What is it like for families with elders to spend down to Medical Assistance?

Marlene S. Stum, Ph.D. Family Social Science

It is one thing to understand the technical descriptions of Medical Assistance eligibility criteria, but what is it really like emotionally and financially for elders and their family members? Many elders and their family members are facing poverty for the first time in their lives. For them, the experience of spending down to Medical Assistance can be new and overwhelming. If you are likely to spend down to Medical Assistance or work with families who will, keep reading!

First, some definitions:

Medical Assistance (also called Medicaid or MA) is a state and federal government program that offers a safety net and provides long-term care benefits. Medicaid eligibility requires an individual to meet poverty-level means-tested criteria for both income and assets. If an elder is married, their spouse is allowed to keep selected types and amounts of income and assets to help protect the other spouse's future financial security.

Spend down is depleting private or family finances to the point where an individual is sufficiently poor to meet the eligibility criteria for Medicaid. The spend down process and transition to poverty can involve multiple losses, including loss of control, choice, and dignity for elders and their family members.