Much of Medicaid spending actually goes for nursing home care. Some of these patients are truly needy and have no assets or resources at all. Others, through effective and legal planning, have preserved their assets to pass down to their families. Done right, they can then qualify for Medicaid to pay for their nursing home care. Even without estate planning, the primary residence is not considered an asset that can be liquidated to pay for the care, even after the owner (and their spouse) have passed. In effect, because we have a system that allows asset preservation, taxpayers are subsidizing the care of nursing home patients so that their survivors can recieve an inheritance. Yes, I know... there are exceptions to this.