One practical answer is this: We need Medicaid for the Elderly because the current generation of people entering care had no idea that they would need the care. It was not poor planning on their part, some of the best economists, health professionals, and insurance actuaries got this one wrong. The simple truth is that we need Medicaid for the Elderly because we have succeeded since the advent of Medicare in making people live longer, but not live better.
On an individual or family level, we need Medicaid for the Elderly because the cost of nursing home care is far beyond the reach of most people. The circumstances of declining physical health, including the health of the brain, are an unavoidable challenge. As we outlive our physical selves, we require care on an unprecedented level.
We constantly struggle between the social goal of having families be able to maintain legacies and help each new generation with a leg up and the social goal of relieving the public purse in favor of stripping families of their accumulated wealth during the process of dying. Both points of view have strong advocates and both have allies in Liberal and Conservative camps.
As of today, Medicaid is a system for the poor, but they do not always have to have been poor. This tension is played out with complicated laws some of which favor one point of view and some of which favor the other. There is no clear, comprehensive, public policy decision and no clear consistent implementation of that policy.
The current generation has been contributing to a system of funding these health care expenses. They should have an expectation that they will be able to access needed care without having to suffer the indignity of complete impoverishment and without loosing hope of leaving a legacy. But, the debate steams forward and the numbers increase every day.