House leaders and some governors have framed the House Medicaid budget reconciliation bill as "making it difficult for more affluent seniors to transfer their assets to relatives, then plead poverty to get Medicaid to pay for them to stay in nursing homes" ["Medicaid Cutbacks Divide Democrats," front page, Nov. 28]. Who, after all, would support the well-off taking advantage of a program intended for the poor?

Like other provisions in the House bill, however, this one would reduce Medicaid costs by ensuring that many people who need help wouldn't get it.

While its Senate counterpart would prohibit practices that people could use to avoid spending their assets for nursing home care, the House bill would make nursing home residents account for every dollar they spent in the five years before their savings ran out -- years in which they did not anticipate a disabling stroke, a broken hip or the onset of Alzheimer's disease. A gift to a charity, a tithe to a church or help for a needy family member would disqualify these people from receiving Medicaid until they paid an equivalent amount to the nursing home, even if they had no money.

Think state governments wouldn't allow people to be thrown out of nursing homes without regard for what happens to them? Ask some 90-year-old widows in states such as Georgia and Kentucky, where Medicaid eligibility rules were changed suddenly.


Director of Public Policy

National Citizens' Coalition

for Nursing Home Reform