People without assets are covered by Medicaid, and that's how it should be. I object to people who shelter their assets by hiding them or giving them to family, then go on the public dole. The Medicaid safety net is intended to catch people before they don't hit the ground, not to comfortably suspend them when they're still ten stories up.
@Jim W., it might be legal but that doesn't make it morally or ethically right. There's no such thing as a free lunch. Someone has to pay the tab. People who intentionally divest themselves of their assets rather than paying for their own nursing home care are taking money from their neighbors' and friends' pockets.
If the US shifted to Canadian or UK style socialized health benefits, I'd be all for it. That would involve higher taxes for everyone though.
Yet, there are perfectly legal avenues to avoid spending your assets on nursing home care even within the five year period, which are considered acceptable.
There is an entire specialty of civil law that concerns itself with elder care law.
These attorneys, for a percentage of the pot, set up trusts which are designed to not be countable as personal assets by Medicaid.
I have a certain amount of sympathy for some of the people who do this.
For example, an elderly couple spend their lives saving their money and doing without vacations and new cars and dining out at nice restaurants, etc. etc. etc. They manage to sock away fifty or a hundred or so thousand dollars, hoping to leave it to their children for their grandchildren's college. Having to spend the entire amount to stay in a nursing home that is dirty, understaffed and doesn't provide them with adequate care, is not fair either.
It's like the über wealthy taking advantage of the tax codes to get out of paying their fair share of income taxes.
If the system is designed a certain way that leaves an open avenue for those who are savvy enough to take it, then by all means, they ought to.
Besides, there is enough wealth in this country that, if spent wisely, could provide health and nursing home care for everyone.
Even if not 100% free, it could be much, much more affordable than it is.