While Medicaid pays for 59% of long-term elder care in the US (its largest category of spending by far), when the program was created it was intended as a “payer of last resort” — a form of insurance that takes over for poor seniors or, as is often the case, senior citizens made poor by their long-term care. With the average cost of a nursing home in New York reaching $128,000 per year, twice the cost of college, Medicaid is an inevitable fact of life for even successful retirees with what seemed like perfect estate planning.

Due to its need-based mandate, Medicaid has notoriously stringent criteria for eligibility, including hard limits on income (zero – any incoming payments must go directly to Medicaid), assets (no more than $14,200 in cash or investments), and gifts, both given and received. These rules became stricter after the Deficit Reduction Act of 2006 (which also made bankruptcy a more difficult, painful process) and will likely be tightened again in the next few years through the currently proposed health care reform. Read more…