Key Comparisons Between Pro-Medicaid and Pro-Private Pay States

Key Comparisons Between Pro-Medicaid and Pro-Private Pay States
February 1, 2005

"The Long-Term Care Dilemma, What States Are Doing Right and Wrong" profiles five states that could be considered "pro-Medicaid" and five that could be considered "pro-private pay."

The "pro-Medicaid" states--Georgia, Michigan, New Mexico, New York, and Texas--make it especially easy to qualify for Medicaid and seldom enforce estate recovery rules. The report shows:

  • The five pro-Medicaid states have the lowest long-term care insurance market penetration, 1 to 5 percent.
  • All five score in the top half of states for Medicaid nursing home census, the percentage of residents whose nursing home bills are paid by Medicaid. Georgia and New York rank fourth and sixth, respectively.
  • Three of the five score in the bottom half of states for home equity conversion; New York and New Mexico are the exceptions.
  • Three of the five were in the top half of states for the number of people utilizing home- and community-based services (HCBS). Georgia and Michigan were are the exceptions.



The "pro-private pay" states--California, Connecticut, Minnesota, Nebraska, and Oregon--have relatively strict Medicaid eligibility systems. They also tend to have more estate recoveries. For these states, the study shows:

  • All five score higher on long-term care insurance market penetration than the pro-Medicaid states. Two are at 6 to 9 percent, two at 10 to 14 percent, and one at more than 15 percent.
  • Four of the five score in the top half of states for home equity conversion, with Connecticut sixth, California ninth, and Oregon tenth.
  • Three of the five states were in the lower half of states for Medicaid nursing home census.