In the state of Oregon, I can qualify for Medicaid because there is no asset testing. As long as you meet the income testing you can qualify for free health insurance which is administered through the state, In fact, living on welfare isn’t that hard, if you know how navigate the system. Yes, even if you’re a physician.
Medicaid isn’t as bad as everyone says. You get all the typical things you’d expect, including:
- office visits
- alternative medicine
- emergency/hospital care
- dental care
- vision care
- long-term care
California is well known for their generous government aid for the poor. 12 million individuals are enrolled at any given time in Medi-Cal, California’s Medicaid program. That’s 30%+ of the state’s population. Hawaii isn’t too far off.
This post is in a series of posts where I explore government benefit program for US citizens. Whether you’re a barista or a physician, you’re not immune from poverty. One day you have it all, the next you lose your medical license and have lost all of your income.
Public Assistance in the US
Like other developed nations, the US government offers generous services for those who don’t have enough money to run their household. Making living on welfare a little less onerous.
The federal government teams up with states to meet the needs of these families. There are at least 127 different federal aid programs – half of which offer cash-value assistance.
The following categories of aid are available according to Wikipedia:
- cash assistance
- food assistance
- utilities subsidies
Programs which you might recognize by name are as follows. And these are often what many get on welfare:
- Affordable Care Act
- CHIP (Children’s Health Insurance Program)
- Healthy Start
- Community Health Center
- SNAP (Supplemental Nutrition Assistance Program)
- NSLP (National School Lunch Program)
- Nutrition Program for the Elderly
- FMNP (WIC Farmer’s Market Nutrition Program)
- EITC (Earned Income Tax Credit)
- Refundable Child Credit
- Make Work Pay Tax Credit
- SSI (Supplemental Security Income)
- Unemployment Assistance
- TANF (Temporary Assistance for Needy Families)
- Job Corps
- Youth Opportunity Grant
- Senior Community Service Employment
- Workforce Investment Act Adult Program
- Section 8 Housing
- Public Housing
- LIHTC (Low Income Housing Tax Credit)
- Homeless Assistance Program
- Rural Housing Insurance Fund
- Housing for Persons with Disabilities
- Pell Grants
- 21st Century Learning Centers
- Adult Basic Education Grants
- LEAP (Low-Income Energy Assistance Program)
- Even Start
- Aid for Graduate and Professional Study for Disadvantaged and Minorities
This, of course, is a very short list since it doesn’t include each state’s individual program, nor the private grants available for individuals. Qualifications for the private programs might depend on:
- where they live
- immigration status
- health condition
- family situation
I give our government credit for the availability of all of these services. Imagine what it takes to pass laws such as these through congress. Imagine securing funding for them year after year. These are the kind of programs which could help someone get back on their feet.
Living on Welfare
What’s Dr. Mo doing writing about public assistance? It’s quite relevant, in fact. Welfare is a needs-based subsidy. It doesn’t matter if you’re an MD, DO, PharmD, or never finished high school.
Welfare has its roots in assisting those who aren’t able to compete in a fair marketplace. A single mother with 3 young children can’t look for a job if she can’t even afford daycare.
A divorced sexagenarian who didn’t accumulate enough credits for Social Security will need government assistance if she can’t find employment.
Even a medical professional who can no longer work as a physician will need some sort of assistance. Like any other household, they have dependents, debt, and the need for shelter, food, healthcare and transportation.
In the US we don’t scrutinize household spending for those who qualify for government assistance. They have the right to dine out, go shopping for clothes, order from Amazon, have nice cell-phones, and drive nice cars.
Many who are on welfare may not even have to pass an asset test. They can have money in their retirement accounts and have real estate equity.
The government doesn’t scrutinize your spending. They will care about your income and, in a distant second, your accumulated assets.
No Immunity to Poverty
It’s silly to assume that you are immune to poverty. Whether you’re a surgeon or psychologist or a dentist. Any one of us could one day lose all of our assets or our ability to earn an income. This might be in the form of disability, burnout, or other career disaster.
Poverty is the norm. Wealth isn’t guaranteed to any of us. In fact, with more wealth comes more risk and more work is needed to maintain that wealth.
As a physician you might end up on Medicaid and will likely take advantage of Medicare. You will probably use your Social Security income. All of these are forms of public assistance; not quite welfare, but it’s a government subsidy, nevertheless.
Taking Advantage of the System
Some professionals have a moral hurdle when it comes to taking advantage of the system. Each has their own line drawn in the sand. One believes that it’s okay to try to minimize their income taxes but not okay to use Medicaid – even if they qualify for it.
Another medical professional is okay with applying for government grants for their low-income clinic but not okay with SNAP even if they lose all of their income.
Some medical professionals will take their ex’s to court over child support and alimony. But they are stark opponents of a colleague going on state disability for back pain.
Physicians are against going on disability but will sign off on disability paperwork for their patients as readily as they give out off-work notes.
If you can exhaust all possible options, as in, you do your best to minimize your spending and use up all assets you can, you can feel good that you’re not taking advantage of the system.
State vs. Federal
This is also getting into the weeds, a little. To give you a big-picture idea, it’s helpful to recognize that most of the public assistance money comes from the federal government. But it is administered by each state. Federal doesn’t want to give out the money and the states will do anything possible to get that money.
If there is a lot of federal funds flowing into a particular state, it eases the burden on state politicians to balance the budget. The state can also shift certain individuals from unemployment to disability. Or from disability to SSI. Another way of saying this is that they can shift certain individuals towards income sources which are federally generated as opposed to locally generated.
Asset Testing and Income Testing for Welfare
Asset testing for welfare is inherently stupid, but fortunately, rarely enforced. If you have a person who is on SSI (supplemental income) and you limit their liquid assets to $3,000, you are forcing them to stay poor. The logic escapes me.
Very few, VERY few individuals want to be poor. Life’s a bitch. Just look back to all of your own hurdles; would you have overcome them if you didn’t have your unique tenacity? Would you have made it through if you didn’t have your family’s support? Would you have succeeded if you also had to battle a mental health or substance abuse disorder?
Not only is asset testing idiotic but so is drug testing. Punishing someone for a substance use disorder is what the medical boards do to physicians. It’s also how, sadly, the medical system treats patients. But I’m getting off-topic.
Income testing is rather straightforward. If you are earning a wage from employment then you will likely have your public assistance limited. You might still qualify for some, but not all.
Not all income is counted towards the income test. If you have a business and you are writing off a lot against your profits, you may end up with very little. You’ll still cover your household spending but won’t show any income; if you catch my drift.
Maybe a family member is paying for your overhead. They aren’t giving you the money directly but they are routinely paying for your rent, your dental care, your medications, your transportation costs, etc. Is this income? Assistance?
Much like the IRS, the states are only aware of what you report. If you’re getting paid under the table or if you’re earning profits from a business and you don’t report it, the states won’t know about your income.
Cash, checking accounts, CD’s, stocks, bonds, and other liquid assets are generally counted towards the asset test. A person with $100k in their checking account is less likely to qualify for SNAP or Medicaid.
Assets which are excluded are:
- value of primary residence
- private possessions
- life insurance
- retirement accounts
- primary automobile
Similar to income testing, asset testing is a self-reported matter. There might be audits but apparently they are rare. If you say that you don’t have any money in a brokerage account, the state will take your word for it.
How likely is it, do you think, that a state like California, which has 30% of its residents receiving some sort of public assistance, will disqualify a bunch of families from their welfare program? What’s their incentive to dig deep into the financial affairs of welfare recipients? How would they deal with those individuals otherwise if there is no more federal funds coming in to support them?
Quality of Life on Welfare
I’m not going to talk about others living on welfare – let’s focus on me, Dr. Mo, living on welfare. What would my quality of life be like living on welfare?
Well, I spend less on my household than the average household on welfare. With this spending I am enjoying an amazing quality of life. I get to spend my days exercising, making healthy foods, socializing with friends, reading, learning, and fighting the state medical boards.
On welfare I could stop fighting the medical boards and would no longer have to worry about earning an income. I can still keep my home and since the majority of my assets are in retirement accounts, I’d qualify for most public assistance programs.
Working the System vs Cheating the System
When I was attending UCI undergrad I had to work the system hard in order to get into medical school. Much like the rest of you, I did a lot of research, made lots of connections, applied to numerous schools, attended a ton of interviews, and kissed ass anywhere I could in order to get into medical school.
As a physician I’ve had to work the system in order to get my patients the kind of access they needed. Working at Kaiser Permanente I had to word my referrals a certain way to make sure the referral wouldn’t be denied.
I’ve had to order tests and document my charts a certain way to protect my ass from a lawsuit. I’ve prescribed antibiotics, antivirals, and ordered CT’s on low-risk patients because otherwise I would have had to answer for a potentially bad outcome.
Getting welfare is no different. If you can get over your moral hurdles then you can live quite a comfortable and luxurious lifestyle on welfare. I’ve already outlined that qualifying for welfare isn’t difficult. Asset testing and income testing shouldn’t be an issue for a physician who usually has few assets early on in their career, with mostly student loan debt.
Should you find yourself in the fangs of the medical board and you’ve done your fair share of fighting, consider relinquishing control and moving your household from that cold, rainy Washington over to beautiful, sunny Hawaii.
You might even be able to volunteer as faculty in the local teaching institutions. You can still earn some money without it counting towards your asset and income testing limits.
Cheating the System
The other day I read about a bunch of physicians who were busted by undercover DEA agents for selling controlled medications to patients in return for cash or sex. I have no idea how much of it is true. A part of me doesn’t want to believe it because, well, I’m gullible like that.
Then again, I realize as much as those doctors are criminals, I myself am among the white coat criminals roaming the wards. Yet I wouldn’t recommend cheating the system when you can use the system to your advantage legally.
My intention is to give you guys hope, not to have you go sign up for welfare. I want to provide options for medical professionals who have gotten in trouble with medical boards. You don’t need to cheat the system to enjoy the benefits of being a US citizen. You may not be able to enjoy a monthly income of $25k but you get to still live a fairly comfortable lifestyle.
I added this section because many physicians even qualify for Medicaid when their income is low enough.
Going part-time, losing your job, taking time off … there are lots of reasons why you might qualify for Medicaid.
Here is a great state-by-state Medicaid Guide. It’s a good place to start to see what the requirements are in order to qualify for government paid health insurance.
Remember, you don’t automatically get Medicaid, but you are as entitled to it as the next person. Read your state’s guidelines and see if you quality. This criteria is often based on your MAGI – modified adjusted gross income.
The Federal Poverty Level income in 2020, for example, is about $13,000 in California and Oregon. For CA you can have up to 260% ($33,000) income and still qualify for Medicaid – or some version of it.