AARP The Magazine - March/April 2010

the Kaiser Commission on Medicaid and the Uninsured, those dollars are dwarfed by the $60 billion Medicaid spent on institutionalized care in 2006.

Some advocates see Medicaid’s complicated spend-down policies (which vary from state to state) as part of the problem and want to get Medicaid out of the long-term-care business. “The disadvantage of Medicaid’s funding long-term care is that it is a poverty program that has limited public access and fragmented services,” says Steven P. Wallace, Ph.D., associate director of UCLA’s Center for Health Policy Research. Others have proposed that Medicare provide long-term care as a benefit, in much the same way it provides the Part D drug benefit today. Still others want a national long-term-care insurance program, something like the CLASS Act proposed by the late senator Edward Kennedy. (See box, opposite.)

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eanwhile, back in Massachusetts, Roberta still wrestles with her agonizing decision to divorce her husband so he could qualify for Medicaid. She has found some peace in the realization that “marriage means more than a piece of paper.” Her love and devotion to Alex have not diminished, and she visits him every day in the nursing home, giving him the latest news about their children. Totally incapacitated now, both physically and mentally, Alex will never improve or return home. But Roberta is grateful for the time they have, as well as the peace of mind that comes with knowing her own future is secure. “I’m grateful I still have my home and enough savings so I won’t be dependent on my children,” she says. “But the real question is, why should health care have to end up in the courts? What kind of a system is that?”;