Continuing my series on Medicaid expansion and Estate Recovery:
Welcome to Chapter 3: "Medicaid is Welfare. It's right to expect repayment."
Our story so far: We now have some confirmation from the disclosures in some states' signup forms that it appears likely that Estate Recovery will apply to those enrolling in Medicaid through the ACA. For example, in WA:
On the WA state "Application for Health Care Coverage" (same application for both the expanded Medicaid called WAH-for WA Apple Health, and the Exchange's subsidized plans), there are these two sentences on page v of the instructions:And in NY the form states:
“Things you should know about Washington Apple Health only:
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.”
When I sign this application, it means:Please share with us any form disclosures or other information you may have on this from your state, particularly if you live in a state that collects not just for long term care, as mandated by federal law, but has gone for the option to collect for all services provided to anyone 55 or older.
I know that Medicaid will not pay medical expenses that insurance or another person is supposed to pay medical expenses that insurance or another person is supposed to pay.
I give the Department of Health any right under the law to try to get payment for medical expenses from my spouse or the mother or father of my child, if my child is under 21 years old.
I give the Department of Health the right to get paid, instead of me, the money owed to me by certain other companies or people in order to pay for my benefits.
I agree to file any claims for health or accident insurance benefits, or any other claims for money or benefits, that I have a right to file.
By applying for Child Health Plus, I agree to pay the monthly fee (premium) not paid for by New York State.
I understand that once I get Medicaid coverage, if I am over 55 or if I am in a medical institution and not expected to return home, the Medicaid program may do the following in order to pay for my medical care:
Take money I already have or that is owned to me.
Take money that was made from selling certain things I own
Take money from people who were legally responsible for me when I got benefits
Yesterday I was able to have a conversation with someone in the NH Medicaid Estate Recovery Department. When I asked her if Estate Recovery would apply to those 55 and older who enrolled under Medicaid Expansion, if NH expands Medicaid, she said:
"As far as I know, yes."
Of course at this moment all of this is not implemented yet since NH has not yet accepted Medicaid expansion. Therefore I could not get answers to questions about how this would apply. She did mention that the NH Breast & Cervical Health Program is now an estate-recoverable item. I hadn't even thought about that: 55 or older and low income? The cost of that mammogram will be taken out of your estate! But I digress.
The person with whom I spoke was quite adamant that it would not be accurate to characterize Medicaid benefits received by those subject to Estate Recovery as a loan. Why not? "Because we don't charge interest!" And of course because there are some people they don't recover from: those under 55, those not using estate-recoverable programs, etc.
Likewise, she was firm that Estate Recovery is not a tax. There are very particular requirements as to what legally constitutes a tax, she told me.
OK, what would she call it, then? "A creditor claim. It's a creditor claim."
Creditor: A creditor is a party (e.g. person, organization, company, or government) that has a claim on the services of a second party. It is a person or institution to whom money is owed. The first party, in general, has provided some property or service to the second party under the assumption (usually enforced by contract) that the second party will return an equivalent property and service. The second party is frequently called a debtor or borrower. The first party is the creditor, which is the lender of property, service or money.Then she explained that Medicaid is a form of welfare, and that it is only right that if people receive welfare, they should pay it back if possible.
The term creditor is frequently used in the financial world, especially in reference to short-term loans, long-term bonds, and mortgage loans. In law, a person who has a money judgment entered in their favor by a court is called a judgment creditor.
The term creditor derives from the notion of credit. In modern America, credit also refers to a rating which indicates the likelihood a borrower will pay back his or her loan. In earlier times, credit also referred to reputation or trustworthiness.
So here is a very important question: Is Medicaid a form of insurance? Or is it welfare?
If it is welfare, and if by taking it one becomes indebted to the state, what are the implications of enrolling millions of people under the ACA who may not understand that the option at the bottom of the income ladder is not insurance at all, but a form of welfare, incurring a debt one is expected to pay back?
It's only right, the person from the Estate Recovery office assured me. If people take welfare, they should expect to have to pay it back.
What do you think?