By NextBestFitLong-term care requires spending down to poverty
Medicare doesn't cover long-term care; Medicaid does only after people exhaust their savings. Hundreds of thousands wait for home-care services.
Evidence
- About 700,000 people on Medicaid HCBS waiting lists (2023).Sources: KFF (2024)
Who's affected
Who is hurt
- Older adults: Coverage rules require exhausting savings and leave people waiting for home care.
- Older and disabled people needing long-term care: Coverage rules require exhausting savings and leave people waiting for home care.
- Family caregivers and affected families: Home-care waiting lists leave families providing care.
Who gains while it lasts
- Hospitals, clinics, and care organizations: Institutional coverage bias benefits nursing-home operators.
- Elder-law planners: Spend-down rules create demand for elder-law planning.
Under your mix of paths
Paths that create or worsen it
Paths that fix or soften it
Using your saved plan. 0 paths picked.Edit all picks
Root causes
- No social long-term care insurance
- Medicaid's institutional bias
Related costs
Open questions
- Should long-term care be covered for everyone? Including room and board?
- Should family caregivers be paid?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Standardized needs assessment and tiered benefitsCovering long-term care can pull unpaid family care into the paid systemChosen
Tiered benefits with set care hours leave some long-term care needs unmet.
Solution paths (3)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Separate public insurance covering home and nursing care based on need, not income.
- +Long-term care requires spending down to poverty
- −Covering long-term care can pull unpaid family care into the paid system
- −Replacing premiums with taxes
Keep Medicaid LTC but end waitlists and raise asset limits.
- +Long-term care requires spending down to poverty
- +Longer waits if demand grows faster than capacity
Public coverage starts after, e.g., 2 years of need; private insurance or savings cover the first part.
- +Long-term care requires spending down to poverty
- −Solves only part of the problem