Ethical Dilemma

Is Medicaid Designed to Protect Inheritances?

FACTS Mrs$.$ Singer is a seventy$-$eight$-$year$-$old widow.

Although she remains somewhat active and lives in her own

apartment, her physical and mental abilities are declining.

She fell recently and needs assistance with bathing and some

routine chores.

Mrs$.$ Singer has two children, a son, Steven, who lives

within fifteen minutes of her home, and a daughter, Kate,

who lives a great distance away. While Mrs$.$ Singer sees

Kate only once a year, she remains in close contact with Ste$-$

ven, who does her grocery shopping, takes her to the doc$-$

tor, and provides transportation, thereby enabling Mrs$.$

Singer to maintain some social life.

Steven has become increasingly concerned about his

mother's declining condition and is unsure how much longer

she can remain in her apartment. Steven has consulted his

lawyer, who suggested that Mrs$.$ Singer give Steven a dura$-$

ble power of attorney authorizing Steven to manage most of

her financial affairs. It would also give Steven the power to

transfer Mrs$.$ Singer's assets to himself so that Mrs$.$ Singer

will qualify for Medicaid should she need to enter a nursing

home. Steven's lawyer explained that in order to qualify for

Medicaid, Mrs$.$ Singer must meet asset and income limits

that are quite low.

Mrs$.$ Singer has substantial assets. She has a portfolio of

investments in stocks, bonds, and certificates of deposit

worth more than $$700,000.$ The durable power of attorney

would enable Steven to strip Mrs$.$ Singer of her assets within

the time frame necessary to allow the declining Mrs$.$ Singer

to qualify for Medicaid.

Mrs$.$ Singer has agreed to execute the power. But Kate

objects to the plan. She does not get along with Steven, does

not trust his judgment, and is concerned that he will not

properly share his mother's assets.

Social, Policy, and Ethical Considerations

Is it ethical for Steven to execute the power of attorney in

an effort to enable his mother to qualify for Medicaid?

Should Medicaid be available only to those with low

income and few assets? Could a national health care

plan provide a solution?

What role, if any, should private insurance play in pro$-$

viding a safety net against the catastrophic costs of nurs$-$

ing home care?

What questions of family ethics does a plan such as

Steven's raise?