Who is Medicaid for?

“Isn’t Medicaid for poor people?”

“If your business is helping people apply for Medicaid, how do you get paid?”

I’ve heard these and similar comments a number of times. They are often the first questions after I explain what I do. Most people know that Medicaid is a social safety net program providing health insurance to people with very low incomes. If my clients are already poor, how does this work as a business?

Although providing health insurance to those with low income is a big and important part of Medicaid, it is not the only part. Medicaid also pays for the long-term care of elderly people—even those who have middle-class income and assets, if the cost of care exceeds their income. In fact, Medicaid pays for 50 to 60% of all long-term care costs in the United States; it’s the de facto long-term care insurance plan for the middle class. That’s the part of Medicaid I deal with.

Think of it this way: when facing a health care bill of $9,000 per month, we’re all poor.

Or consider that nearly a third of people turning age 65 will deplete their savings and need to rely on Medicaid. Full stop. In other words, one third of seniors 65+ are or will be poor by Medicaid’s standards.

As AARP puts it:

Medicaid provides a critical safety net not only for low-income people, but also for formerly middle-income people who have spent their life savings paying for long-term services and supports.

So most of my clients are, in fact, middle-class. They come to me once they know they will need long-term care. They look at the cost of a nursing home, look at their life’s savings, and face a simple fact: they may not be poor yet, but they will be. Someone tells them they should look at Medicaid. That’s when they know they need help.

My clients still have money, but are seeing it evaporate rapidly. Without any legal help, they will lose nearly all their savings—they’ll end up with $2,000 if single, or somewhere between $50,000 and $128,000 if they have a spouse. The rest of their money is going away—to pay for one more nursing home bill before Medicaid kicks in, if nowhere else.

My job as a lawyer is to help my clients be proactive. With planning, I can often ensure a good amount of that evaporating money is saved for the spouse, is saved for the family, or is used to provide for my clients’ future needs.

My job is also to take the worrisome task of the Medicaid application, do it well, and do everything in my power to make sure the process goes smoothly. Sometimes I catch and solve problems that would have left a client both penniless and ineligible for Medicaid. When one mistake on a Medicaid application could cost tens of thousands of dollars, it’s worth hiring an attorney to make sure it’s done right.

Even so, often the most valuable thing I do is give my clients peace of mind and clarity. With Medicaid, it’s hard to know just what you can and can’t do, what will and won’t happen, and what resources you can and can’t keep. I answer those questions.

Medicaid is not just for poor people. It is, increasingly, for the elderly middle class who have no other options.