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  •  55+ Medicaid just a Collateral Loan. (0+ / 0-)

    Every dime paid out after your 55th birthday is a loan to be recovered from your estate.  This "clawback" was passed by the Democratic Party in 1993 when VP Gore broke a tie.  It is a cornerstone of O'care.  It will soon be on steroids as Medicaid is fully privatized.  Estate recovery is big revenue for the States.  It gets a little aggressive when private outfits recover on contingency.

    •  This isn't precisely true. Sorry. (1+ / 0-)
      Recommended by:

      The whole idea of Medicaid is that it is for those who can not afford care. So if you CAN afford care you should be paying — at least some of the costs.

      So if someone who has a lot of assets has to go into a nursing home — they are usually not the ones deciding — it was too easy to "gift" all their assets to their kids who would then dump Mama onto the state's tab. So that was closed off by the 5 year look back rule.

      From the Medicaid website:


      States may not recover from the estate of a deceased Medicaid enrollee who is survived by a spouse, child under age 21, or blind or disabled child of any age. States are also required to establish procedures for waiving estate recovery when recovery would cause an undue hardship.
      Furthermore, not all payments by Medicaid are ever recoverable: They are not a loan. Recovery is generally only applied to costs that are attendant with long term care such as in nursing homes.

      But why would you think it unfair that people could hoard wealth and just dump their costs on taxpayers?

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Mon Sep 30, 2013 at 05:43:37 AM PDT

      [ Parent ]

      •  How about laid off workers with house & savings? (0+ / 0-)

        55+ and can no longer compete in O's global economy.  O'care will not allow them on his "exchanges" with no income to buy subsidized junk private insurance they gotta go to Medicaid no choice.
        And you are wrong about the clawback.  That starts with your 55th birthday for all costs besides nursing home care.  You are an operative apologist on this and wrong about how it works.

        •  I'm trying hard to be outraged... (0+ / 0-)

          ...but, gotta be honest here, I feel like the argument that you should be able to pass all your money on to your children without any interference to be not much more defensible in this case than it is when the Republicans talk about death taxes.

          Sure, it's scary when you realize that you aren't sure how well your kids (grandkids, great-grandkids) will do without you around to help them. But on the other hand, there are an awful lot of people who, you know, don't have any parents. Would you really prefer that you be able to take advantage of state-sponsored health care, and then, when you pass on, deny others the opportunity to do so by not paying what you can for that care, after you are no longer around to need the money?

          •  It's Fairness Fred. (0+ / 0-)

            The laid off worker should be able to use his savings to buy a crap private insurance "exchange" policy if he wants to keep his house in the family.  Why do targeted younger (voters) get subsidies while the older worker is denied them and forced into Medicaid's collateral loan program?  We both know the answer.  It stinks and is not fair.
            That worker should have been allowed to buy into Medicare instead.  Medicaid really sucks after your 55th birthday and it is not getting any better as the rentiers take it over under O's watch.

          •  Rationalizing Targeted Subsidies (0+ / 0-)

            That are actuary oriented to private profits of insurance companies does appear to have a moral hazard.  I'm curious if you support 100% clawback of the ACA subsidies from all ages and classes or just those for the 55+ and poor.
            Of course that is the problem with this scheme claiming to be health care.

      •  How it really rolls... (0+ / 0-)

        The Collateral Loan

        [I]f an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.” Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market. ...

        Furthermore, to increase enrollment in health coverage without requiring people to complete an application on their own, states are advised to automate enrollment whenever possible by using existing databases for social services programs such as SNAP (food stamps) to enroll people who appear eligible for Medicaid but are not currently enrolled. Therefore, you could find yourself auto-enrolled in Medicaid against your will if your state acts on this advice.

        .... You won’t find the following info in the ACA. It’s in the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.

        a) OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going beyond nursing homes and other long-term care institutions. In fact, The Centers for Medicare & Medicaid Services (CMS) site says that states have the option of recovering payments for all Medicaid services provided. The Department of Health and Human Services (HHS) site says at state option, recovery can be pursued for any items covered by the Medicaid state plan.

        b) The HHS site has an overview of the Medicaid estate recovery mandate which also says that at a minimum, states must pursue recoveries from the “probate estate,” which includes property that passes to the heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds.

        c) Some states use recovery for RX and hospital only as required by OBRA 1993; some recover for a few additional benefits and some recover for all benefits under the state plan. Recovery provides revenue for cash-strapped states and it’s a big business.

        Medicaid is a state program.  Here are the rules for New Jersey:
        The Division of Medical Assistance and Health Services (DMAHS) is reinforcing and updating guidelines that were issued in Medicaid Communication No. 00-16, dated August 10, 2000, governing the recovery of correctly paid Medicaid benefits from the estates of deceased Medicaid clients or former Medicaid clients. The following is a list of important points to remember when determining eligibility and discussing this topic with applicants, clients, authorized representatives and families:
        • Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form.
        • DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time.
        • Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery.
        • The estates of deceased clients who were enrolled in various Title XIX Waiver Programs (such as ACCAP, GLOBAL Options, CCW, etc.) ARE subject to recovery. ...
        I hope this fills in the gaps on how this rolls.  Every state has similar "estate recovery" programs which are an important feature of "revenue neutral" O'care.

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