and friends is expected to incur the financial burden. Out-of-pocket spending in 1998 covered about 26 percent of long-term care. (Feder, Komisar, and Niefeld). Once savings are nearly diminished, Medicaid then becomes an option. Medicaid is explicitly responsible for financing long-term care for persons with low incomes, including those who become poor as a result of spending on medical or long-term care. Federal rules entitle elderly and disabled persons to Medicaid benefits if their incomes and assets are low enough to qualify them for the federal Supplemental Security Income. Enacted in 2000, it is a cash assistance program for those with an income of no more than $532 per month, and nonhousing assets less than $2,000 for individuals. (Schneider, Fennel, and Keenan) Medicaid has become the primary source of financing long-term care, in 1998 it accounted for 40 percent of national nursing home and home-care expenditures. (Feder, Komisar, and Niefeld) Of the estimated twelve million people in the U.S. needing long-term care, about half are under the age of sixty-five. These include those with physical disabilities; persons with developmental disabilities; and persons with chronic diseases such as diabetes, emphysema, and AIDS. Medicare covers disabled persons under age sixty-five, however, only after they have received Social Security disability benefits for two years. Only 33 percent of the home-dwelling population ages eighteen to sixty-four with long-term care needs have Medicare coverage. About half have either private health insurance (28 percent) or Medicaid (25 percent). Ten percent of the long-term care population in this age group is uninsured. (Feder, Komisar, and Niefeld)The financial burden of a middle-income person needing long-term care is most often incurred by the person and their family. Stringent financial eligibility requirements, implemented on the state level, effectively exclude most middle-income persons from M...
