Another Perspective on Applying for Medicaid


Sarah’s family couldn’t believe the situation they were in. After her stroke, they brought her home from the rehabilitation facility and planned a comprehensive 24/7 care plan, which involved professionals, family and willing friends and neighbors.

After a month, everyone, including the professional caregiver, was exhausted.

Sarah was a “two-person assist.” Her husband and children didn’t have the strength to lift her and turn her on a regular basis and, even with a paid caregiver, they were reluctant to ask friends and neighbors to throw their backs out.

Sarah did not have long-term care insurance, and the couple’s joint savings, which had seemed robust just a few months ago, was taking hits of several thousand dollars a month in out-of-pocket expenses.

The local elder care organization suggested that the family might want to consider applying for Medicaid.

Sarah’s husband blanched. He was a retired corporate executive. How had he been reduced to considering asking for charity?

First, let us consider a few facts:

  • Medicaid is not charity. It is a public benefit program available to those in our society who have extraordinary medical needs and/or limited incomes.
  • A significant proportion of the Medicaid budget in each state goes for custodial and intermediate care for aging individuals, many of whom had long work histories and saved for their retirement.
  • Medicaid can be accessed for both institutional care (skilled nursing facilities, etc.) and “community care” which is provided at home or in qualified living situations.

And then, the most popular refrain, “but they take everything....”

Did you know that:

  • Spouses may transfer assets between them with no penalty? Because Sarah’s personal income was under $2000/month (which is very common for women who raised children and only joined the workforce later in life), she qualified with limited income and assets.
  • If Sarah enters a skilled nursing facility, her husband may still retain over $100,000 in assets and enough income to maintain his home and pay his personal expenses. He will not be “bankrupted” due to Sarah's placement. He may continue to live in his home for as long as he wishes.
  • If one of Sarah’s children comes to live with her and cares for her, that individual may continue to live in the family home for as long as Sarah wishes. Only when she leaves the home will the state look at recovering some of the expenses attributable to her care.

These are all things that can be done in a fairly timely manner and do not require extraordinary professional expenses. It is wise to have a one-time consultation with an elder law or medicaid planning attorney. They will ask questions which might reveal aspects of the person’s financial and personal situation that could be problematic when it comes to Medicaid eligibility.

Ideally, families and couples have had these conversations years before a stroke or other major health crisis strikes. But even if they haven’t, calling local agencies and professionals can help them begin the process of getting things organized and setting up a game plan.

Often, individuals and families who have been financially comfortable and self-sufficient assume that public resources are not for “people like us.” To the contrary, with elders living longer and experiencing more health issues, savings and retirement funds are less likely to last. Many middle-income families will need to supplement their resources with assistance from local care organizations.

Using every available method of support is not an admission of failure. It is a gift to your loved one and family. With sufficient care resources paid for by a variety of sources, you will have the chance to enhance the quality of everyone’s life for years to come.

Margaret Johnson Ware

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Margaret Johnson Ware, MBA, has more than 15 years of experience assisting individuals in navigating issues regarding health insurance, family caregiver support and access to health services. She is an independent consultant to individuals, families and aging and health organizations, including

Visit: My Medicare Matters

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