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.)
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?”;
Mary A. Fischer wrote about chronic illness in the January–February issue.