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Entire Families Suffer When Parents' Pensions Are Too Big for Medicaid : Health Care: Some sacrifice savings for children's tuition to pay parental nursing home bills. Others risk everything to bring an extremely ill person into their home.


WASHINGTON — Ora Lee Ingram knew it was time to put her mother in a nursing home when she began wandering away from their home and into the traffic of a busy highway.

The nursing home promised to keep close watch over the spry, 80-year-old retired postmaster for Ingram, who was weakened by her own struggle with breast and bone cancer.

But that was before the nursing home realized Ingram's mother, Retha Cooper, earned $33 too much from her pension to qualify for Medicaid in Arkansas--but not nearly enough to pay the monthly bill.

"I hope they don't turn her out," said Ingram, who is retired from a Waldenburg, Ark., Dairy Queen and does not have the money to cover the difference between her mother's monthly $1,335 pension and $2,000 in nursing home costs. "I can't take care of her, and she can't take care of herself."

Like hundreds of other families nationwide, mother and daughter are trapped in what Scott Holladay, an advocate for the elderly in Arkansas, calls "the pension penalty."

"These are people who all their lives worked hard and played by the rules, did their jobs from 8 to 5 for 30 years. They got a pension, and now they're cut out of the system. They're not wealthy; they're just over the limit," said Jill Quadagno, a professor at Florida State University who studied the problem in Florida and Texas.

Some families sacrifice savings set aside for their children's college tuition to pay their parents' nursing home bills. Others risk their own health, quit their jobs or strain their marriages to bring an extremely ill or bedridden person into their home, Quadagno said.

The problem occurs in 18 states that do not extend Medicaid, the government's health insurance program for the poor, to elderly nursing home residents when their incomes exceed the state limit but fall short of their monthly medical expenses. California is not one of the 18.

Advocates for the elderly are pressing the White House to address the issue as part of health care reform. A Clinton Administration official, speaking on condition of anonymity, said the Administration is considering a requirement that all states have programs for the medically needy.

Quadagno estimates that in states lacking such programs for the elderly, 20% of retirement-age men and 5% of women have incomes that put them at risk of the pension penalty should they need to enter a nursing home.

"If the costs of nursing home care exceed a family's income, they're left out in the cold," said Ron Pollack, executive director of Families USA, an advocacy group for the elderly, who has raised the issue with the White House. "This really causes enormous hardship."

Medicaid officials say the situation arises because states have to draw the line somewhere in deciding who is eligible for a program that has seen its costs explode in recent years.

"You can't cover everybody. We're just not funded to do that," said Ray Hanley, Arkansas Medicaid director and chairman of the State Medicaid Directors Assn.

"I've had conversations with people who fall just outside that line, and it's tough," Hanley said.

Quadagno's research led her to a Florida woman who spent four years taking care of her incontinent mother. The woman would feed and diaper her elderly mother before work, on her lunch hour and after coming home in the evening and fixing dinner for her own family.

The mother's pension disqualified her for Medicaid coverage in the nursing home and, like Ingram, her daughter could not afford to cover the difference.

In Arkansas, Marzell Brazil, 69, earns $2 too much to qualify for Medicaid, but her nursing home bill exceeds her widow's pension by $600 a month. Her three daughters are splitting the difference and any additional costs.

Families snared in the pension penalty say it is not fair.

"She's worked hard all these years," Ingram said of her mother.

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