Medicaid was passed into law in 1965, back when Lyndon B. Johnson was President. At age 60, I am old enough to remember LBJ. Many of you who are reading this had not yet been born.
The cost of living was a lot less then than it is now. First-class stamps and candy bars both went for a nickel. You could fill up your tank with gas that cost $.30 a gallon. You could buy a full-sized new car for around $3,000. And when Congress and the President decided on how much a nursing home resident should be able to keep from his or her income toward meeting personal needs, they decided that $30 per month would be a fair allowance.
Fast forward to 2014. First-class stamps now cost $.49. Most convenience stores now charge a dollar or more for candy bar. Gas costs around $3.50 per gallon. Most full-sized cars cost upwards of $25,000. But the Medicaid personal needs allowance is still stuck at $30 per month for an Illinois nursing home resident. In an uncharacteristic show of compassion, Missouri recently raised its personal needs allowance to $45 per month.
So what is it that the $30 (or $45) is supposedly enough for a nursing home resident to be able to pay for? Let’s start with hair care. Unfortunately, for many women, that alone can consume the entire allowance. But the list certainly does not end there. It also includes all clothing and shoes, toiletries and personal care items, any food other than what is provided by the nursing home, telephone service, cable or satellite television service, books and magazines, eyeglasses beyond one pair every two years, hearing aids and hearing aid batteries, dental work, and essentially anything else other than the food, shelter and medical care that are furnished to nursing home residents.
It seems fair to suggest that there is no way that anyone can only be expected to pay for all of those things on $30, or even $45, per month. Of course, a nursing home resident cannot “dip into savings” to pay for those things either. In order to apply successfully for Medicaid long-term care benefits, an Illinois nursing home resident must have $2000 or less in assets; the asset limit is only $1000 in Missouri.
Many people who are not familiar with the Medicaid personal needs allowance and asset limit harbor the unfortunate misimpression that the primary goal of legal planning directed toward protecting a portion of an elder’s life savings from Medicaid spend- down is to benefit the elder’s adult children. At least as practiced at Dent-Coulson Elder Law, that is never the case. Our client, when we are hired to assist with planning, is always the elder. Our first goal is always to ensure that our client can continue to maintain a decent human existence. Respectfully, $30 (or $45) is nowhere near enough for that to happen.
We are blessed to be given the opportunity to enable many elders to be able to afford to maintain a decent existence during the final years of their life, if they have to spend them in a nursing home. But not every elder is able to have the benefit of good and caring legal help, and not every elder has family members who are both willing and able to help subsidize their needs out of their own pockets. There are people in nursing homes in Illinois who continue to be forced to live on $30 per month, or in Missouri on $45 per month.
The amount of the Medicaid personal needs allowance is determined legislatively in each state. Thus, at any time, the Illinois or Missouri legislature could choose to enact an increase. To the credit of the Missouri legislature, they have already done so to some extent. Granted, $15 is not a lot of money, but for a nursing home resident who has had to choose which basic necessities of life to do without, it is a meaningful increase.
If you believe that your state’s Medicaid (MO Healthnet in Missouri) personal needs allowance for nursing home residents should be increased to an amount that more closely reflects the current cost of the items that nursing home residents are personally responsible to pay for, we encourage you to contact your state representative or state senator, or both, to make known your views.