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New Article Discussing Medicaid Enrollment and Wealth Transfers

On June 11, 2024, the Gerontologist published an article on Medicaid enrollment and Intergenerational transfers of wealth among older adults. The article was based on a review of data from 2008 through 2018 analyzing estate planning and family wealth transfers of older adults aged 65 and older who became Medicaid recipients.

There were 8,347 respondents who were not Medicaid recipients at the baseline but became Medicaid recipients over the study period. About one-third participated in estate planning and asset transfers. Married recipients were more likely to transfer money than widowed or unmarried recipients. White, well-educated, married men were most likely to engage in estate planning. At one point the writer states: “White older adults are four times more likely to engage in estate planning than their Black counterparts.”

The article seems to take the position that planning amounts to circumventing Medicaid policy and that policymakers should consider promoting the financial health of low-income families. However, the article also states that the average amount transferred by an unmarried person was $5,379.13 and the average amount transferred by a married participant was $16,286.94; given the price of bread (or the price of a new vehicle), one could reasonably question whether any policy change would significant improve any family’s financial health.

The writer seems to be more concerned with social justice and the potential wealth gap among families with different demographics than preventing wealth transfers. She writes that Black families  might have limited access to planning, while “[m]ore privileged families are able to take advantage of elder law attorneys who can explain common methods to secure assets for children and out of the purview of Medicaid’s look-back period.”

This author questions whether more affluent families are the only ones engaging in Medicaid planning. My experience suggests otherwise. My experience suggests that affluence may dictate the planning method or strategy, but most everyone wants to pay as little as possible while receiving good care. More than twenty years ago, this author took the position that Medicaid Planning is ethical within the current system. “[W]e believe the law should be structured to provide adequate health care, including long-term care for all persons, regardless of economic status or age. Elders should be guaranteed access to good health care. Until universal access becomes a reality, we conclude that Medicaid planning is justified within a health care system that elevates profit over patient care.” See T. Takacs & D. McGuffey, Medicaid Planning: Can it be Justified? Legal and Ethical Implications of Medicaid Planning, 29 William Mithell L.R. 111 (2002).


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