Q: My mother with early Alzheimer's has a Medicaid waiver and moved into assisted living. Does Medicaid pay everything?

A: On spending down to Medicaid: I very much appreciate those who believe that Medicaid eligibility rules should be adhered to and that those who are confronted with long-term care costs should spend down all of their own assets before qualifying for Medicaid benefits. I would like to take a moment, however, to argue that this is not always the best route either for the well being of the elder and/or the family.

Let me preface by saying that in my work I could really care less about inheritances. Although the desire to pass along assets is strong, most understand that it is the needs of the one requiring care and their spouse (if applicable) that is paramount.

That being said, let's consider the question that was implied: Does Medicaid pay for everything?

The answer is that Medicaid never pays for "everything." In a nursing home, the client is going to need many things that Medicaid will not pay for (including rudimentary things like CLOTHING). If a patient is entering an assisted living facility under long-term care diversion, income will definitely be required to pay for room and board expenses plus any additional levels of care that may be required in the future. In short, I believe it is very, very bad advice to simply spend down without exploring reasonable methods to preserve funds for the care receiver's benefit. It is true that some of these methods may also preserve a portion of assets for heirs, but that certainly is not always the case.

In my view, the most effective planning is that which coordinates the client's own resources along with public benefits so he/she can age in place for as long as possible with as much dignity and financial peace of mind as possible. There are several methods to preserve a portion of the patient's assets for their use while still being able to qualify for Medicaid immediately or within relatively short periods of time. I encourage all of you confronted with these matters to not go blindly down the path of spend down.