Aided by their scheming attorneys, too many people have become adept at tricking taxpayers into paying for their nursing home care, a consultant for the nation's long-term care insurance companies said Thursday.
"Only the suckers pay," said Stephen Moses, president of the Seattle-based Center for Long-Term Reform Inc.
In Kansas, roughly one-third of the state's nursing home residents pay for their care. The remainder are on Medicaid, experts said.
There's little to stop people from hiding their assets in ways that make them eligible for Medicaid, Moses said.
"Medicaid is no longer this nation's safety net for the truly needy," he said. "It's become an inheritance protection program for the rich and middle class."
It's no surprise, he said, that Medicaid, a blend of state and federal monies, is going broke.
Moses' comments were part of a half-day conference for legislators and state officials at the Robert J. Dole Institute of Politics on Kansas University's west campus. His appearance was co-sponsored by the Kansas Health Care Assn., a group representing the state's for-profit nursing homes; and Flint Hills Center for Public Policy, a conservative think tank.
When asked how many Kansans were bilking the system, Moses said he didn't know. He noted that a recent survey in Nebraska found few instances of egregious asset-shifting.
But, he said, many once-prosperous farmers were on Medicaid after their sons and daughters assumed ownership of the family farms. These family members, he said, are not obligated to pay their parents' nursing home bills.
The big-city rich, he said, hide their assets in home equity, new cars and term life insurance policies, all of which are exempt from Medicaid eligibility calculations.
"Heaven forbid that anyone pay for their own care," Moses said. He urged legislators to look for ways to encourage middle-age Kansans to buy long-term care insurance as a solution to the problem of curbing Medicaid costs.
Kansas Insurance Commissioner Sandy Praeger attended the conference. Moses' scenarios, she said, were based more on anecdote than fact, especially as they apply to Kansas.
"I don't think we have people in Kansas abusing the Medicaid program, as indicated," said Praeger, who lives in Lawrence. "There may be some, but I don't think it's a high percentage."
That's not the case in California, said David Slack, a Lawrence-based consultant on aging issues.
"Out there, you can look in the Yellow Pages and you'll see full-page ads for people who'll help you hide your mother's assets so that as soon as she needs a nursing home, she'll be eligible for Medicaid," Slack said. "I've never understood why the state and federal government haven't been more aggressive in going after them."
States often file liens on the homes, cars and estates of nursing home residents on Medicaid in hopes of recovering part or all of their costs, Slack said.
"We're pretty aggressive," said Scott Bruner, Medicaid director within the Kansas Department of Administration. "Last year, we collected $5 million - our biggest year ever."
Praeger has been reluctant to advocate for long-term care insurance because, she said, "problems in the marketplace" have resulted in fiscal instability, disputes over coverage and unexpected jumps in premiums.
Sen. Chris Steineger, D-Kansas City, argued that Moses' plan would do little to control health care costs.
"This doesn't lower costs; it just shifts the cost from government onto people," Steineger said. "That doesn't solve anything."
Molly Wood, an elder-law attorney in Lawrence, scoffed at Moses' platform.
"It's true, what he's saying could happen," she said. "But does it happen? No. Do you really think people with assets are going to give away those assets so in three years they can go on welfare and live in a nursing home? As an elder-law attorney who's dealt with probably 3,000 people on this very subject, I can say that's not been my experience."
She added, "Kansans don't do that."
Not so, said Rep. Judy Morrison, R-Shawnee.
During a question and answer session, Morrison, a conservative, announced that she and her husband intend to shift their assets in ways that will protect their daughter's inheritance.
Morrison, 64, said she and her husband have worked too long and hard to let the government deplete their daughter's inheritance to pay for their nursing home care.
Going on Medicaid, she said, would not cause her to "feel guilty."