Jackie Sartoris

Jackie Sartoris

“Is that all?” Her voice rises in panic. I move the phone a bit away from my ear.

“Well, that’s the rule, although there are exceptions. You can have about $120,000 in financial assets …” She cuts me off. “I’m younger than my husband! How am I supposed to pay for my own care if I spend most of our savings on his?”

It’s a good question, and one I hear frequently working with elders. Right now, if one spouse needs nursing home or assisted living care, the couple won’t qualify for help from Medicaid — known as MaineCare — if their financial assets exceed about $120,000. A home, car, and some other kinds of assets are generally exempt. Income continues to flow to the spouse at home up to a certain amount, and assets can be converted to income, but a widowed or single person cannot have significant, available assets and qualify for state aid. Deeding property or giving assets to family members can disqualify the elder from receiving financial help during a penalty period.

It puts Maine elders who’ve lived frugal, careful lives in an unfamiliar, uncomfortable position. At up to $10,000 a month, watching a lifetime of savings evaporate in months is scary, especially if an age gap or substantial health difference means that one spouse will live independently for a long time after the other enters nursing care. Facilities whose clients go on MaineCare watch their bottom lines evaporate, too, as the reimbursement rate paid for by the state is much lower than the private pay rate.

The system for caring for elders today is challenging. With Maine’s population now the oldest in the nation, our state struggles to keep up with retirement and nursing care costs even without the baby boom bulge. Our elders need more financial support to age in place, which they overwhelmingly want, and which happily saves public resources — if we invest them wisely. Our local aging agencies, struggling for years with flat funding, need more staff to meet the challenge as more seniors and their families seek information and support. Our demographics and relative poverty already put Maine at risk even with the current federal Medicaid program. We need more help, not less.

Instead, proposals in House Leader Paul Ryan’s Affordable Health Care Act (aka “Trumpcare”), those in the Trump budget, and the tendency of Governor LePage and DHHS Commissioner Mary Mayhew to prefer tax cuts over vital social investments is shaping up to provide a massive blow against the elder families of Maine.

The proposed federal budget breaks repeated promises that candidate Trump made not to cut Medicaid, Medicare, or Social Security. The budget would cut federal spending on Medicaid, $800 billion over a decade, leaving it to states to fill the gap. Medicaid currently provides a guaranteed federal share per person, regardless of how many seniors become eligible. The proposed budget would likely devastate the ability for elders and their families to pay for institutional care while also caring for a parent left home, and likely decimate the number of facilities providing such care. The lost federal funding would be unaffordable for our relatively poor state to shore up.

The federal proposal would also give states more flexibility to make qualifying for benefits harder. One goal, long advocated by LePage and Mayhew, is that MaineCare beneficiaries — even the disabled — should be required to work or lose their benefits. Working for nursing home benefits clearly can’t be proposed for elders, but reducing the savings a family can keep for a senior still living at home? That seems more far more likely if a Republican succeeds LePage with Republicans in charge in D.C.

Where will the money go? The budget has the money diverted from longstanding federal investments in our elders going to the wealthiest Americans in the form of tax cuts. Including, in a bit of irony, ending the estate tax, which opponents cleverly term the “death tax,” and claim will harm family farms. The estate tax applies, right now, only to the tiny portion of estates that exceeds $5.5 million for an individual, $11 million for a couple. Almost no one pays this tax – fewer than .02% – but for those 5000 per year, their families will pocket $268 billion over 10 years. You could call that a death windfall.

Maine elders paying nursing home costs often ruefully note that their children “will get nothing” once they’re gone. “We don’t need anything,” is the response I hear, over and over, even from middle-aged children of very modest means. “It’s for your care.” While there are legal ways to put resources aside, for most Mainers, caring for their elders comes first, even at the cost of an inheritance.

It’s an ethic those in control in D.C. don’t seem to share.