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View Diary: So are the ACA "Subsidies" or are they LOANS!?! (166 comments)

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  •  I think that is referring to Medicaid expansion (4+ / 0-)
    Recommended by:
    nolagrl, suesue, scotths, Sylv

    but not if you buy insurance on the exchange, whether you get a subsidy or not.

    Ed FitzGerald for governor Of Ohio. Women's lives depend on it. http://www.edfitzgeraldforohio.com/

    by anastasia p on Wed Nov 06, 2013 at 07:31:56 PM PST

    •  Well, in California the "Medicaid" (4+ / 0-)
      Recommended by:
      Mr Robert, Chi, Norm in Chicago, raines

      Expansion is MediCal, and it sure does seem that some people will be surprised BIG TIME, when they find out that they will have to repay those"subsidies."

      Currently the premiums for a couple in their late fifties is around one thousand bucks a month. If a couple was on Medical for ten yeas, you're  talking about over 120,000 worth of monies that the State will want to recoup. So it's easy to calculate how little in assets a couple will leave behind for their offspring when the State comes after their assets in order to recoup the MediCal expenses.

      Offer your heart some Joy every day of your life, and spread it along to others.

      by Truedelphi on Wed Nov 06, 2013 at 07:36:08 PM PST

      [ Parent ]

      •  If they're recieving MediCal (11+ / 0-)

        why should they be leaving any substantial assets to their heirs?

        •  who said they should, really? (1+ / 0-)
          Recommended by:
          beverlywoods

          I'm hearing it that many people do not know, it is not discussed, and it's surprising. It certainly should be part of decision. It's a huge financial decision, has a big impact for some people I suppose. People who own homes prior to their reduced circumstances may not want to not be able to leave it to their kids.

        •  Because of several things - (0+ / 0-)

          Number One) The President himself said that we would be subsidized. I repeat that word, "subsidized."

          Note that subsidy is not a loan. The two things are extremely different.

          Number Two) We don't have a choice in the matter. The ACA is a MANDATE that requires us all to participate. if you don't participate, you get fined.

          The one segment of people that is being told by the Democratic Leadership (and by every one who is super loyal to the Democratic leadership) that they have not a thing to lose by dealing with the ACA is the underclass of Americans who don't make much money. (Here in California, in terms of getting MediCal, which is referred to as MediCaid in other states, that amount is
          around $ 10,000 for an individual and $ 16,000 for a couple.)

          There is so much wrong with this picture that at times I can't see straight. Including the fact that even super Obama supporters like Bill Maher are saying that insurance premiums would come down, if there was reform of the medical and pharmaceutical industry's price fixing. Why should an artificial hip that costs some $ 380 get sold to a hospital for $ 13,000? Why should the hospital charge the patient (or their insurer) some $ 22,000?

          Then if you would scroll  to my questions to BruceMacF, that is an entire other issue. Those who are just a bit better off are not on MediCal but on the Exchange, and then the $ 200 out of $ 1,100 in premiums they pay allows them to not have to allow the STATE to recoup their subsidies when they die, while the ner indigent lose their $ 45,000 trailer. How fair is that?

          Offer your heart some Joy every day of your life, and spread it along to others.

          by Truedelphi on Wed Nov 06, 2013 at 10:33:30 PM PST

          [ Parent ]

          •  This rule was before the ACA. Check with (2+ / 0-)
            Recommended by:
            Sylv, Kane in CA

            the up to date law before obsessing about it.

            Get a Dem majority in 2014 and we can look at some further steps to reduce costs.

            Has anyone ever heard about someone's survivors losing some big asset?

            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 Thu Nov 07, 2013 at 05:07:42 AM PST

            [ Parent ]

            •  Really off topic, but... (1+ / 0-)
              Recommended by:
              beverlywoods

              In 1972 my father was crippled in a workplace accident, and we had to go on GA for three months while Social Security completed the paperwork. We were give $140 a month for those 3 months. The state of New York placed a $10,000 lien on our house, which they collected on when my father died in 2005.

              •  It's not all that off topic. Your (1+ / 0-)
                Recommended by:
                beverlywoods

                Story accentuates two facts that most people don't want to think abut:

                One) "Normal" people can fall upon hard times. People don't think it will happen to them. But it does and it can.

                Two) Our country is the only country in the civilized world that has such re-appropriation polices when a person falls on hard times.

                Meanwhile the crooks at the top who have stolen trillions are living the high life. And they laugh themselves silly while the middle class continues to propagate the notion that "People need to lift themselves up by their own damn bootstraps."

                Offer your heart some Joy every day of your life, and spread it along to others.

                by Truedelphi on Thu Nov 07, 2013 at 11:56:30 AM PST

                [ Parent ]

        •  Because people receiving health care subsidies (2+ / 0-)
          Recommended by:
          Orj ozeppi, beverlywoods

          are not going to be asked to pay the money back when they're dead. Why take it back from the poorest people if you're not taking it from anyone else?

          •  They're not being taken back from the poorest (0+ / 0-)

            people. The poorest people don't own any assets when they die. And they're not being taken away from any poor people. Not a single one. Only from the estates of dead people. The reason these rules exist is that it permitted people who own homes but have no income to receive Medicaid benefits. That's right. It expanded Medicaid to allow more people with no income to get benefits.

            This is not a function of the ACA. It's decades old Medicaid rules.

            •  "the estates of dead people" (0+ / 0-)

              can be the assets of some people otherwise extremely poor.

              Estate Recovery is really a great way of making sure that those in poverty leave their families in poverty too.

              If you act out of anger, the best part of your brain fails to function. - the Dalai Lama

              by beverlywoods on Thu Nov 07, 2013 at 07:57:33 PM PST

              [ Parent ]

              •  No, it's not (0+ / 0-)

                It would be nice if everyone could inherit a big pile of money. Some can't. Some of the people who would otherwise inherit that pile of money might be in poverty. Some of them may be quite wealthy. Someone who dies with a house worth $750,000 and no mortgage, and was a Medicaid beneficiary, and received $100,000 of Medicaid benefits still leaves an estate of $650,000 to their heirs. That's still a lot more than most people inherit. And you think the taxpayers should subsidize those rather wealthy heirs?

                •  this kind of example (0+ / 0-)

                  is often used to get people to believe that estate recovery is a fine thing and perfectly fair.

                  For one thing I think it would be far more common for the Medicaid bills to be much higher than that and the home value to be much lower. Keep in mind that for all they do, the estate recovery offices only "recover" a fraction of a percent of what is spent on Medicaid.

                  But in the broader picture of what we as taxpayers spend and who we subsidize and who has to pay it back, no, I don't think estate recovery is fair, and I think it is probably about to get a whole lot less fair.

                  If one person gets $50,000 worth of subsidies and another person gets $50,000 worth of Medicaid, why are we going after the Medicaid recipient's family assets and not the subsidy recipient's family assets?

                  If you act out of anger, the best part of your brain fails to function. - the Dalai Lama

                  by beverlywoods on Fri Nov 08, 2013 at 03:43:02 AM PST

                  [ Parent ]

      •  Truedelphi, I am in GA & saw similar language (4+ / 0-)
        Recommended by:
        falconer520, Lujane, samddobermann, blw

        on paperwork for my child.  Who has severe ID & other disabilities, will never have an "estate" and will require SSI & medicaid for life.  Sigh.

        I think (but am not certain) that what you describe has been an initiative in effect for decades across the states.

      •  The 'subsidies' most people are talking about ... (8+ / 0-)

        ... are the help that people on the Health Insurance Exchanges receive if they are between the Poverty Line and 4x the poverty line.

        The Medicaid Expansion ~ MediCal in California ~ to people not previously eligible for Medicaid if they are under 1.4x the poverty line is supposed to be fully funded by the Federal government for the first few years, then phasing down to 90% funded by the Federal government after a few years transition.

        If the State government applies the current clawback provisions to people's care that was funded 90% to 100% by the Federal government, its not very clear what the clawback is based on.

        This is, in any event, something to bear in mind for people who are in the range where they are allowed to go either way, that there is no risk of an assets clawback if they go with the Health Insurance Exchanges.

        Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

        by BruceMcF on Wed Nov 06, 2013 at 07:43:09 PM PST

        [ Parent ]

        •  And Note that each state's ... (2+ / 0-)
          Recommended by:
          Kane in CA, worldlotus

          ... Medicaid program rules can vary, due to the shared federal/state funding of the system, so always double check claims online against the rules in your state ... a claim can be true, for the poster's state, and false, for your state, both at the same time.

          Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

          by BruceMcF on Thu Nov 07, 2013 at 08:38:03 AM PST

          [ Parent ]

      •  how could anyone qualify for medical and have (7+ / 0-)

        an estate?

        •  Its an income test, not a wealth test ... (16+ / 0-)

          ... you could be unemployed or only part time employed but still own your own home outright.

          Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

          by BruceMcF on Wed Nov 06, 2013 at 07:50:04 PM PST

          [ Parent ]

          •  Thank you for that. Many "well off" (4+ / 0-)

            Middle Incomed, middle aged people were wiped out by the economic collapse. And their health suffered on account of it also.

            They may be needing to be on MediCal, but now their home and other assets, like cars, etc., are ripe for the taking to pay back the MediCal once they have died?

            Offer your heart some Joy every day of your life, and spread it along to others.

            by Truedelphi on Wed Nov 06, 2013 at 08:30:55 PM PST

            [ Parent ]

            •  This only applies if the person goes into (2+ / 0-)
              Recommended by:
              samddobermann, BruceMcF

              long term care.

              •  Link? (0+ / 0-)

                Those are the kind of details that would really help in discussion of this topic. The only contact a lot of middle class families have with Medicaid are elderly relations in long term care.

                Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

                by BruceMcF on Thu Nov 07, 2013 at 08:14:04 AM PST

                [ Parent ]

              •  Again, that simply is not the case. (1+ / 0-)
                Recommended by:
                beverlywoods

                At least not in California. We were given the brochure and we were told to our faces that the expense of our being on MediCal, a program that allows for doctor visits, hospital ER visits and hospital stays, medical treatment, as well as for the nursing home care, would be recouped were we to die while on the program. Exact language is contained in my opening OP.

                In 1995, over 14 million people were on MediCaid programs  across  the USA. Many of these people were families with small kids, and not anyone in the family in a nursing home.

                In California, MediCaid is called MediCal

                Offer your heart some Joy every day of your life, and spread it along to others.

                by Truedelphi on Thu Nov 07, 2013 at 12:00:07 PM PST

                [ Parent ]

                •  If they had small kids, they're protected from (0+ / 0-)

                  estate recovery.

                  You always have the choice of not getting Medical. You don't want to risk it, buy regular insurance. If you've got assets you need to protect, there are ways around it. I guess I just don't understand the "I have to find SOMETHING wrong with millions getting more healthcare" attitude.

                  •  Now that the ACA is mandated, and people are (0+ / 0-)

                    Encouraged to apply for the insurance through the Calif. exchange, they won't realize until they have signed up what it means. Again, we got our brochure telling us about this in the mail, some weeks after we were on MediCaid.

                    Offer your heart some Joy every day of your life, and spread it along to others.

                    by Truedelphi on Sat Nov 09, 2013 at 01:42:24 PM PST

                    [ Parent ]

          •  Traditional Medicaid has an assets test (4+ / 0-)

            that is very stringent -- you can own your home, but not much else. So what this enabled states to do was pay for nursing home care or whatever, and when the person died, put a lien against the home. It enabled people to get assistance when they had little cash, just a non-liquid asset.

            I was on Medicaid for a while, under a special program that did not have an assets test, and I had to sign something similar to this. Assuming they're good at keeping records, and that I die in the same state, my estate will someday (hopefully in another 30 years or so) have to pay back what they paid out on my behalf. That seems a fair trade.

            What I believe is different is that the ACA Medicaid expansion seems to have eliminated the asset test, at least for people in the expansion zone -- so yes, for those folks, there is a risk that when they die, decades from now, the state will demand reimbursement for actual expenses paid on the person's behalf (not for the premiums that would have been paid if they'd been purchasing commercial insurance).

            IMO this is one of the many pieces that should get clarified and fixed when Congress settles down and decides to repair the ACA rather than try to trash it. It will be tricky, though, because the recoupment provision makes it easier to convince states to go ahead and expand Medicaid.

            •  It's been the case since forever, as far as I know (0+ / 0-)

              The strategy for dealing with it is to shed assets before entering a nursing home, if you have no spouse or children under 21.

              My great aunt's long, slow battle with cancer is the source of all the furniture, dishes, and cookware a cousin and I had for our first apartments way back in the days of yore.

              •  Yes, the question is ... (2+ / 0-)
                Recommended by:
                radical simplicity, beverlywoods

                ... the reach of the estate clawback ... the obscurity would be due to the fact that Medicaid varies from state to state and that in most states its mostly limited to pregnant women & women with young children and to people in nursing homes, so not a lot of people have experience with what happens with "regular" Medicaid health coverage in their state for people 55+.

                Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

                by BruceMcF on Thu Nov 07, 2013 at 08:18:18 AM PST

                [ Parent ]

                •  Yup (0+ / 0-)

                  In MA, clawback attaches to assets that were held within 5 years of entering the nursing home, on a prorated basis - so 100% of the asset's value can be looked at for clawback purposes if the asset is owned the year the person enters the nursing home, 80% if it was handed to an irrevocable trust the year before, 60% if entrusted 2 years before, etc. We know this because of my father's strokes.

                  Note, though, this just means that if you have nursing home bills of, say $100k, and your house was in your possession and fully paid off when you entered the nursing home, and you had no spouse and no children under 21 at the time, then all of the house's sale value can be looked at for recovery of that $100k. Thus, if the house sells for $400k, there are $300k in assets that remain after the clawback. If, however, the house is worth only $100k, and it was put into a trust 4 years ago, then only $20k of the house's sale value can be used to reimburse the state for that $10k in care. Beyond 5 years, none of the home's value is accessible for clawback .. if it was put into an irrevocable trust. Note: irrevocable - the owner cannot retain control over the asset via a revocable trust.

                  BUT - that's just for standard medicaid use of a nursing home. The rules related to the ACA are different.

                  The laws are different in every state, so there is no one answer that is true for everyone at the national level.

                  Folks who are in a position to need to know the specifics will need to talk to someone in their home state with proper expertise. Looking up random hearsay on the internet, or looking at old brochures from pre-ACA is pointless.

              •  Another strategy is to put your house in a trust, (1+ / 0-)
                Recommended by:
                radical simplicity

                and make the beneficiaries the trustees

                •  a trust (not necessarily so trusty) (1+ / 0-)
                  Recommended by:
                  beverlywoods

                  Per Oregon (& Fed allowable) "trusts" --- Ooops #@%$

                  Oregon estate recovery law defines “estate” very broadly, so as to facilitate recovery of Medicaid assistance paid regardless of how it passes upon a recipient’s death. OAR 461-135-0832. Federal Medicaid law allows (and Oregon has opted for) an “expanded” definition of “estate” that includes not only the assets in a person’s probate estate (as determined by state law) but also those assets that pass outside of probate, including through:

                      Joint Tenancy/Tenancy by the Entirety
                      Life Estates
                      Living Trusts
                      Certain Annuities

                  ~A govt lobbied, campaigned and selected by corporation... is good for corporation. Bad for people.~ -8.88 -8.36

                  by Orj ozeppi on Thu Nov 07, 2013 at 09:53:14 AM PST

                  [ Parent ]

        •  Because everyone has an estate, even if it is just (3+ / 0-)
          Recommended by:
          Mr Robert, Heavy Mettle, Lujane

          their family photo album.

          You have watched Faux News, now lose 2d10 SAN.

          by Throw The Bums Out on Wed Nov 06, 2013 at 08:04:10 PM PST

          [ Parent ]

      •  nonsense. They will not b e collecting premiums (2+ / 0-)
        Recommended by:
        radical simplicity, tommymet

        They are paid by the Federal government.

        They could go after uncompensated care. There is an exception under Federal law for cases of need.

        Why are you looking at a pre- ACA pamphlet anyway? Check with Medical again for the existing rules.

        In part this rule was put in to catch cheats when there was an asset limit to Medicaid eligibility.

        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 Thu Nov 07, 2013 at 05:03:07 AM PST

        [ Parent ]

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