Skip to content

Medicaid Planning Legally and Ethically, Part 1: The Basics

Receiving proper medical care in the United States can be a challenge sometimes, in no small part due to the many legal complications surrounding it. In particular, navigating the various requirements surrounding Medicaid can feel like putting together a 1000-piece jigsaw puzzle while blindfolded. Some of this comes down to people waiting far too long to learn about the process: Medicaid is for the elderly and those who need institutionalized care, so many choose to cross that bridge when they reach it.

However, the smarter option is to prepare for these types of issues ahead of time, ensuring that you won’t be caught flatfooted when you need to understand the process. Medicaid planning is an essential step in life, irrespective of your current age or need. It is simply a matter of taking the time and effort.

What Is Medicaid?

Medicaid is a federal assistance program that is administered at the state level and is designed to help those who are financially eligible pay for the cost of long-term care and allows access to other medical and healthcare benefits.1 It was first established under Title XIX of the Social Security Act of 1965, with federal statute and regulations governing the Medicaid program found at 42 U.S.C. Code 1396a (1988 & Supp. V. 1993) and 42 C.F.R Code 430-36, 440-42, 447, 455-56 (1994).2 Intended to serve the needs of the poor and medically needy, Medicaid has strict financial requirements for eligibility.

Medicaid encompasses a wide variety of services, which in turn are provided by an equally wide variety of professionals and volunteers. That said, it has its limits. For one, it only covers nursing home care, along with some in-home care under special waiver programs. Meanwhile, Independent living facilities and assisted living facilities are not covered.3 The care provided is also usually limited: while it provides coverage for those in need of skilled nursing care, such as physical therapy, it does not cover most basic needs like a private room, telephone, personal clothing, or entertainment costs.4 It also doesn’t cover many important medical needs like dentistry and eyecare, so it is important to have a plan in place.5

The Challenges of Medicaid

Perhaps the biggest issue with Medicaid is the simple fact that demand is far greater than the supply. At least 70% of Americans who turn 65 in any given year will need long-term care services and support at some point in time.6 Extended lifespans and surging drug prices have made elder care increasingly expensive, which in turn has led to a great deal of “fiscal tug-of-war” between government officials and medical professionals.

While the state might be required to cover patients that cannot pay for medical care, there are several limits to their service, whether it be through more documentation, increased taxes, or offering a limited number of visits.7

What Is Medicaid Planning?

Thankfully, while Medicaid’s many requirements and qualification standards can be difficult to follow, there are services built around navigating the process and getting the best possible results. In a future blog, we’ll talk about Medicaid Planning, how it helps, and how to qualify for Medicaid coverage.


Endnotes

1.  Alperin, S. (n.d.). 11 Frequently Asked Questions For Medicaid Planning Attorneys. Alperin Law. Retrieved October 8, 2021, from https://www.alperinlaw.com/blog/11-frequently-asked-questions-for-medicaid-planning-attorneys.cfm.

2.  Regan, S. P. (1995). Medicaid Estate Planning: Congress’ Ersatz Solution for Long-Term Health Care. Catholic University Law Review, 44, 1217–1267. https://scholarship.law.edu/cgi/viewcontent.cgi?article=1612&context=lawreview

3.  Alperin, S.

4.  Hale Ball. (2021, March 6). Medicaid planning attorneys: Northern Virginia. Hale Ball. Retrieved October 8, 2021, from https://haleball.com/practice-area/elder-law/medicaid-planning/.

5.  Alperin, S.

6.  Hale Ball.

7.  Takacs, T., & McGuffey, D. L. (2002) Medicaid Planning: Can It Be Justified? Legal and Ethical Implications of Medicaid Planning. William Mitchell Law Review, 29(1). https://open.mitchellhamline.edu/cgi/viewcontent.cgi?article=1598&context=wmlr

About the author

Author profile

Christopher Ripley is a Valparaiso native and a lifelong Indiana resident. He is the oldest of five children. After graduating from Valparaiso High School, Chris attended Purdue University where he received his B.S. in Mathematics. He then attended law school at Indiana University in Bloomington where he received his Juris Doctorate. Chris has practiced law since 2013 and has served clients across the State of Indiana from Porter County to Evansville in a variety of legal matters. Chris is licensed to practice law in Indiana and Illinois.

Share this:

Leave a Reply

Your email address will not be published. Required fields are marked *