Asset Transfers among those Accessing the Medicaid Program: Are Wealthy Older Adults Gaming the System?

Medicaid is the largest payer of long-term services and supports and millions of older Americans rely on the means-tested program for health care coverage. There has been longstanding concern that wealthy older adults are taking advantage of the program by divesting assets in order to qualify for coverage. The existing research on the issue is somewhat dated, does not focus on the question of asset transfer, and often lacks a significant longitudinal view. Thus, questions remain about whether states need to tighten asset eligibility rules to prevent the wealthier older adults from accessing the program. This analysis explores longitudinal data from the Health and Retirement Study (1998 to 2016) to determine the extent to which wealthier Americans age 50 and older engage in asset transfer to access Medicaid. Our findings demonstrate that this may occur among a relatively small proportion of wealthy older adults, and that tightening Medicaid eligibility criteria would likely have a small to modest impact on the financial status of the program.

Autoethnography and the Digital Volunteer

This chapter explores the contribution that autoethnography can make to the understanding of digital work. The example used is a digital volunteering role involving moderating a locally based online group that supports members to give away their unwanted items. An autoethnographic approach can: focus in detail on the experiences of ambiguity and uncertainty that lie at the heart of the work of moderating the group; examine the socially embedded and materially contingent qualities of the work; and take a longitudinal view on the development of digital work over time. The autoethnographic approach is inherently limited in its focus on a singular, subjective set of experiences, but acts an indicator of some otherwise undocumented aspects of the work of a digital volunteer. Autoethnography can be combined with other approaches: here interviews were used to explore a more diverse array of digital volunteering contexts, with the interview guide designed to explore some of the concerns that the autoethnography had brought to light.

MO504LOW BIRTH WEIGHT ASSOCIATES WITH SMALLER KIDNEY SIZE IN MIDDLE-AGED WOMEN

Background and Aims Low birth weight is associated with increased risk of kidney disease due to lower nephron endowment leading to hyperfiltration and subsequent nephron loss. Nephron number is thought to associate with kidney size. We compared kidney size measured by magnetic resonance imaging (MRI) with ultrasonography and measured glomerular filtration rate (mGFR) in adults with normal versus low birth weight. Method Healthy individuals aged 42-52 years with Low birth weight (LBW – 1100-2300g) and normal birth weight (NBW - 3500-4000g) were invited. GFR was measured using plasma clearance of iohexol. Kidney volume was measured on MRI images using axial T2 images and coronal T1 images with fat saturation without contrast enhancement, calculations were performed according to the ellipsoid formula - π/6 x Length x Width x Depth. Ultrasonographic imaging was done using a dorsal approach. In the maximal longitudinal view the parenchymal area was calculated subtracting the area of a manual tracing around the renal pelvis from the area of a manual tracing of the whole kidney. Volume and area from the two kidneys were added and total value was used for analyses. Kidney size measurements were compared between the two groups of LBW vs NBW, and analysis using Pearson’s correlation coefficient R between kidney volume and measured GFR and parenchymal area was performed. Results We included 102 individuals (54 LBW, 48 NBW). Total kidney volume was 302 ± 51 ml for female NBW vs 258 ± 48 ml for female LBW (p=0.002). For men, total kidney volume was 347 ± 51 ml vs 340 ± 65 ml (p=0.7). Measured GFR was significantly associated with kidney volume with R=0.52 (p<0.001) for women and R=0.39 (p=0.007) for men. Kidney parenchymal area measurements using ultrasonography showed similar results with an R=0.77 between the MRI and the ultrasonography measurement and similar differences for sex and birth weight were seen. Conclusion Healthy middle-aged females born with LBW have smaller kidneys than healthy middle-aged females born with NBW, no difference were seen for males. Kidney volume associate with measured GFR.