Gender, race, and the distribution of social assistance: Medicaid Use Among the Frail Elderly

Class-based theories of the welfare state suggest that welfare states stratify by social class, thus universal benefits are praised for fostering social equality and class solidarity whereas poverty-based benefits are criticized for fostering greater inequality and class conflict. Feminist theorists suggest that, in addition to social class, universal and poverty-based benefits are organized around dimensions of gender and race. I examine these arguments in conjunction with old-age reliance on Medicaid—the poverty-based long-term care system in the United States. Compared to white men, older Blacks, Hispanics, and women of all races have greater long-term care needs and fewer economic resources with which to meet those needs. Even when differences in income, education, age, marital status, and nursing home use are taken into account, gender and race are significantly related to Medicaid use. As Medicaid recipients, Blacks, Hispanics, and women of all races disproportionately face persistent poverty and discrimination. Even when they are not Medicaid beneficiaries, these groups are particularly likely to suffer other consequences of a poverty-based long-term care system related to state variations in coverage, informal care giving, and spousal impoverishment.