Here is a snipit from a great article written 10 years ago.
When it was created in 1965, the Medicaid program was supposed to be a welfare program for the poor. The Medicaid long-term care benefit was included in the program almost as an afterthought. The inclusion of this benefit literally created the long-term care industry.
The reason for the explosive growth in what was thought to be an otherwise small benefit can be attributed to how the benefit has been abused. Although Medicaid was designed to serve the poor, it unintentionally came to serve the middle class because of two problems in the program:
The ineffectiveness of its "spend down" provision, and
The ability of beneficiaries to transfer (or hide) their assets, which enabled the middle class to qualify as poor.
Trying to restore Medicaid long-term care
to its intended recipients, the poor, has been a struggle from the start.