2023 Theses Doctoral

Grave Robbers: Medicaid Estate Recovery and its (Un)intended Consequences on Low-Income Families

Spishak-Thomas, Amanda

This dissertation includes three papers examining financial long-term care planning among low-income aging adults and the consequences of Medicaid policies like estate recovery. Paper one considers Medicaid estate recovery and its impact on Medicaid enrollment and homeownership among low-income adults age 65 and older. Paper two examines the estate planning and wealth transfer behaviors of a cohort of older adults newly enrolled in Medicaid. Finally, paper three presents a case study of Medicaid estate recovery in North Carolina. Collectively, these three papers find that Medicaid policies that target older adults may be having disparate effects depending on socioeconomic status, race, and rurality and exacerbating disparities in intergenerational transfers of wealth while recouping little for state Medicaid programs.