Medicaid programs across the country are violating a Medicaid law that requires that all assistance by friends and family members must be voluntary. This brief, based on a review of over 100 administrative decisions in several states, shows how Medicaid programs violate this law to the detriment of people receiving Medicaid. Medicaid programs often deny services based on family assistance that is not available. This puts lives at risk, increases the chances that a beneficiary will have to be institutionalized, and forces families to make impossible choices between caring for a family member and going to work. The issue brief released by Justice in Aging outlines states’ responsibility to respect the voluntary nature of assistance, examines how some states approach the issue, and suggests public policy responses to ensure that states authorize adequate assistance.