Keep means testing, but expand home care

Keep Medicaid LTC but end waitlists and raise asset limits.

Draft decision:ChosenPhase 0: PreparationConfidence: medium · not yet reviewed

Ends home-care waitlists now.

How this path connects

Addresses

This path

Keep means testing, but expand home care

Creates or worsens

No new problems identified.

What would actually have to change in law, agencies, payment rules, or systems.

Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.

What it fixes

Long-term care requires spending down to poverty
Raising Medicaid asset limits and expanding home care ends waitlists at lower cost than universal long-term care insurance. Spend-down remains, and the middle class remains unprotected.
Longer waits if demand grows faster than capacity
Expanding Medicaid home care ends waitlists for those services.

What it creates or worsens

None identified.

Who gains

Older adults
- Long-term care requires spending down to poverty: Coverage rules require exhausting savings and leave people waiting for home care.
Older and disabled people needing long-term care
- Long-term care requires spending down to poverty: Coverage rules require exhausting savings and leave people waiting for home care.
Family caregivers and affected families
- Long-term care requires spending down to poverty: Home-care waiting lists leave families providing care.
Low- and middle-income households
- Long-term care requires spending down to poverty: Raising Medicaid asset limits and expanding home care ends waitlists at lower cost than universal long-term care insurance. Spend-down remains, and the middle class remains unprotected.
People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
People with ongoing or specialist care needs
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.

Who loses

Hospitals, clinics, and care organizations
- Long-term care requires spending down to poverty: Institutional coverage bias benefits nursing-home operators.
Elder-law planners
- Long-term care requires spending down to poverty: Spend-down rules create demand for elder-law planning.
Taxpayers and public budgets
- Long-term care requires spending down to poverty: Raising Medicaid asset limits and expanding home care ends waitlists at lower cost than universal long-term care insurance. Spend-down remains, and the middle class remains unprotected.