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“Systematic Lies” Improvising Poverty for Government Assistance

By Yaw Appiadu, MPH

“I worked hard all my life and now the government is using that against me!”

I have heard comments like this many times before from those that come to me for help, their voices filled with frustration. I have been assisting the aged, blind, disabled and their families with Medicaid applications for over two years. Most of the time,  families contact my organization when they hit a financial crisis based solely on spending their life savings on homecare services or when they can no longer afford medical services. “I can’t afford that!” cried an 87-year-old woman after realizing how much she needs to pay for spend down in order to get Medicaid. Many people like her face a dilemma: forgo medical services or face impoverishment to get the help they need. When an individual refuses medical care exclusively because of concerns over cost, his or her quality of life declines substantially. When a consumer says, “I can’t afford that,” what do I do as a Medicaid enroller?

  1. Urge the consumer to apply for Medicaid despite the anticipated spend down amount? or
  2. Let them go home without having the necessary care they need?

Most of the time, it usually comes down to advising the consumers on the benefit of having health insurance. Continuous care for the aged, blind and disabled is an integral part of making sure they stay out of a nursing home. Physicians are able to detect health issues at the initial stage for an early intervention. The yearly cost of New York State nursing home can range upwards of $150,000 (See Fig.1 below) as compared to the average yearly cost of $50,000 for homecare services. One might think that the Department of Health will adequately fund advocacy groups and independent living centers to educate people on the benefits of homecare services, its cost effectiveness and also guide them through some of the programs like pooled trust (a trust that allows you to become financially eligible for Medicaid).

Fact: Homecare services are very expensive. It is easily possible for a middle class family to spend their lifetime savings on homecare services in a short time. The monthly Medicaid eligibility income for a household size of two is $1,209. Any excess income made by an applicant would have to be spent down on healthcare before Medicaid kicks in. A couple with monthly expenses more than $1,209 is left with a difficult decision:

  1. Cut down their expenses and apply for Medicaid or
  2. Live life without the necessary health care.

Homecare includes skilled nursing, medication management, nutrition therapy, physical therapy, occupational therapy, speech therapy, and other rehabilitative services for consumers in the comfort of their home. Medicaid can also provide help with daily activities like eating, bathing, and dressing. Many families prefer getting homecare services to nursing homes but the spend down cost they face even after Medicaid approval makes it difficult for them to continue to live in their home.

Many families are forced to contrive or improvise poverty to get the services they need without going broke. Medicaid eligibility is not only based on your monthly or yearly income but on resources as well. So think of it, a couple that worked hard to secure their future and now have IRA’s, savings, annuities, stocks, bonds, mutual funds, trust accounts might not qualify for Medicaid if their resources are over $21,750. The big question is this: is the system forcing the aged, blind and disabled into poverty to get the services they need?

Many people hire lawyers to redistribute their income and resources to become eligible for Medicaid. I call it “Systematic Lies.” Let us pretend we are poor to get the services we need from the government. They usually have two options;

  1. To get poor systematically (Spend their lifetime resources/savings on the services they need)
  2. Systematically impoverish themselves (Legally pretend they are poor to get the services they need)

Although people are becoming wise to the best ways of gaining eligibility for government assistance without being penalized for things which they labored for their entire lives, the laws are not keeping up with them. “Systematic Lies” is the new norm.

Fig 1

(NYS Department of Health, 2015)


New York State Department of Health. 2015. Estimated Average New York State Nursing Home Rates. Retrieved from

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