A lot of Americans stand four-square for individual responsibility -- up to a limit. They reach their limit when a parent enters a nursing home.
Woe betide the state that asks an adult child to help pay the nursing-home bill, as a couple of states have recently found. Suddenly, you hear the squeals of a stuck pig. Mama isn't our responsibility, they cry; let Medicaid (meaning the taxpayer) pay.
Luckily for the taxpayers, the vast majority of older Americans don't need nursing homes. Either they make it on their own or their children take care of them voluntarily. Many adult children make a considerable personal and financial sacrifice to keep their older parents at home. Others, of course, don't.
State budgets feel the strain the most. When an elderly nursing-home resident runs out of money -- as most of them do within a year -- state-financed Medicaid picks up the bill. Some Medicaid money comes from the federal government, but the Reagan administration has steadily been putting the squeeze on these funds.
As a result, the states have cut back on some services, while also scrounging for new sources of funds. One likely source is the well-to-do offspring of parents on Medicaid. In some cases, these children got substantial monetary gifts from their parents before the parents went on Medicaid. Had the parents kept the money, they could have paid their own nursing-home bills for a while, instead of becoming instantly dependent on the state.
Medicaid can be refused to an elderly parent who transfers property to children within two years of applying for medical assistance. But gifts of up to $10,000 or so can usually be made without question; larger gifts may also be okay, if they're part of a reasonable estate plan and not made merely to qualify the parent for Medicaid.
In other cases, the children might stand to inherit a house, a farm or other property that the state's Medicaid rules allow the senior to keep.
"People say that the state should take care of mother," says retired Idaho state senator John Barker, who helped write that state's now-moribund law on filial responsibility. "I argue that the family shouldn't get the farm until they take care of their mother and father."
When Medicaid first began, in the mid-1960s, a number of states looked for financial assistance from children who were financially capable. The nursing homes solicited contributions to supplement the welfare payments made for the elderly parent's care. But this approach gradually was phased out, and it became illegal to make such requests.
But a number of states objected, and the Reagan administration recently reinterpreted the rules. On paper, it's now all right for a state to ask for help from children, as long as the plan meets certain technical rules.
Unfortunately, it has become much more difficult than expected to meet the requirements. "Politically, the administration got cold feet on this issue," Barker told my associate, Virginia Wilson.
In Idaho, family contributions were set according to ability to pay, with escape clauses for families with special expenses such as children in college. Barker estimates that about 15 to 20 percent of the families could afford to pay some modest part of the bill.
But Idaho's attorney general recently ruled that the law contravened murky federal rules, and offered the families a refund. Half of them let the Medicaid system keep the money, as token assistance to their parents; the other half took their money back. Idaho maintains a general fund for voluntary, tax-deductible contributions to Medicaid, but hardly anyone pays any attention to it.
Mississippi is facing a similar setback. There, the state subtracts one day of Medicaid payments a month for each nursing-home patient; the home then tries to collect the missing payment from the patients or their relatives. No one is refused Medicaid if the family doesn't contribute. Nevertheless, most patients and families have been paying the requested $30 to $45 a month, according to Peggy Seale, of Mississippi's Medicaid program.
But the federal government ruled against the program, again on arcane technical grounds. It's on appeal, but the state hasn't much hope of winning.
Several other states have tried and failed to get children with money to contribute to their parents' nursing home bills. But this issue isn't going to go away. It is decent and right for financially capable children to offset the welfare cost of caring for their parents. Eventually, the burdened taxpayer will demand that they pay.