in order to secure Medicaid benefits, nor would their housing wealth have offered more than limited revenue for Medicaid.