Well, Medicaid is a Federal medical bills assistance program that pays medical bills for eligible, needy persons. It is administered by each state. All payments are made directly to the providers of medical and other health care services. The Medicaid-eligible person does not pay the health care provider for services. The only exception is a patient in a Medicaid-approved nursing facility who may be required to contribute part of his/her income toward the cost of care.

Medicaid is welfare for the poor, the true and honest poor. Medicaid is NOT for people of means trying to fake impoverishment in order to get on the dole. That door has been slammed shut.

Reflecting a national problem, leaders of North Carolina's nursing home and long-term care facilities say that the money which Medicaid provides for patient care simply isn't enough to cover costs.

North Carolina's problems reflect a grrowing national concern. It's a trend that likely could send the industry spiralling into a financial crash, said the head of a reform group.

As the public funding infrastructure implodes over the next decade or two, we're going to hurt a lot of poor people who won't have any access to a decent safety net.

Stacy Flannery, with the N.C. Health Care Facilities Association, said that nursing homes in North Carolina are approaching a $14-per-patient per-day loss when caring for Medicaid patients. And she said that the care of about 75 percent of the patients in North Carolina nursing homes is paid for by Medicaid.

"We are completely at the mercy of Medicaid for our stability," she said. Flannery said that for the current rate year, which ends Sept. 30, nursing homes in North Carolina are projected to incur a $117-million loss for Medicaid patients..

"You can only bleed your private-pay patients so much," Flannery said.

If changes aren't made, wage-earners in future decades could be paying larger sums of their earnings just to help pay for the upkeep of the elderly and other health benefits, he said.

At the current pace, 40 percent of all wages would be needed to pay for Social Security, Medicare, Medicaid and Veterans Administration benefits by 2050, Moses said.

"The trends can't continue and won't," he added.

Flannery would like to see a tax credit reinstated that would give individuals a break if they purchase their own long term care insurance, and we agree.

In any case, long term care insurance is wise for all to consider, as you cannot count on the citizenry and its elected officials to loosen their purse strings at this late date. It won't happen any time soon, believe me. That's fantasy-based wishful thinking. Period.