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View Diary: "Medicaid is Welfare. It's right to expect repayment." With poll. (60 comments)

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  •  When read in full, the linked application says: (3+ / 0-)
    Recommended by:
    ban nock, Urban Owl, elfling
    By law (RCW 41.05A.090 and WAC 182-527), if you are age 55 or older AND receive WAH services, Health Care Authority (HCA) may recover from your estate (assets you own at the time of death) to repay HCA for the costs of health care assistance. This is called ESTATE RECOVERY. Estate Recovery does not occur until after death and the death of your surviving spouse, if any. HCA may recover the costs for state-only funded long-term care services received at any age.
    HCA may recover the costs for state-only funded long-term care services received at any age.

    This is a complex topic that financial planners have been addressing for years with clients who need help with it.  There’s even a “For Dummies” book about it, though I’m not sure it’s comprehensive, it’s okay for basic information, like this:


    In 1993, the U.S. Congress passed an act that requires each state to demand repayment for Medicaid benefits that had previously been provided to certain citizens for certain services:

    Certain citizens: People over the age of 55 who have received Medicaid payments within a specified period of time.

    Certain services: Payments for nursing homes and nursing care facilities, home and community-based services, related services at hospitals, and prescription drugs.

    There’s a war on the middle class and poor people in the US.  Fear, confusion, and doubt are some of the weapons used against them.  Knowledge and information are essential for people to be able to defend themselves.

    • Google “Medicaid estate planning”
    • Check with Medicaid and HHS. There’s useful info on their websites
    • Use your community resources

    This topic is complicated because estate recovery is implemented differently in the states. It also conflicts with probate laws that vary from state to state. In other words, what’s true in one state isn’t always true in another.

    There may be confusion over the designation “long term care.”  The same healthcare services and medical treatment can be given to two different people and estate recovery may apply to one but not the other.  The factor that makes the difference is whether the patient has been placed under long term care.  Of course for people who don’t have an estate, none of this would be a concern.

    There is no existence without doubt.

    by Mark Lippman on Thu Oct 24, 2013 at 07:03:58 AM PDT

    [ Parent ]

    •  Whay you are highlighting doesn't make (4+ / 0-)
      Recommended by:
      tardis10, fauve, elfling, beverlywoods

      any difference to this discussion.

      We all know that states can and do recover for Medicaid long term care/nursing homes for anyone of any age. That's no surprise.

      What most people are unaware of is that many states attempt recovery NOT just for nursing home and long term care but any and all other services that were provided under the medicaid umbrella if the recipient is over 55.

      By law (RCW 41.05A.090 and WAC 182-527), if you are age 55 or older AND receive WAH services, Health Care Authority (HCA) may recover from your estate (assets you own at the time of death) to repay HCA for the costs of health care assistance.
      You do see that it says "health care assistance" without any qualifier, right?

      WAH is Washington Apple Health and is simply the instate name for Medicaid under the expansion.Washington's Apple Health aims to simplfy Medicaid
      There is no indication that it is only long term care, quite the opposite.

      I would be happy and relieved to learn if there is absolutely no concern for someone over 55 with assets who receives care under the Medicaid expansion in regards to liens and estate recovery outside of long term care. So far, no one has demonstrated that.

      “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

      by Phoebe Loosinhouse on Thu Oct 24, 2013 at 07:26:16 AM PDT

      [ Parent ]

      •  Your answer is in the referenced statutes: (3+ / 0-)

        RCW 41.05A.090 and WAC 182-527 and in federal law referenced by both statutes:

        Title 42 USC Sec. 1396p

        People with assets at risk should seek help from a qualified professional if their own efforts don't answer every question.  

        Acting on the advice of anonymous uncredentialed individuals on the internet isn't advisable.

        There is no existence without doubt.

        by Mark Lippman on Thu Oct 24, 2013 at 08:18:29 AM PDT

        [ Parent ]

        •  I completely 100% agree (2+ / 0-)
          Recommended by:
          lurker123, beverlywoods

          with your reply and it is what I would do for myself if I suspected that this issue or possible non-issue would affect me.

          It is something to be discussed with an elder-law professional and the state's Medicaid office and probably both.

          I am grateful for beverlywood writing her diaries because I for one would not have known it was even a possible issue without her diaries.

          “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

          by Phoebe Loosinhouse on Thu Oct 24, 2013 at 08:23:33 AM PDT

          [ Parent ]

        •  part of it (0+ / 0-)
          (a)  Imposition of lien against property of an individual on account of medical assistance rendered to him under a State plan  
           (1) No lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State plan, except—  
           (A) pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual, or  

           (B) in the case of the real property of an individual—  
           (i) who is an inpatient
          in a nursing facility, intermediate care facility for the mentally retarded, or other medical institution, if such individual is required, as a condition of receiving services in such institution under the State plan, to spend for costs of medical care all but a minimal amount of his income required for personal needs, and  

           (ii) with respect to whom the State determines, after notice and opportunity for a hearing (in accordance with procedures established by the State), that he cannot reasonably be expected to be discharged from the medical institution and to return home,  
          except as provided in paragraph (2).

          Paragraph (2) protects family members [spouse, children under 21] living in the home.

          This still allows liens after death with no other qualified family members living at home.

          (b)  Adjustment or recovery of medical assistance correctly paid under a State plan  
           (1) No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan may be made, except that the State shall seek adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan in the case of the following individuals:  
           (A) In the case of an individual described in subsection (a)(1)(B) of this section, the State shall seek adjustment or recovery from the individual’s estate or upon sale of the property subject to a lien imposed on account of medical assistance paid on behalf of the individual.  

           (B) In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of—  
           (i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or  

           (ii) at the option of the State, any items or services under the State plan (but not including medical assistance for medicare cost-sharing or for benefits described in section 1396a (a)(10)(E) of this title).

          There seems to be a state option to be broad in recovery except for Medicare cost sharing and what I think "section 1396a (a)(10)(E)"is help to federal SSI recipients.

          What "related" relates to and how is unclear to me.

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