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Elderly Assets, Medicaid Policy, And Spend‐Down In Nursing Homes

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  • Edward C. Norton

Abstract

Recent economic research has suggested that Medicaid long‐term insurance may reduce the personal savings levels of elderly citizens. This analysis shows that the opposite behavior, due to welfare aversion, actually happens. Barring any behavioral effects, personal wealth and income alone should determine the length of time an individual must stay in a nursing home until spend‐down occurs. Wealth and income data from two different samples of the elderly are used to predict the distribution of time until spend‐down, which is then compared with the actual distribution of the time until spend‐down among residents of nursing homes. Contrary to expectations, it appears that the elderly receive transfers to avoid Medicaid eligibility. This result cannot be explained away by sample selection, demographics, or uncertainty about prices. One implication of this result is that Medicaid could expand eligibility by raising the asset limit without dramatically increasing expenditures or the number of residents who spend‐down.

Suggested Citation

  • Edward C. Norton, 1995. "Elderly Assets, Medicaid Policy, And Spend‐Down In Nursing Homes," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 41(3), pages 309-329, September.
    • Handle: RePEc:bla:revinw:v:41:y:1995:i:3:p:309-329
    DOI: 10.1111/j.1475-4991.1995.tb00122.x
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    Cited by:

    1. De Donder, Philippe & Pestieau, Pierre, 2011. "Private, social and self insurance for longterm care: a political economy analysis," IDEI Working Papers 719, Institut d'Économie Industrielle (IDEI), Toulouse, revised Jun 2014.
    2. David J. G. Slusky & Donna K. Ginther, 2021. "Did Medicaid expansion reduce medical divorce?," Review of Economics of the Household, Springer, vol. 19(4), pages 1139-1174, December.
    3. Helmuth Cremer & Pierre Pestieau, 2018. "Means‐Tested Long‐Term Care and Family Transfers," German Economic Review, Verein für Socialpolitik, vol. 19(3), pages 351-364, August.
    4. Junhao Liu & Anita Mukherjee, 2021. "Medicaid and long‐term care: The effects of penalizing strategic asset transfers," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 88(1), pages 53-77, March.
    5. William F. Bassett, 2007. "Medicaid's Nursing Home Coverage and Asset Transfers," Public Finance Review, , vol. 35(3), pages 414-439, May.
    6. Jonathan Gruber, 2003. "Medicaid," NBER Chapters, in: Means-Tested Transfer Programs in the United States, pages 15-78, National Bureau of Economic Research, Inc.
    7. Bridget Hiedemann & Michelle Sovinsky & Steven Stern, 2018. "Will You Still Want Me Tomorrow?: The Dynamics of Families’ Long-Term Care Arrangements," Journal of Human Resources, University of Wisconsin Press, vol. 53(3), pages 663-716.
    8. Bergquist, Savannah & Costa-Font, Joan & Swartz, Katherine, 2018. "Long-term care partnerships: Are they fit for purpose?," The Journal of the Economics of Ageing, Elsevier, vol. 12(C), pages 151-158.
    9. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    10. Pestieau, Pierre & De Donder, Philippe, 2013. "Private, social and self-insurance for long-term care in the presence of family help: A political economy analysis," CEPR Discussion Papers 9587, C.E.P.R. Discussion Papers.
    11. Michelle Sovinsky & Steven Stern, 2016. "Dynamic modelling of long-term care decisions," Review of Economics of the Household, Springer, vol. 14(2), pages 463-488, June.
    12. Lee, Daeyong, 2019. "Effects of the Medicaid expansion on low-income, childless household savings: Evidence from the Affordable Care Act," Economics Letters, Elsevier, vol. 181(C), pages 164-168.
    13. Jennifer L. Troyer, 2002. "Cross‐Subsidization in Nursing Homes: Explaining Rate Differentials Among Payer Types," Southern Economic Journal, John Wiley & Sons, vol. 68(4), pages 750-773, April.
    14. Goda, Gopi Shah & Golberstein, Ezra & Grabowski, David C., 2011. "Income and the utilization of long-term care services: Evidence from the Social Security benefit notch," Journal of Health Economics, Elsevier, vol. 30(4), pages 719-729, July.
    15. Darius N. Lakdawalla & Robert Schoeni, 2003. "Is nursing home demand affected by the decline in age difference between spouses?," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 8(10), pages 279-304.
    16. David C. Grabowski & Jonathan Gruber, 2005. "Moral Hazard in Nursing Home Use," NBER Working Papers 11723, National Bureau of Economic Research, Inc.
    17. Lara Gardner & Donna Gilleskie, 2006. "The Effects of State Medicaid Policies on the Dynamic Savings Patterns of the Elderly," NBER Working Papers 12208, National Bureau of Economic Research, Inc.
    18. Jeffrey R. Brown & Amy Finkelstein, 2009. "The Private Market for Long‐Term Care Insurance in the United States: A Review of the Evidence," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 5-29, March.
    19. William F. Bassett, 2004. "Medicaid's nursing home coverage and asset transfers," Finance and Economics Discussion Series 2004-15, Board of Governors of the Federal Reserve System (U.S.).
    20. Kristin J. Kleinjans & Jinkook Lee, 2006. "The link between individual expectations and savings: Do nursing home expectations matter?," Economics Working Papers 2006-05, Department of Economics and Business Economics, Aarhus University.
    21. Grabowski, David C. & Gruber, Jonathan, 2007. "Moral hazard in nursing home use," Journal of Health Economics, Elsevier, vol. 26(3), pages 560-577, May.

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