LTC Bullet: Who Gets Medicaid LTC?

Friday, October 9, 2026

Seattle—

LTC Comment: The incomes and lifetime earnings of people receiving Medicaid long-term care benefits may surprise you, after the ***news.***

*** HEALTH AFFAIRS, the prestigious peer-reviewed health policy journal, published an article titled “Medicaid Asset Limits And Enrollment Among Older Adults And People With Disabilities” by Andrew Anderson, et al., in its June 2026 issue. In its current issue, Health Affairs published my letter to the editor critiquing that article, and the author’s  reply to my letter. All of this is behind a paywall and restricted, but here’s a snippet from my letter and one from Dr. Anderson’s reply to give you the flavor of the exchange.
Moses: “A more relevant line of inquiry would examine both why people with substantial assets can qualify for Medicaid long-term care at all and how policy design might better align the program with its intended role as a safety net for those most in need.”
Dr. Anderson: “We agree that future research should examine how eligibility rules, long-term care financing, and access to care interact, including whether current policies best serve people with the greatest needs.” ***

*** ILTCI ’27: The Intercompany Long-Term Care Insurance Conference for 2027 will convene March 14-17, 2027 at the JW Marriott Indianapolis. Conference organizers have made available the 2027 ILTCI Exhibitor & Sponsor Prospectus. They report: “We’ve welcomed more than 1,000 attendees two years running, and the room is full of long-term care insurance decision makers. If your goal is to get in front of the people who decide, this is where to be.” We will keep you apprised of details about attending ILTCI ’27 as they become available. ***
 

LTC BULLET: WHO GETS MEDICAID LTC?

LTC Comment: People must have extremely low income to qualify for Medicaid LTC benefits. At least, that’s what I read constantly in the media. Count me dubious. There is nothing in the Medicaid law or regulations that requires such a stringent standard.

So I asked Gemini AI: “What percentage of people who receive Medicaid LTC benefits have incomes in each of the five income quintiles?”

Here’s the answer I received:

“Income of Medicaid LTC recipients by quintile

“According to data from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE), Medicaid long-term services and supports (LTSS) beneficiaries are distributed across lifetime income quintiles as follows:

• Lowest Quintile: ~48%
• Second Quintile: ~22%
• Middle Quintile: ~15%
• Fourth Quintile: ~10%
• Highest Quintile: ~5%

“While Medicaid is a means-tested welfare program, individuals in higher lifetime income quintiles can qualify for Medicaid LTC coverage due to high long-term care expenses relative to their income, spending down assets to meet state eligibility thresholds, or utilizing Medicaid eligibility rules and spousal protection allowances.”

I followed up with this query: “What are the cash amounts for each income quintile?”

Answer: “In research by the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) regarding long-term services and supports (LTSS), income quintiles are typically evaluated using lifetime earnings (adjusted for inflation).   

Because annual income fluctuates significantly in retirement, ASPE measures lifetime income based on total career earnings over 40 years. The cutoff dollar amounts for older adults (converted into estimated average annual lifetime earnings) for each of the five quintiles are:   

• Lowest Quintile (Bottom 20%): Under $37,100 per year (under $1.48 million total lifetime earnings).   
• Second Quintile (20%–40%): $37,100 to $61,100 per year ($1.48 million to $2.44 million lifetime).   
• Middle Quintile (40%–60%): $61,100 to $85,690 per year ($2.44 million to $3.43 million lifetime).   
• Fourth Quintile (60%–80%): $85,690 to $118,830 per year ($3.43 million to $4.75 million lifetime).   
• Highest Quintile (Top 20%): Over $118,830 per year (exceeding $4.75 million total lifetime earnings).   

LTC Comment: So, what can we make of this information? Thirty percent of Medicaid LTC recipients are in the top three quintiles of annual income, between $61,100 and $118,830 and above. The same 30 percent have lifetime earnings between $2.44 million and $4.75 million and above. Adjusting for inflation since their derivation, these numbers would be substantially higher today.

We can conclude that (1) relatively high income does not obstruct Medicaid LTC eligibility and (2) lifetime earnings of many people receiving Medicaid LTC benefits were high enough that they could have easily purchased private LTC insurance.

This brings us back to the big question. Why don’t people worry about LTC and plan for it? The answer is pretty simple. If they ignore LTC and the time comes when they need it, Medicaid pays for any catastrophic costs. That’s the perverse incentive built into LTC public policy that leaves most people unprotected privately and reliant upon public assistance.

The ramifications go far beyond merely trapping so many otherwise financially responsible people on welfare-financed LTC. Medicaid’s extremely low LTC reimbursements—about 70 percent of private-pay rates—drag down access to and quality of care for everyone, the affluent and the poor alike.

To make sense of what ails LTC, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. To find ample private funds for LTC, check out “Medicaid’s $100+ Billion Leak.” For what not to do, see “Medi-Cal-amity: California’s Reckless Expansion of Medicaid Long-Term Care to the Affluent.” See also “Better Long-Term Care for Billions Less.” Much more on long-term care here.