The Price of Forgetting: The Cash Goes in a Year, the House Waits for the Second Death

A Special Report. The desk takes the two numbers from Day 6 that fit on one line, $410,000 and $405,262, finds they were printed in different years' dollars, and follows the median estate from the diagnosis to the funeral home through Medicare, Medicaid and probate. The cash is gone in about a year. The house is exempt until the second death. The state pays last, collects behind the undertaker, and keeps at most half of what it collects. The same Federal Reserve table that prices the estate is cited on page 29 of a nursing-home REIT's investor deck, under the words "Significant Pricing Power".

On Day 6 of Boomer Week the desk set two figures beside each other — the median net worth of a household aged 65 to 74, and the lifetime cost of caring for one person with dementia — observed that they were roughly the same size, and put the calculator down. The next morning the desk's own cartoonist picked it up. The Daily Cartoon of September 8 did the subtraction on a receipt tape and printed the answer at the bottom: Remaining estate, $4,738.

The desk went to check the arithmetic and found that it cannot be performed. The first number is in 2022 dollars. The second is in 2024 dollars, and it is not a measurement: it is a 2015-dollar figure from a 2017 journal article, reflated by a consumer price calculator. The same 2026 report that prints $405,262 on its web page prints the same underlying number as $417,263 in 2025 dollars inside its own PDF. One estimate, three dollar-years, one document. Subtract across them and the difference is a fact about inflation calculators, not about anybody's estate.

So the desk did the receipt instead: the same household, followed from diagnosis to probate, every line's dollar-year printed beside it and every statute dated. The finding is not the one the cartoon drew. It is narrower, and worse.

Stated at full strength: the median household on the edge of retirement holds about $410,000, a dementia diagnosis costs about that much, and the disease is therefore priced, as if by design, to consume exactly one lifetime of saving. Medicare will not pay for the bed. Medicaid will, after the household has spent itself down to two thousand dollars, and then the state sends a letter to the estate. The state is last in line for everything: last to pay, last to collect. And nobody built this.

Three of those four claims survive contact with the sources. One does not.

The household, and the course. The household is the Federal Reserve's: a family whose "Age of reference person (years)" falls in the 65-to-74 bracket in 2022, which is to say born between 1948 and 1957. The Boomers, at the age the Boomers are now. The Fed retired the label head of household, and the desk uses the Fed's.

The disease arrives later than the survey. Median age at diagnosis is 81, so this receipt prices an event of the 2030s at 2025 and 2026 prices, and Exhibit C says so on every line.

The course is a stated convention and the desk labels it as one: five years from diagnosis, the first three at home or in residential care, a nursing home from year four. The anchors are real. The BMJ's 2025 meta-analysis: "Median time to nursing home admission, derived from 23 studies, was 3.3 (IQR 1.9-4.0) years", and "Admission probabilities increased from 13% within the first year of study entry to 35% within three years and 57% within five years from baseline". On the whole span: "The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women." The Alzheimer's Association says it rounder: "People age 65 and older survive an average of four to eight years after a diagnosis of Alzheimer's".

The odds, plainly, because the receipt is only owed by the households it happens to. From Nature Medicine, 2025: "The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41–43)", with "higher lifetime risk of dementia in women versus men (48% (95% CI: 46–50) versus 35% (95% CI: 33–36))". Forty-two percent after 55 also means fifty-eight percent never get this bill. That is the defense's first argument and the desk files it here rather than saving it.

Line 1. The estate. Median net worth, reference person aged 65 to 74, 2022 survey, 2022 dollars: $410,000. The mean is $1,780,710, four and a third times the median, printed once because it is the number the marketing leans on. For the bracket above, 75 or more, the median is $334,700.

A note on provenance, since this piece is about a number wearing three dollar-years: the Fed publishes these tables twice, and they disagree. The public file, which Day 6 used and this receipt uses throughout, gives 410 and 1,780.71; the internal file and the Bulletin give 409.9 and 1,794.6. The gap is a disclosure artifact, under one percent, and the desk prints it rather than pretend it did not open two files.

The composition matters more than the total. Among that bracket in 2022: 76.13 percent own a primary residence, median value $320,000; 32.17 percent carry debt secured by it, median balance $110,000; 50.99 percent hold retirement accounts, median value $200,000. Each median is conditional on holding the thing, so the three are computed over three different populations and cannot be added or subtracted. The desk's working figure of roughly $90,000 in countable non-housing money is a construction from those rows, and it is illustrative.

Two facts follow that the rest of the receipt turns on. The largest asset of the median estate is a house. The second largest is a tax-deferred account, which is countable for Medicaid in most states and which the exempt-homestead rules never touch.

And the diagnosed household is poorer than either bracket. From the Annals of Internal Medicine study of decedents: "The dementia group was older at the time of death (88 years, compared to 82, 85, and 83, respectively), less likely to be married (25%, compared to 44%, 35%, and 39%), and had lower median household wealth at the beginning of the study period ($115,942 compared to $243,168, $203,748, and $220,771)." Those are 2010 dollars. This receipt is being run on a household wealthier than the households the disease actually finds.

Line 2. Two prices of a diagnosis. There are two honest ledgers, they measure different things, and Exhibit A runs them in parallel without ever netting one against the other.

The gross ledger values everything the illness consumes, including hours nobody billed. From the Journal of the American Geriatrics Society, 2017: "From time of diagnosis (mean age of 83 years) discounted total lifetime cost of care for a person with dementia was $321,780 (2015 dollars)." Of that, "Families incurred 70% of the total cost burden ($135,300, in the value of informal care and $89,840 in cash out-of-pocket payments)", while "Medicaid payments ($44,090) accounted for 14% of total cost and Medicare payments ($52,540) accounted for 16% of total cost." The seventy percent is doing heavy work and it is a valuation choice: "The value of informal caregiving was $19.71/hour". Two-thirds of the family's share is hours priced at a wage. The cash the study can trace is $89,840.

That is the figure the Association restates, and where it restates it changes what it says. The web page: "The total lifetime cost of care for a person living with dementia is estimated at $405,262 in 2024 dollars." The PDF of the same 2026 report: "is estimated at $321,780 per person living with Alzheimer's dementia in 2015 dollars ($417,263 in 2025 dollars)". Same study, two restatements a year apart, both current, both the Association's own. That is not an error. It is the reason the cartoon's subtraction cannot be performed.

The cash ledger is the one that touches an estate, and it is smaller and sharper. Same Annals study, last five years of life, 2010 dollars: "Average total cost per decedent for dementia ($287,038) was significantly greater than for those who died of heart disease ($175,136), cancer ($173,383), or other causes ($197,286), p<0.001", and "average out-of-pocket spending for dementia patients ($61,522) was 81% higher than for non-dementia patients ($34,068)". Then the line that belongs on a receipt: "Out-of-pocket spending for the dementia group (median, $36,919) represented 32% of wealth measured five years before death, compared to 11% for non-dementia decedents (p<0.001). This proportion was greater for Blacks (84%), those with less than high school education (48%), and unmarried/widowed women (58%)." Measured against money that is not the house, it stops being a proportion of anything: "Out-of-pocket spending as a ratio of financial wealth (i.e., excluding housing) was even larger: a median of 242% for dementia and 81% for other diseases."

The third column is the caregiver's, totaled separately and never subtracted from the estate, because it is not the estate's money: imputed informal care of $83,022 for the dementia group against $38,272 for the others, and "the costs of informal care were more than double for married women in the dementia cohort: $177,767, compared to $65,136 for married women at low risk of dementia."

Line 3. Medicare pays for the cardiologist. The statute as it stands, quoted whole because the sentence is the whole of the mechanism: "Notwithstanding any other provision of this subchapter, no payment may be made under part A or part B for any expenses incurred for items or services—" and, at paragraph (9), "where such expenses are for custodial care (except, in the case of hospice care, as is otherwise permitted under paragraph (1)(C));". The regulation defines the term by exclusion: "(Custodial care is any care that does not meet the requirements for coverage as SNF care as set forth in §§ 409.31 through 409.35 of this chapter.)" The hospice parenthetical is a later addition, so this is the statute as it stands rather than the 1965 text. Hospice does not solve it either: "Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility."

What Medicare does pay for is a rehabilitation stay: short, conditional, priced by formula. The condition is a hospital stay of "not less than 3 consecutive days before his discharge from the hospital in connection with such transfer." The length: "Part A limits SNF coverage to 100 days in each benefit period" — a benefit period, not a year. The price is arithmetic: coinsurance "equal to one-eighth of the inpatient hospital deductible for each day (before the 101st day)". The 2026 deductible is $1,736; divide by eight and the day rate is $217.00, which is what CMS published on November 14, 2025: "the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $217.00 in 2026 ($209.50 in 2025)." Eighty days at $217 is $17,360. Then, in Medicare.gov's words: "Days 101 and beyond: You pay all costs."

A door closes before a household reaches even that. The three days must be inpatient days: "The 3-day rule requires the patient to have a medically necessary inpatient hospital stay of 3 consecutive calendar days, not including the discharge day or pre-admission time in the emergency department (ED) or under outpatient observation." The Inspector General counted the consequence in 2013: "Beneficiaries had over 600,000 hospital stays that lasted 3 nights or more but did not qualify them for SNF services." Which Medicare this describes also matters now, because "More than half (55%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026" — plans that may waive the three-day rule, and that the Inspector General found in 2022 were denying prior authorizations, thirteen percent of which met Medicare's own coverage rules. A Medigap Plan G covers everything to day 100 and nothing after it.

The wrong detail is the government's own. The Internal Revenue Service, in Publication 502: "You can include in medical expenses the cost of medical care in a nursing home, home for the aged, or similar institution," including "the cost of meals and lodging in the home if a principal reason for being there is to get medical care." The tax code calls the bed medicine. The insurance statute calls it custody. Both are current law.

Line 4. The private-pay years. This is the stage the cartoon's receipt tape skipped, and it is where the money actually goes. Between Medicare's hundredth day and Medicaid's nursing home lie the years in assisted living or at home, and Medicaid's waivers are forbidden by statute to pay the housing: the waiver covers "the cost of home or community-based services (other than room and board)".

The prices are the industry's own, from CareScout's 2025 survey, in 2025 dollars. Assisted living: "The national median monthly cost increased 5% to $6,200, or $74,400 annually." A home aide at forty-four hours a week: "the annual cost of care totals $80,080". The nursing home, when it comes: "$355 per day, bringing the annual cost to $129,575" for a private room, and "$315 per day, or $114,975 annually" for a semi-private one. CareScout publishes no memory-care line at all; the widely quoted memory-care figure comes from referral aggregators, and the desk does not use it.

Against roughly $90,000 of countable money, at the semi-private rate net of a Social Security check, this stage lasts about a year. That is the first finding, and the one the piece is named for.

Line 5. The spend-down. Eligibility comes before the check, so this line comes before the next. The federal standards for 2026, from the Medicaid agency's own chart: a resource standard of $2,000 for an individual and $3,000 for a couple; a community spouse resource allowance from $32,532.00 to $162,660.00; a maximum monthly maintenance needs allowance of $4,066.50; home equity limits of $752,000.00 to $1,130,000.00; an income cap of $2,982.00.

The clerk's comparison is inside that same chart, which prints, of the figures it indexes, a CPI increase since September 1988 of 171.1 percent. Every protective number on the page has nearly tripled since 1988. The $2,000 the applicant is allowed to keep is not on that list and has not moved.

Behind the standards is a memory. The look-back runs 36 months, extended for "any other disposal of assets made on or after February 8, 2006, 60 months", and any uncompensated transfer inside it is divided by "the average monthly cost to a private patient of nursing facility services in the State" to produce months of ineligibility. States differ at the edges: California reinstated an asset test on January 1, 2026 — "The most you can own (asset limit) is $130,000 for one person", falling to "$21,000 for one person" in July 2027 — and looks back thirty months, not sixty.

One purchase the spend-down permits, and it is the last line of this receipt: burial spaces are excluded outright, and a designated burial fund is excluded up to a limit if it is "kept separate from all other resources". The family may pre-pay the funeral. It may not pre-pay anything else.

Three things happen the month the countable money reaches $2,000, and none is in the brochure. Nonpayment becomes a lawful ground for discharge — "The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility" — on notice "at least 30 days before the resident is transferred or discharged." The application enters what everyone calls Medicaid pending, and the rule there is a ceiling, not a countdown: determination may not exceed "45 days for all other applicants". And someone signs the admission contract. A facility may "not require a third party guarantee of payment to the facility as a condition of admission", but it may require a person "who has legal access to a resident's income or resources available to pay for care in the facility, to sign a contract (without incurring personal financial liability)". The Consumer Financial Protection Bureau has documented what collectors do with that signature afterward. Pennsylvania, separately, keeps a colonial statute under which a child has "the responsibility to care for and maintain or financially assist an indigent person"; a nursing home used it in 2012 to win "a verdict in favor of HCR in the amount of $92,943.41" against a son — a case that was neither a dementia case nor a Medicaid one.

Line 6. The check goes to the front desk. There is no Social Security rule here; Title II never touches the check. What reaches the facility is set by Medicaid's post-eligibility rules, which deduct a list and send the remainder on. The statute: "in determining the amount of the individual's or couple's income to be applied monthly to payment for the cost of care in an institution, there shall be deducted from the monthly income" a personal needs allowance, which "is $30 for an institutionalized individual and $60 for an institutionalized couple". Then the agency must reduce its payment to the institution "by the amount that remains after deducting the amounts specified in paragraphs (c) and (d) of this section".

Thirty dollars a month is a floor, not a rate, and the subsection that sets it contains no indexing clause at all. States may go above it and most do: Pennsylvania went to $60 in January 2025, Ohio subtracts "a personal needs allowance (PNA) of seventy-five dollars" from January 2026, and nationally "The median allowance was $50 a month in 2018; Florida had the highest personal needs allowance, at $130 per month".

The check, from the Social Security Administration's January 2026 table after a 2.8 percent adjustment: "All Retired Workers | $2,015 | $2,071", and "Aged Widow(er) Alone | $1,867 | $1,919". Against 2025 prices the annual gap the estate must close is $104,723 for a private room, $90,123 for a semi-private one, $49,548 for assisted living and $55,228 for a home aide. Divide $410,000 by each and the estate covers the gap for 3.9, 4.5, 8.3 and 7.4 years. Those divisions are the desk's, they mix 2022 wealth with 2025 prices and 2026 checks, and Exhibit C prints all three vintages beside them.

Line 7. The house, and the letter after the funeral. The house is exempt while the person is alive, and no planning is required to make it so. Three doors open onto it before the state's does.

The first is the lien: a state may not lien a living recipient's property except, among other cases, where it determines "after notice and opportunity for a hearing" that the resident cannot reasonably be expected to come home. The second is the equity bar, a threshold rather than a cap — above the state's chosen limit, $752,000 to $1,130,000 in 2026, the applicant is simply ineligible. The law of July 4, 2025 moves that ceiling in the direction most coverage got backwards: section 71108 permits a state to set an amount "that exceeds such amount, but does not exceed $1,000,000", effective "beginning on January 1, 2028." A million dollars is below the 2026 indexed maximum. For the highest-limit states the 2025 law cuts the home exemption. The third door is private: a reverse mortgage falls due when "For a period of longer than 12 consecutive months, a borrower fails to occupy the property because of physical or mental illness" — which is the month the diagnosis moves the borrower into a facility.

One door opens outward. A transfer of the home is not penalized if it goes to a son or daughter "who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual", and who "provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility".

Then the person dies and the statute stops permitting and starts commanding. "In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual's estate". Not may. The wait is real: recovery "may be made only after the death of the individual's surviving spouse, if any". The probate estate is mandatory; everything past it — "assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement" — is a state option. And the hardship waiver is not mercy: the agency "shall waive the application of this subsection (other than paragraph (1)(C)) if such application would work an undue hardship". Every state, by federal command. The commonly quoted "49 states" is a survey count of reported criteria, not a count of states that chose to have the protection.

Now the size of it. In fiscal 2019 "states collected approximately $733.4 million from beneficiary estates". Against its two proper denominators it nearly vanishes: 0.1 percent of all Medicaid spending that year, and between "0.53 to 0.62 percent" of fee-for-service long-term care. Five states — Massachusetts, New York, Pennsylvania, Ohio and Wisconsin — "account for 38.5 percent of all recoveries". And the state does not keep it: under the matching formula the federal government is "equitably entitled" to its pro rata share of every dollar recovered — more than half in forty of the fifty states, never less than half anywhere, and at a median of 59.81 percent across the table, Massachusetts and New York sitting at exactly fifty. "The State" in the charge is two governments, and the junior partner keeps the smaller piece.

Whose houses it runs through turns the charge around. The Medicaid commission sampled 578 Medicaid decedents aged 65 and over, in 2016 dollars: "At age 65 and older, the average net wealth among Medicaid decedents was $44,393", "three-quarters of beneficiaries had net wealth below $48,500", and "Average home equity held by the total sample was $27,364." Its own conclusion: "The program mainly recovers from estates of modest size, suggesting that individuals with greater means find ways to circumvent estate recovery and raising concerns about equity." The letter does not often arrive at the $410,000 household. It arrives at the $48,500 one.

Running the other way, at full weight: Medicaid spending on people with Alzheimer's or other dementias "is projected to be $77 billion in 2026", and per-person Medicaid payments for beneficiaries with dementia are "more than 22 times as great" as for those without. The state recovers $733.4 million against $77 billion — less than one percent of what it spends on this one disease.

One named household, from a public record, in 2001-to-2004 dollars, and not a stand-in for the median. In the asset assessment for Dolores Barg, "$104,875 was excluded. This amount corresponds to the value of the home, one jointly-owned vehicle, and a burial lot." She "died, having received $108,413.53 in Medicaid benefits", and the county pursued her surviving husband's estate. The Minnesota Supreme Court held that "Dolores Barg had no interest in property at the time of her death that can form the basis for recovery against the estate of Francis Barg." The county collected $63,880 anyway, because the son administering the estate had already allowed that much and never challenged it. The opinion never says dementia, and the desk does not add one.

As to whether anyone planned it: for the recovery line, someone did. The Tax Equity and Fiscal Responsibility Act of 1982 "allowed states to impose liens on certain beneficiaries' property before death, which had been previously prohibited." Before the 1993 reconciliation act made recovery mandatory, twenty-two states did it voluntarily; the section that changed that is headed, in the Statutes at Large, MANDATE TO SEEK RECOVERY. In 2021 the Medicaid commission recommended that "Congress should amend Section 1917(b)(1) of Title XIX of the Social Security Act to make Medicaid estate recovery optional". Congress has not. What nobody planned is the interaction: a means test frozen at $2,000, an exemption that survives until a second death, and a disease that outlasts both.

Line 8. The funeral. The last median on the receipt, from the funeral directors' 2023 price study and still their most recent: "the median cost of a funeral with casket and burial has increased only 5.8% over the past two years (from $7,848 to $8,300)", and with cremation, "from $5,810 to $6,280". Those are 2023 dollars, and the figure "does not take into account interment in a cemetery, monument or grave marker costs, or cash-advance charges". The median funeral is now a cremation: "the U.S. cremation rate is projected to reach 63.4% in 2025, more than double the burial rate of 31.6%."

The month of death pays nothing toward it. Benefits run "ending with the month preceding the month in which he dies", so the last check goes back. What the program does pay is "an amount equal to $255, whichever is the smaller, shall be paid in a lump sum" — a cap written into the act in September 1954 and never touched.

Then the ranking, and it is where the charge's second clause fails. Medicaid is the payer of last resort. It is not the creditor of last resort. In Texas, "Class 1 claims are composed of funeral expenses and expenses of the decedent's last illness," while the state's claim for "repayment of medical assistance payments made by the state" is Class 7 of eight — behind the funeral, behind administration, behind secured creditors, child support, taxes and the cost of a prison stay. In Ohio the funeral is second and the state eighth, below the nursing home's own unpaid bill. Pennsylvania puts administration first, the family exemption second, and then in one third class: "The costs of the decedent's funeral and burial, and the costs of medicines furnished to him within six months of his death, of medical or nursing services performed for him within that time, of hospital services including maintenance provided him within that time, of services provided under the medical assistance program provided within that time", while the Commonwealth's older claims sit at 5.1, below the gravemarker and below six months of back rent. Florida ranks the state third of eight, ahead of the doctors of the last illness, and then cannot reach the house at all.

Heirs are last in line. The funeral director outranks the state in every state the desk opened.

So which ledger crossed zero? On the gross ledger, $410,000 less $405,262 leaves $4,738 and either funeral takes it under — by $3,562 with a burial, $1,542 with a cremation. That is the cartoon's arithmetic, and it is a valuation across three dollar-years, not a probate. On the cash ledger, the one that describes money leaving an account, roughly $90,000 of countable money meets an annual gap of $90,123 and is gone in about twelve months. The house is not reachable at all until the second death, and what the state may take then is capped by what Medicaid actually paid on the person's behalf. That is priceable, with one caveat printed after it. The Department of Health and Human Services studied 44 states and found that nursing homes "received an average Medicaid payment of $198 and a median Medicaid payment of $195 per resident per day", on data from what it calls "the latest pre-pandemic period (2019)". Carried to 2025 by the index this desk has been printing all along — 255.657 in 2019 against 321.943 in 2025, a factor of 1.259 — the median rate becomes $245.56 a day, or $89,629 a year. The median owner-occupied house in this bracket, $320,000 in 2022 dollars, is $352,025 in 2025 dollars. One divided by the other is three years and eleven months. The caveat: that rate is the whole bill, and the resident's own Social Security is applied to it first, so Medicaid's outlay — the only thing the state may ever recover — is smaller than the rate, and the real crossing is later than 3.9 years.

And notice what the arithmetic just did. Set the 2022 house against the undeflated 2019 rate, which is the tempting way and the way the desk first ran it, and the answer is four and a half years. Put both in the same dollars and it is 3.9. This piece opened on two numbers that could not be subtracted across their vintages. The same trap was waiting at the other end of it.

The cash goes in a year. The house waits for the second death.

The desk is required to argue the other side at full strength, and here the other side is strong.

Most people never get the bill. Forty-two percent lifetime risk after 55 means fifty-eight percent never receive this diagnosis, and the BMJ authors caution that pooled admission rates may be overstated because most of the underlying studies did not account for competing mortality.

Medicaid is the only program in the country that pays for a long custodial stay, and it is required to. Nursing facility services for adults are on the mandatory list a state plan must provide "for making medical assistance available, including at least the care and services listed in" that list. There is no hundred-day limit and no improvement standard: under the Jimmo settlement, coverage "does not turn on the presence or absence of a beneficiary's potential for improvement, but rather on the beneficiary's need for skilled care." Medicaid is "the primary payer for 63% of nursing facility residents". It spends $77 billion a year on this disease and recovers under one percent of it.

Most of that money no longer goes to institutions. "KFF estimates that 5.1 million people used Medicaid home care in 2023 compared with only 1.4 million people who used institutional long-term care." The honest cut against it, from the same source: "Nursing facility care is a required Medicaid benefit, but states can choose whether to provide most home care services."

The seventy percent is a valuation, not a bill: two-thirds of the family's share in the gross ledger is hours priced at $19.71, and the cash the underlying study can trace is $89,840 in 2015 dollars. And the house is exempt without any planning, through a surviving spouse, a minor or disabled child, a caregiver child and a sibling with an equity interest. The desk will not print the line that a family which plans five years ahead keeps the house: it is advice, and the statute already does it for families who plan nothing.

And the price is not a margin. MedPAC, March 2026: "In 2024, the estimated all-payer total margin for freestanding SNFs (reflecting all lines of business, all payers, and investment income) was 2.1 percent, up from 0.4 percent in 2023." In the same year, "40 percent of SNFs had negative all-payer total margins, down from 46 percent in 2023." The private rate this receipt uses is partly a cross-subsidy for a Medicaid rate that does not cover cost. Beside it, from the same chapter, because the desk does not get to quote only the sympathetic half: the fee-for-service Medicare margin was 24 percent, and "over three-quarters of nursing facilities reported making payments to related third parties", which MedPAC says means total margins "may be understated".

The couple has a defense the individual does not. Under the 1988 spousal-impoverishment law the institutionalized spouse "shall not be ineligible" where he or she has assigned support rights to the state, leaving the state to sue the community spouse rather than the household to spend down. It is the one provision on this receipt written to protect the household, and it is why 1988 belongs on the date column beside 1982 and 1993.

The last caveat is the desk's own. The 2025 Survey of Consumer Finances is not out: "Summary results for the 2025 study will be published in late 2026". Every wealth figure here is three years old, the protective standards are indexed and the $2,000 is not, and the house price is the least fixed number in the piece.

Returned to audit.

claim: the median estate survives a dementia diagnosis · status: undercut, on the cash ledger, for the single household — the countable money is gone in about a year, the house is beyond reach until the second death and is then exposed only to what Medicaid actually paid — which at the median rate, both figures carried to 2025 dollars, equals the whole house at three years and eleven months, and the state's letter collects behind the undertaker and returns at least half of what it collects to Washington · confidence: carried by three counts the desk performed twice, each with its dollar-year printed: $410,000 (2022) against $405,262 (2024), a coincidence of vintage; $114,975 (2025) less $24,852 (2026), a gap of $90,123 a year; $733.4 million (FY2019) against $77 billion (2026).

Sources used: - Federal Reserve Board — "Changes in U.S. Family Finances from 2019 to 2022: Evidence from the Survey of Consumer Finances" (Bulletin, October 2023) — https://www.federalreserve.gov/publications/october-2023-changes-in-us-family-finances-from-2019-to-2022.htm - Federal Reserve Board — "Changes in U.S. Family Finances from 2019 to 2022 (Federal Reserve Bulletin, vol. 109, no. 4, October 2023)" — https://www.federalreserve.gov/publications/files/scf23.pdf - Federal Reserve Board — "Survey of Consumer Finances, historical tables in 2022 dollars, public data (scf2022_tables_public_real_historical.xlsx): Tables 4, 6, 9 and 13, age-of-reference-person rows" — https://www.federalreserve.gov/econres/files/scf2022_tables_public_real_historical.xlsx - Federal Reserve Board — "Survey of Consumer Finances, historical tables in 2022 dollars, internal data (scf2022_tables_internal_real_historical.xlsx): Table 4, age-of-reference-person rows" — https://www.federalreserve.gov/econres/files/scf2022_tables_internal_real_historical.xlsx - 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