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THE BIG SECRET ABOUT MEDICAID: IT’S A MIDDLE-CLASS BENEFIT, TOO  
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Ron Lieber
March 21, 2025
New York Times
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_ If you have a parent short on savings, a disabled adult child or a
minor with special needs, Medicaid may be your backstop. Plenty of
people are unaware. _

Illustration: Robert Neubecker / New York Times,

 

“I never thought that Medicaid would become an issue in my family,
but it has.”

That was the first line of a note I received this week from a retired
investment industry veteran whose autistic son receives coverage from
the program. A similar email arrived from one of the most affluent
towns in California.

Yes, Medicaid primarily serves Americans with the lowest incomes, and
you may not count yourself among them.

But now that the program is potentially on the chopping block, as
Republicans in Congress seek to make up to $2 trillion
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spending cuts, it’s a good time to consider others who qualify.

It could be an aging parent who needs nursing home care, whose
significant nest egg has been drained after 20 years of retirement. Or
it could be a 26-year-old adult child who can’t be covered on your
health insurance anymore but is not yet making much money. Or perhaps
it’s a severely disabled child.

Millions of people who are financially comfortable now may be just one
bad break away from needing Medicaid for themselves or a member of
their immediate family. Without coverage, the cost of care for an
aging parent or a sick or disabled child — of any age — can be
ruinous.

Medicaid is a shield against anxiety for the luckiest among us. If
there is any chance your family could face enormous bills from
situations like the ones that follow, the Medicaid policy debate
affects you, too.

Long-Term Care

Medicaid pays for nursing home
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long-term care
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people who have mostly run out of money.
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not pay
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such care in most circumstances.)

Often, middle-aged people are astounded when they start helping an
aging parent or another relative and find that the median annual cost
of a semiprivate room in a nursing home is $111,325, according to
an annual survey
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Genworth, a company in the long-term-care planning business.

They’re relieved when nursing home employees tell them that their
parents will qualify for Medicaid once those parents draw down their
own funds (or already do qualify) — and it won’t cost the adult
children anything.

“This is everybody’s coverage,” said David C. Grabowski
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health care policy at Harvard Medical School.

Your 26-Year-Old Adult

One law that most people don’t appreciate until they hit their 20s
(or their child does) is a requirement
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health insurers allow most parents to keep that child on their plan
until the child turns 26, providing it offers coverage for dependents.

After turning 26, they’re on their own. And no matter how well-off
you are, it doesn’t guarantee that your 26-year-old will have
gainful employment, let alone the kind that has employer-provided
health insurance.

Enter Medicaid, which often covers individual adults who earn no more
than $21,597
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The website
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KFF, a nonprofit health research group, has a number of clear
explainers [[link removed]] on
various categories of eligibility. (Which state you live in can matter
a lot for all categories of Medicaid beneficiaries, and states
administer the programs.)

People in their 50s don’t usually boast about their 20-something
children being on Medicaid. I know of two recipients in my circle in
this category, because I inquire about such things. Ask around;
they’re probably in your circle, too.

The Disabled

For most children with an incurable but not fatal condition — and
many adults with a disability that prevents them from working or
earning much — there is usually at least one family member managing
some aspect of their care. But those family members may not be paying
for it.

If your minor child has, say, spina bifida or cerebral palsy, your
health insurance may not cover every therapy or the health aides who
will allow you to avoid becoming a full-time caregiver.
Medicaid often steps in
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pay for many such expenses, no matter how much the parents earn.

Some adult children with autism may not be able to work, drive to work
or live alone without a lot of help. But they may still want
independence. The assistance and aides necessary for them to live away
from family, though, may not be on the family’s dime. Medicaid pays
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expenses for those who are eligible, no matter their parents’
assets.

So if you’re pregnant or considering becoming a parent, Medicaid is
a likely backstop if your child ends up needing an enormous amount of
care. The same thing is true if your 20-year-old college student has a
disabling accident, your 25-year-old has a severe stroke and only
partly recovers or your 30-year-old has a life-altering mental health
diagnosis.

It may also be true if you want to adopt. When Kelly M. Smith and his
partner adopted two brothers from the Connecticut foster-care system
and moved them to North Carolina, the boys qualified for Medicaid and
stayed on it until they were young adults.

Later on, Mr. Smith’s grandmother turned 100 and could no longer
live alone. Medicaid paid for her nursing home care until she died.

“Medicaid supports everyone, including us upper-incomers,” he
said.

Mr. Smith sent me the loveliest picture of his family, and he wasn’t
the only one who shared snapshots. But the messages with some of those
photos were harrowing. When parents hear about the possibility of even
moderate Medicaid cuts, they are scared out of their minds. They’re
also teeming with rage at what they see as the cruelty of it all.

President Trump has promised
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to cut the program. Rhetoric around Medicaid “fraud, waste and abuse
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floats in the ether, but there is no formal legislative blueprint
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All we have for now are the statistics and the stories. The statistics
are these: Medicaid pays for roughly 50 percent
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services and support
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nursing homes and in-home care), according to KFF, and the program
covers more than 70 million people.

The stories are yours to tell — and to coax out of others who might
otherwise be disinclined to discuss a delicate part of their financial
lives.

“Talk about it. Celebrate it,” said Brittany van der Salm, who
spent years working for consulting firms that helped states improve
their Medicaid programs. “It’s something to be proud of. You’ve
made a great decision for yourself in seeking and getting care.”

_[RON LIEBER [[link removed]] has been
the Your Money [[link removed]] columnist
since 2008 and has written five books, most recently “The Price You
Pay for College.” More about Ron Lieber
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* Medicaid
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* social safety net
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* The Social Safety Net
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* Working Class
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* middle class
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* elder care industry
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* long term care
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* special needs
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* Disabled
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* disabilities
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* birth defects
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* nursing home care
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