Responsibilities for financing nursing home care: Individual motivations for material wealth transfer

This study explores individual motivations for the divestment of assets to qualify for Medicaid nursing home benefits. Medicaid is a means-tested health insurance program that provides benefits to individuals determined to be impoverished according to income and asset criteria. With Medicaid estate planning (MEP), an individual\u27s assets may be divested in order to preclude consideration of such assets in determining eligibility for Medicaid. Despite strong interest among policymakers, very little empirical research has examined individual behaviors in MEP. ^ Accordingly, the primary objective of this qualitative, exploratory study was to apply a theory-based approach in identifying primary individual and social-level factors related to MEP. Research questions include: What are the individual and social level factors that influence material wealth transfer behaviors in the context of Medicaid long term care (MEP)? Do the following factors play a role in MEP: perceived individual rights to material legacy, individual rights to inheritance, perceptions of government responsibility to provide long term care and social norms of filial responsibility? ^ Eighteen focus groups were completed, with a range of 5–12 participants per group, for a total of 155 participants. Groups were developed to ensure representation from individuals with differing race/ethnicity, experience with the long term care, and socioeconomic status. Transcripts were analyzed with QSR NUD*IST 4.0 software. The data illuminate the complexity of MEP by identifying relevant social norms (bequests, inheritance and filial responsibilities), attitudes (toward nursing home use and financing) and perceptions of control (actual control, perception of control and desire for control). A number of potential disincentives and incentives to MEP were identified by individuals presently using or anticipating use of long term care. The focus group approach generated new insights, as the perspectives of older individuals living in the community and their families have not been represented in the research to date. The study also demonstrates the value of the theory of planned behavior in organizing qualitative inquiry. Implications for policy address: (a) regulation of Medicaid estate planning, (b) Medicaid as a middle class program, (c) Evolving norms of shared responsibility, (d) estate recovery policy and (e) changing nature of bequests.