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Reports that under a third of the increasing numbers of US citizens needing long‐term care (LTC) in a nursing home pay their own fees; and that Medicaid (health programme for the poor) meets over half of LTC costs. Describes the rules applied to qualify for Medicaid LTC payments, the growth of “Medicaid estate planning” to shield the income/assets of the middle classes so that they can qualify and the actions taken by the government to restrict misuse of Medicaid and reduce its costs. Explains methods which are still being used to protect middle class income/assets without losing Medicaid eligibility; and the alternative of private LTC insurance, including its tax implications. Discusses efforts to develop a partnership between Medicaid and the insurance companies in some states; and the pros and cons of the plans available for both individuals and the government.