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It is my understanding that many people who are not currently insured will be visiting the California exchange, and if their income is low enough, and they are not offered insurance through work, they will get insurance through MediCal.

I spent today cleaning out the closet. Among other items I came across was a brochure sent to this household some years ago (circa 2008-2009) when we qualified for MediCal.

Here is what it says in the brochure, sent by Health and Human Services:

"When a Medi-Cal beneficiary is 55 years of age or older at the time of death, the State will collect from his/her estate the cost of Medi-Cal services received including insurance premiums paid an d payments made to managed care on or after the 55th "birthday."

The brochure goes on to detail exclusions, such as if your spouse has survived your death, they won't go after the estate until the spouse has also died. And they exclude a household where a child survives a parent AND IS UNDER THE AGE of 21.

So is this still in place?

Again, this is not something I found out about by watching Fox news, or the RW Denouncers. It is right there inside the brochure issued by California Dept of Health and Human services.

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Comment Preferences

  •  Tip Jar (4+ / 0-)
    Recommended by:
    RBinDLH, Chi, Sylv, beverlywoods

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

    by Truedelphi on Wed Nov 06, 2013 at 07:29:30 PM PST

  •  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 ]

  •  Trued - this topic has been the subject (12+ / 0-)

    of some discussion here at DKOS although I am sorry that I can't find the specific diaries. I believe the consensus is that the way the ACA was drafted, for those people 55 and older  the expanded Medicaid would work in the same manner as Medicaid does now. The government would have a priority claim on the assets of the estate at the time of death for the cost of care. Understand that this was just a few diaries on a blog and should not be taken as legal advice. If this situation applies to you, or someone you know, I would encourage you to seek expert advice in your state on this matter.

    "let's talk about that"

    by VClib on Wed Nov 06, 2013 at 07:42:47 PM PST

  •  kossack beverlywoods has written several (15+ / 0-)

    diaries on this, beginning here: Unintended Consequences. The answer isn't clear to me and seems likely to vary by state (it's a federal requirement but not implemented uniformly), but it seems to be a valid question.

  •  Good question... and yes it is probably still (5+ / 0-)

    in place.

    A lot of people getting "subsidies" aren't going to be happy when they discover the fine print.

    But, perhaps the rules changed with Obamacare itself... although I doubt it.


    One does not become enlightened by imagining figures of light, but by making the darkness conscious. --Carl Jung

    by bronte17 on Wed Nov 06, 2013 at 07:43:25 PM PST

    •  They might not be happy when they discover ... (10+ / 0-)

      ... the fine print ... especially if they get a Bronze Plan, which may not be as crap insurance as many crap insurance plans out there, but are still awfully leaky umbrellas, if they are expected to only cover an average of 60% of health care expenses ...

      ... but the people getting subsidies won't have this issue in their fine print, that will be a worry for those who are in Medicaid instead of in the Health Insurance eXchanges (HIX).

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

      by BruceMcF on Wed Nov 06, 2013 at 07:48:17 PM PST

      [ Parent ]

      •  So then explain the fairness of the system... (4+ / 0-)
        Recommended by:
        Lujane, Chi, raines, beverlywoods

        I am admiring what  you have written. Yes, I find it  it is clear and easy to understand.

        But are you saying that if a Californian is desperately poor, and they apply to the Exchange, then the Exchange directs them to MediCal (Which is exactly what happens) then that poor person will owe 100% of the cost of the insurance policy premiums yet meanwhile  my husband and I who are a bit better off and can come up with some $ 200 a month to help pay for our subsidized premiums, and we don't have to worry that the State will go after us should we die, as we have remaine d "on the Exchange" but the poorer person will, again in my example of an older person, be liable for the five hundred a month in premiums if a single person, or the one thousand bucks a month if part  of a couple?? So just having that $ 200 bucks to help pay for the one thousand a month premium means you are OLLIE OLLIE OCEAN FREE, but the poor people can get their estate wiped out?

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

        by Truedelphi on Wed Nov 06, 2013 at 08:37:19 PM PST

        [ Parent ]

        •  Are there Medicaid premiums? (3+ / 0-)

          I have never seen a figure for Medicaid premiums except in some comments here. My understanding is that only actual costs can be recovered (nursing home fees, for example).

          The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

          by ybruti on Wed Nov 06, 2013 at 08:50:33 PM PST

          [ Parent ]

          •  According to Wikipedia, there are premiums paid (0+ / 0-)

            by the state to managed care organizations:

            Beginning in the 1990s, many states received waivers from the federal government to create Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to a significant proportion of Medicaid enrollees. Nationwide, roughly 60% of enrollees are enrolled in managed care plans. Link
            It seems possible that these premiums might be recovered at the death of persons who were enrolled in Medicaid at age 55+. Also, the cost of hospitalizations.

            The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

            by ybruti on Wed Nov 06, 2013 at 10:10:03 PM PST

            [ Parent ]

            •  they are "capitation costs" (0+ / 0-)

              and they can be very high. In AZ it is over $3000 per month - not including any medical services you may actually use.

              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 08:04:09 PM PST

              [ Parent ]

        •  No (4+ / 0-)

          They won't be liable for it. If the 2nd to die leaves a significant enough estate, those premiums will be repaid from the estate. Can you explain why the state should not be reimbursed?

          •  I have a daughter (26) who not wealthy, (2+ / 0-)
            Recommended by:
            beverlywoods, bronte17

            but will inherit her father's house at the time of his death. She is currently living with her father at the family home, because of her low income situation. Because real estate is so expensive in the Bay Area, she will probably be living there for the rest of her life. I also have another, older daughter who lives nearby with her husband and granddaughter, who will also someday inherit this property, and possibly may end up living there.
            Their father, my ex-husband, is not wealthy. He is 63, and is currently employed; he makes just over minimum wage as a caregiver.
            If something happened to my ex, and had to sign up for Medical, I do not want my two daughters, and granddaughter loose the one inheritance - a roof over their head - to loose their home the state of California

        •  Trued - I think that Medicaid is free (2+ / 0-)
          Recommended by:
          Kickemout, beverlywoods

          I don't think Medicaid participants pay any premiums. However it seems, the way the ACA is currently drafted that if you die after age 55 your estate would owe Medicaid what they have paid in for your care, although in some states it's only nursing home care. I think members of Congress are becoming aware of what would seem to be a drafting error based on the example you present. However, it is difficult to think that the GOP will allow some relief on this point, given their view of poor people.

          "let's talk about that"

          by VClib on Wed Nov 06, 2013 at 10:27:20 PM PST

          [ Parent ]

          •  In California, it is the amount they pay on your (1+ / 0-)
            Recommended by:
            VClib

            Behalf, regardless if it is simple health care like Dr visits and a hospital stay or if it is nursing care.

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

            by Truedelphi on Thu Nov 07, 2013 at 12:02:43 PM PST

            [ Parent ]

        •  No, Not the premiums — since there aren't any (0+ / 0-)

          but the costs. Usually only the long term care costs.

          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 05:14:10 AM PST

          [ Parent ]

        •  Actually, since this was first thought up (3+ / 0-)
          Recommended by:
          tommymet, beverlywoods, bronte17

          By the Heritage Foundation, I wouldn't be surprised.

          After all, we can't have the poor actually accumulating enough to leave poverty, or to help their children leave poverty, can we. (sarcasm)



          Women create the entire labor force.
          ---------------------------------------------
          Sympathy is the strongest instinct in human nature. - Charles Darwin

          by splashy on Thu Nov 07, 2013 at 08:12:10 AM PST

          [ Parent ]

    •  Question (5+ / 0-)

      If they are on Medicaid under whatever name, surely they do not have to purchase insurance and would therefore not strictly be getting a subsidy?

      On the general point and looking at the scheme from the outside; the ACA monthly subsidies are surely in effect advances against what is expected to be the individual's tax liability at the end of the year. That's why you are asked for your expected income in the calculation. If somebody grossly underestimates their income they have the subsidy clawed back (from their tax rebate?) and similarly they are entitled to a credit if they overestimate - say they loose their job.

      Perhaps framing the subsidies as an income tax credit would have made selling the scheme easier?

      We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

      by Lib Dem FoP on Wed Nov 06, 2013 at 07:59:44 PM PST

      [ Parent ]

      •  Well, what I am having a problem with is (0+ / 0-)

        The situation I explain to Bruce, one thread above yours.

        Obama himself has stated that if you are very poor, you will have no worries, as you will be 100% subsidized. And that expression "subsidies" implies no STATE of California or Georgia or wherever coming after your assets.

        Anyway I won't type everything out all over again, but would be interested in having you read my question to BruceMacF and then replying here.

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

        by Truedelphi on Wed Nov 06, 2013 at 08:41:11 PM PST

        [ Parent ]

        •  No (2+ / 0-)
          Recommended by:
          NotGeorgeWill, Norm in Chicago

          That state will not come after anyone's assets. It may come after assets of the estate when the MediCal beneficiaries die. Why should this not be so?

          •  For starters, the explanation offered by the (1+ / 0-)
            Recommended by:
            beverlywoods

            Pesident of the USa as the gospel truth was that if you could not afford the MANDATED insurance premiums then the government would be "giving" you, the poor individual, some subsidies. Not "loaning" but GIVING! OFFERING.

            The President himself has addressed the fact that those who are indigent will have 100% of their premiums paid for. ONE HUDNRED FRIGGIN'  PERCENT.

            But now it turns out that the subsidies are actually loans.

            The government created a POS legislation that is forcing people to buy a product they didn't previously buy. And those people  will get bit in the butt when they die, as the home  they bought and paid for will be sold so the STATE can recoup their monies.

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

            by Truedelphi on Wed Nov 06, 2013 at 10:00:08 PM PST

            [ Parent ]

            •  Explain how (0+ / 0-)

              anyone will get "bit in the butt" when they die? If they're dead, they're dead. They're getting exactly what was promised while they're alive.

              •  What Obama told us was that the indigent would be (0+ / 0-)

                Subsidized.

                Not "loaned" monies that the state would come after once they died. Offered subsidies.

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

                by Truedelphi on Wed Nov 06, 2013 at 11:12:22 PM PST

                [ Parent ]

                •  so you can't actually explain (0+ / 0-)

                  how anyone will get "bit in the butt"?

                  •  I know a few people with low incomes AND homes. (2+ / 0-)
                    Recommended by:
                    tommymet, beverlywoods

                    I'd bet a few of them would rather tighten their belts a  bit and pay a few hundred a month for subsidized insurance rather than expose their only real assets to the whim of present or future state government. If some part of the process has been handed over to the private sector, like management, you can bet it mirrors the private prison model: good money and guaranteed income.  

                    I'll look around now, but I'll bet it costs over a grand a month per patient in states with that model, whether you use medical services in a given month or not.

                    Yes, I'm talking out of my butt. At least I am aware of it, though.

                    "The right is correct on one thing...we really are a bunch of easily outraged nitpickers."

                    by potato on Thu Nov 07, 2013 at 06:53:07 AM PST

                    [ Parent ]

                    •  It's really not the whim (0+ / 0-)

                      of present and future state governments. The laws exist now. If you have assets but still qualify for Medicaid, then its possible that expenses paid by Medicaid on your behalf will be recovered from your estate after you die. If heirs want to protect their inheritance, they can take care of their parents without relying on Medicaid. If heirs don't have the wherewithal to do that, then Medicaid will at least provide some protections. It's unclear to me why anyone thinks this is unfair or unreasonable.

                      •  It is unfair and unreasonable because shelter (1+ / 0-)
                        Recommended by:
                        beverlywoods

                        is a basic human need.  
                        You buy a home in this nation by taking out a loan with interest.  Over the life of the loan you already pay the principle perhaps several times over.  You struggle to meet the mortgage every month but, you pay for interest for a couple of decades on top of what the home is worth. This in a nation that is so wage depressed that even full time workers will die in the hole.  Getting government help to enable workers to meet a basic human need of shelter will only dig that generational hole deeper.
                        Say you have a child and modern education has put that child under crushing debt such that they will not be able to marry, buy their own home, pay for their own children.  They are paying several times the principle of that educational loan.  Modern young adults are up against impossible indentured servitude that creates generational poverty as they have children they cannot afford.
                        You may want to leave your kids some place to live so that child can raise a family in it.
                        Claw back after death is entropic and dissipative of wealth once again impoverishing the would be middle class with generational race to the bottom.
                        In a place like NM where generational lands are passed down through families, it serves to dissipate those families leaving future generations to dwell in trailer park slums rather than rural ranches and lands.  The ancient land grants and generational ranches concentrate into the hands of the few and into the hands of carpet bagging rich who could care less about cultural and natural heritage such as water rights.
                        The estate tax was abolished by the Republicans for the rich but, once again only the poor are left to pick up the tab to pay for civilization as they are are subjected to generational wealth stripping. It is a poverty penalty tax.
                        The medical system is rife with cost over run, inefficiency, and profit taking and paying for that with generational degeneration is unreasonable.
                        By the time the financial industry is done taking it's lion's share cut from closing the deals of estate wealth stripping, very little is left for the government to take.

                        •  I don't think this makes much sense (0+ / 0-)

                          A parent acquires a home, is fortunate enough to be able to pay off the home during their lifetime, but has insufficient cash flow to provide for their own support during later years. The state steps in and provides care, and is reimbursed upon the death of the parent, if, and only if, there is equity in the home. The child is not left with any net debt. In fact, if there is sufficient equity in the home to cover the expenses reimbursed to the state, the child gets it. Why should the state not get reimbursed?

                          •  Because the state did not provide the (0+ / 0-)

                            social and financial infrastructure to ensure that that the elderly are situated to be taken care of without impoverishment.  These are people that worked all their lives.

                          •  Keep in mind (0+ / 0-)

                            that most elderly are eligible for medicare. This issue would only applicable if they're covered by both medicare and Medicaid. There are some expenses Medicaid pays in some states that medicare doesn't cover. Like nursing homes. HIX policies (probably) won't cover nursing homes either. This really has nothing to do with the ACA. Medicaid recovery predates the ACA by almost 2 decades.

                          •  Why not take back the other subsidies then? (2+ / 0-)
                            Recommended by:
                            Orj ozeppi, beverlywoods

                            People are being treated very differently depending on whether they fall above or below the line at which they are going into Medicaid or given heavily subsidized exchange policies.  

                            I can't see why these two groups of people should be treated differently.

                            And in fact I don't see any reason why anyone should be subject to this.

                            Is there any other first world country that does anything like this?

                            We're trying to move to a model in which everyone gets health care. It no longer makes sense, if it ever did, to treat some of them as welfare recipients.

            •  Only those on Medicaid (2+ / 0-)
              Recommended by:
              tommymet, beverlywoods

              Those with more money that will be on the exchanges get the subsidies for free, with no claw back, as far as I can tell.

              You know, so we can keep poor families as poor as possible by taking everything accumulated by their parents for the Medicaid the parents got after they retired.



              Women create the entire labor force.
              ---------------------------------------------
              Sympathy is the strongest instinct in human nature. - Charles Darwin

              by splashy on Thu Nov 07, 2013 at 08:15:18 AM PST

              [ Parent ]

    •  Fine print is easier (1+ / 0-)
      Recommended by:
      Calamity Jean

      than dying in a pool of blood on the bath floor, because the DEA convinced ER personnel that anyone who isn't a nun is a drug abuser in search of pain meds.  And you can't get health 'insurance.'

      Joy shared is doubled. Pain shared is halved. Spider Robinson

      by nolagrl on Wed Nov 06, 2013 at 08:08:11 PM PST

      [ Parent ]

    •  Look at Title II of the ACA which (0+ / 0-)

      covers Medicaid.

      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 05:12:20 AM PST

      [ Parent ]

  •  That isn't new - that's always been part of (15+ / 0-)

    Medicaid, or the state variants thereof. In this country where access to health care is not an absolute right, and still isn't, if you have expenses beyond your financial means, medicaid will kick in, even if you are fairly well to do, but they get to put a lien on your house to pay for some or all of it if and when you die.

    I repeat, this is not new; this has been in place for a decade. Also, if you go into a nursing home and need medicaid to pay for it, and most do, the nursing home gets most of your retirement check to pay for it.

    People don't know about this until they go up against it. I understand why they don't want someone eating up tens of thousands of dollars in medical care and then leave a mansion to their kids, but this his middle class and low middle class income people hard.

    The ACA didn't create this, it inherited the situation. If it doesn't seem fair, it isn't. The government expropriates Grandmas house for the price of keeping her alive. But if we thought we lived in a fair country, we wouldn't be on the Daily Kos trying to change things, would we?

    Just another underemployed IT professional computer geek.

    by RhodeIslandAspie on Wed Nov 06, 2013 at 07:47:34 PM PST

    •  That should have been "been in place for decades." (5+ / 0-)

      Just another underemployed IT professional computer geek.

      by RhodeIslandAspie on Wed Nov 06, 2013 at 07:49:17 PM PST

      [ Parent ]

    •  What is new is that ... (11+ / 0-)

      ... people with incomes under 1.4x the poverty line are hearing that they will get health insurance under the Medicaid Expansion, at least in the 25 states that are implementing a Medicaid Expansion ...

      ... and while previously many state's had wealth as well as income tests for qualifying, now there is only going to be an income test in those 25 states, and some people may choose to go into the Medicaid Expansion instead of the HIX for the lower deductibles without realizing the downside in terms of clawback from their estate.

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

      by BruceMcF on Wed Nov 06, 2013 at 07:53:35 PM PST

      [ Parent ]

    •  I thought that (3+ / 0-)
      Recommended by:
      tardis10, Lujane, sewaneepat

      in your nursing home example, that an elderly person who has assets cannot get Medicaid coverage for a nursing home until those assets are exhausted. And this is not part of the ACA, it's part of Medicaid. What I didn't know was what the diary asks.

      "Every Pootie is a masterpiece." - Da Vinci

      by mdsiamese on Wed Nov 06, 2013 at 07:54:18 PM PST

      [ Parent ]

      •  That would apply to cash assets (6+ / 0-)
        Recommended by:
        Mr Robert, RBinDLH, mdsiamese, Lujane, raines, Pluto

        or assets that could be sold easily, like stocks and bonds. They don't really expect you to sell your two bedroom house that you may have been living in for most of your life, because you've got to live somewhere. But government wants it eventually, either when you sell it, or you die and pass it on to your heirs.

        Just another underemployed IT professional computer geek.

        by RhodeIslandAspie on Wed Nov 06, 2013 at 08:19:00 PM PST

        [ Parent ]

      •  mds - the point of the diary is that the ACA (4+ / 0-)
        Recommended by:
        raines, splashy, tommymet, beverlywoods

        is expanding the population of people eligible for Medicaid as well as offering significant subsidies to others. While the subsidies have no claw back after someone passes, that is a feature of Medicaid. Her question is how is it fair that the subsidy comes with no strings attached but the expanded Medicaid population has their "subsidy" (free Medicaid) with strings attached?

        "let's talk about that"

        by VClib on Wed Nov 06, 2013 at 10:32:31 PM PST

        [ Parent ]

    •  what is so unfair about having a sick person (4+ / 0-)

      pay his own bills out of his estate after he dies? What could be more fair than lending someone money that only is paid back after the person no longer exists?

      •  I agree, society should be reimbursed... (2+ / 0-)
        Recommended by:
        Kickemout, doc2

        A mind like a book, has to be open to function properly.

        by falconer520 on Wed Nov 06, 2013 at 08:02:13 PM PST

        [ Parent ]

        •  Including Businesses Who Get Tax Breaks To (4+ / 0-)

          improve the economy, but decide it ain't working out and pack up and leave town with taxpayers holding the bag.

          "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

          by kerplunk on Wed Nov 06, 2013 at 08:25:15 PM PST

          [ Parent ]

        •  I don't agree because society is paying (2+ / 0-)
          Recommended by:
          raines, beverlywoods

          poverty wages and not providing dignified work for people.  Look, masses of middle aged are under-employed, unemployed and being paid a fraction of previous wages.  These people used to make enough money to buy a mortgage.  They are watching their offspring struggle in this impossible economy but, hope to give their children a windfall so they can support a family or just have a place to live.
          I don't agree because social reimbursement means generational wealth stripping with the wealth concentrating at the "top" financial industry.

      •  I don't get the feeling that most industrialized (12+ / 0-)

        countries expropriate the house for the cost of giving somebody lifesaving health care. I could be wrong on this, but I have a feeling I'm not.

        Just another underemployed IT professional computer geek.

        by RhodeIslandAspie on Wed Nov 06, 2013 at 08:06:25 PM PST

        [ Parent ]

        •  Of course they don't. And when (5+ / 0-)

          Other nations decide their health system needs reform, they look into the costs and the profit margin of the health services and devices and other goods.

          Rather than working on seizing a $ 50K trailer from some semi-indigent person, officials in other nations  see to it that an artificial hip, cost to manufacture under $ 400, is not sold to the hospital or clinic for $ 13,000. And then they don't have the hospital charging the individual patient, (or the government,) some   $ 22,000 for the operation. (The example and the figures I cite were the ones that Bill Maher choose a few weeks ago, when he admitted that he thought that health care costs were in need of regulation.)

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

          by Truedelphi on Wed Nov 06, 2013 at 08:48:47 PM PST

          [ Parent ]

        •  No, they tax in advance. Pay (2+ / 0-)
          Recommended by:
          RhodeIslandAspie, tommymet

          the higher taxes that most countries collect than the pittance here and care can be prepaid.

          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 05:20:50 AM PST

          [ Parent ]

      •  Or (3+ / 0-)
        Recommended by:
        Kane in CA, offgrid, Lujane

        Why should the country increase their beneficiaries' legacy money?

        The same principle is used in England for retirement home care (though not the medical element). This has to be paid for unless the person has total assets below a certain figure which includes the equity in their home. People have been forced to sell their homes to pay for their care although this is often deferred until after their deaths and a claim made on their estate (this should now be the practice rather than the exception but the regulations have not kept up).

        We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

        by Lib Dem FoP on Wed Nov 06, 2013 at 08:07:11 PM PST

        [ Parent ]

      •  What's Unfair Is The ONLY People Who Have To (12+ / 0-)

        pay back their medical insurance premium subsidy are those who get Obamacare via Medicaid.

        Those who got a subsidy without going on Medicaid, don't have to pay back the subsidy.

        "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

        by kerplunk on Wed Nov 06, 2013 at 08:09:03 PM PST

        [ Parent ]

        •  But it's the way we calculate things in this (5+ / 0-)

          country. Social security retirement, or advisability is treated as earned income, even if the recipient gets more out of it than they ever put it, but SSI is not considered earned income, because SSI is for the poor. That's why someone on social security can work a part time job with little or no penalty, but someone on SSI who works a part time loses a big chunk of their check.

          When I buy into the exchanges, my subsidies are considered something I've earned, where the medicaid folks are considered being given something. Go figure. But remember this. There's a good chance we'll all end up on medicaid sometime in our life if we go through a prolonged illness, and if we've got something, they'll come after us to pay for it.

          Just another underemployed IT professional computer geek.

          by RhodeIslandAspie on Wed Nov 06, 2013 at 08:24:03 PM PST

          [ Parent ]

          •  Why (1+ / 0-)
            Recommended by:
            beverlywoods

            are you considered to have earned it if you are a working person just above the cutoff, but not if you're just below it?

            It may be the way we do things, but that doesn't mean it makes sense or is equitable.

            We're trying to get to where health care is something everyone is entitled to, like the rest of the civilized world. Now would be a good time to start changing our thinking about Medicaid.

        •  Thank you. That is one of the thoughts that (2+ / 0-)
          Recommended by:
          kerplunk, beverlywoods

          Occurred to me, and I wrote about it at greater length up thread a bit.

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

          by Truedelphi on Wed Nov 06, 2013 at 08:49:45 PM PST

          [ Parent ]

      •  However keep in mind that it applies to all assets (0+ / 0-)

        no matter how little they are worth.  So you know that handmade sweater grandma knit for you while she was in the hospital, better give that back.  Don't forget any family photo albums as well  Oh, and don't even think of scanning them into your computer either as the copyright also goes to the state government.

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

        by Throw The Bums Out on Wed Nov 06, 2013 at 08:10:14 PM PST

        [ Parent ]

        •  I Believe They Will Let You Keep What They Term (0+ / 0-)

          "personal items" and furniture and one car and $2000 in the bank.

          I'm considering furnishing my home with antiques such as a china hutch built in 1794 worth $150,000.  Also have a Rolls Royce sitting in the garage.  

          "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

          by kerplunk on Wed Nov 06, 2013 at 08:20:37 PM PST

          [ Parent ]

      •  Here is where the unfairness comes in - (4+ / 0-)
        Recommended by:
        RBinDLH, splashy, raines, beverlywoods

        According to what people both here and on DU are saying, the "MediCaid individual" ends up with the state coming after their assets, but the "subsidized" person who is slightly better off doesn't have that worry.

        Let's say that  a Californian is desperately poor, and they apply to the Exchange, then the Exchange directs them to MediCal (Which is exactly what happens) then that poor person will owe 100% of the cost of the insurance policy premiums yet meanwhile  my husband and I who are a bit better off and can come up with some $ 200 a month to help pay for our subsidized premiums, and we don't have to worry that the State will go after us should we die, as we have remaine d "on the Exchange" but the poorer person will, again in my example of an older person, be liable for the five hundred a month in premiums if a single person, or the one thousand bucks a month if part  of a couple?? So just having that $ 200 bucks to help pay for the one thousand a month premium means you are OLLIE OLLIE OCEAN FREE, but the poor people can get their estate wiped out?

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

        by Truedelphi on Wed Nov 06, 2013 at 08:44:12 PM PST

        [ Parent ]

        •  Do you have a link to show the cost of (0+ / 0-)

          Medicaid premiums?

          The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

          by ybruti on Wed Nov 06, 2013 at 08:54:47 PM PST

          [ Parent ]

          •  Here is the official link for ACA premiums (0+ / 0-)

            And if you are poor enough you will be enrolled in MediCal:

            https://www.coveredca.com/

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

            by Truedelphi on Wed Nov 06, 2013 at 10:05:47 PM PST

            [ Parent ]

          •  Medicaid premiums ("capitation") (2+ / 0-)
            Recommended by:
            ybruti, beverlywoods

            These sites seem to give some indication of "capitation" rates (for at least 36 states) ----(and these figures are not current  i.e. 2001).  

            A quick peek at rates [chart]

            A more in-depth study, also not current ('97-'98) ---See just past 1/2way down page.  

            I think these give some idea of what "premium" amounts states might be "clawing back".

            ~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 09:01:58 AM PST

            [ Parent ]

            •  All of the capitation rates from 2001 (2+ / 0-)
              Recommended by:
              Orj ozeppi, beverlywoods

              are higher than a 54-year-old single man in Central California with $16,000 income would have to pay ($37) for a subsidized Blue Shield plan in the Covered Çalifornia exchange.  With a little bit less income, he would be forced into Medicaid and all his costs after age 55 would be "clawed back" from his estate.

              The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

              by ybruti on Thu Nov 07, 2013 at 09:57:07 AM PST

              [ Parent ]

        •  But for the others, it's a tax credit (0+ / 0-)

          The non-Medicaid subsidized person is actually getting tax credits, right? A tax credit does not have to be given back, does it? Certainly not to the state since it is a federal credit.

        •  causing hereditary generational poverty (3+ / 0-)
          Recommended by:
          splashy, raines, beverlywoods

          way to go, government!

          Keep the poorest people poor, and their children and childrens' kids without an inheritance. NO upward mobility for you but heck, if you are struggling working-middle class, we'll let you pass stuff on.

          It is an imbalance. I'm remembering that African Americans have starkly less inheritance (usually none) compared to the average for White Americans. Researchers believe that is one cause of generational poverty in the African American community.

          •  though I'm not clear what would be right (1+ / 0-)
            Recommended by:
            sewaneepat

            I'm thinking it's strange the policies are different. I'm glad subsidized folks don't have to pay it back.

            Maybe it's a stingy thing. "heck at least these folks contribute something" vs not.

            Yet, many Medicaid people pay for it. I have Medicaid and depending on my income or if I can work at all (am disabled) I pay between $9 and $67 per month for the 20% Medicaid covers (Medicare, which I pay $109 for, covers the other 80%). So as you/anyone can see the "takers" actually pay, sometimes as much as the discounted people on the exchange it seems.

            My single person coverage costs say $150 while you are saying coverage for a couple is $200.

            I bet loads of people don't know you pay for Medicare. I pay it sounds like about the same amount as someone making more who pays the subsidized amount via the ACA exchange, at least by this example. I pay >10% of my income for health insurance.

          •  Yes! That IS the point, isn't it (0+ / 0-)

            We know that was set up by the right wingers. No one else would be so crass, callous and cruel.



            Women create the entire labor force.
            ---------------------------------------------
            Sympathy is the strongest instinct in human nature. - Charles Darwin

            by splashy on Thu Nov 07, 2013 at 08:25:04 AM PST

            [ Parent ]

        •  No, that's silly, medicaid doesn't have premiums (0+ / 0-)

          The possibility will be a lien for CARE.

          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 05:26:27 AM PST

          [ Parent ]

      •  Not the point (1+ / 0-)
        Recommended by:
        denise b

        The point is that those that make enough to go on the exchanges can get subsidies that aren't expected to be paid back, while those that don't who are forced into Medicaid don't have that luxury.



        Women create the entire labor force.
        ---------------------------------------------
        Sympathy is the strongest instinct in human nature. - Charles Darwin

        by splashy on Thu Nov 07, 2013 at 08:20:56 AM PST

        [ Parent ]

      •  Read Vclib's post just a bit above yours. n/t (0+ / 0-)

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

        by Truedelphi on Thu Nov 07, 2013 at 12:03:44 PM PST

        [ Parent ]

    •  If Grandma Owns as Much As a House (8+ / 0-)

      an elder law attorney needs to be obtained yesterday because there are loopholes that, of course, can be found by those who have something to preserve. But you don't have to be in the yacht class to be able to preserve something.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Wed Nov 06, 2013 at 08:01:49 PM PST

      [ Parent ]

      •  Yes. The loopholes may not have been (3+ / 0-)
        Recommended by:
        Mr Robert, raines, tommymet

        intended for us common peasants, but that doesn't mean we might not be able to make use of them.

        Just another underemployed IT professional computer geek.

        by RhodeIslandAspie on Wed Nov 06, 2013 at 08:07:14 PM PST

        [ Parent ]

      •  Here in California (2+ / 0-)
        Recommended by:
        offgrid, tommymet

        you can preserve your home by signing it over to your heirs prior to your death. I think you have to sign over the home ten years before your death but it might be a bit longer.

        My mother was concerned that this might affect her and while this didn't come up we made certain that her home was in my name just in case.

        As far as ACA is concerned, those on Medicaid need to consult with a family law attorney if they own their own home and want to protect it.

        The only trouble with retirement is...I never get a day off!

        by Mr Robert on Wed Nov 06, 2013 at 08:36:49 PM PST

        [ Parent ]

    •  It is not just your house, it is everything you ow (0+ / 0-)

      own including any family heirlooms (regardless of worth) and even your family photo albums.

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

      by Throw The Bums Out on Wed Nov 06, 2013 at 08:05:05 PM PST

      [ Parent ]

    •  An element of fairness (2+ / 0-)
      Recommended by:
      RhodeIslandAspie, raines

      There used to be a specialty of elder law practices that showed people how to hide their assets and get free nursing home care for the families elderly people.  The elderly could give away their assets to the relatives, then be technically poor and get nursing home care paid by the rest of us.

      The changes in the law in the time period in the diary required that people spend down their assets before they got the free Medicare services.  Say the elderly couple had lived fifty years in a modest bungalow on what is now a million dollar seaside lot.  Should they be able to give that away then get free care?  That was an example of the situation.

      To be clear, the healthcare insurance marketplace exchange subsidies do not relate to this.  The non-subsidized free Medicaid expansion might relate.

      It is common for technical correction bills to follow large new laws like the ACA.  This is an example of the need.  The Republican House won't permit the correction bill.

  •  On the so-called death tax the RWNJ talk of. (3+ / 0-)
    Recommended by:
    Mr Robert, ybruti, offgrid

    The estate tax does not even kick in for estates worth less than 7 figures, but the right wing goes on and on how the Democrats are in favor of a death tax. But nothing do they ever say about this much more common death tax. I'm not saying that personal real estate should be exempt, but you'd think that there should be some bottom limit under which there would be an exemption.

    Just another underemployed IT professional computer geek.

    by RhodeIslandAspie on Wed Nov 06, 2013 at 08:30:02 PM PST

  •  My suggestion: (2+ / 0-)
    Recommended by:
    mdsiamese, NotGeorgeWill

    You don't have to take the assistance offered by medicaid.

    You won't have your assets forcefully collected off of you, it just means that when you die of natural causes (rather than through suffering due to a lack of insurance), the value of your estate will be used to cover any medical debts.

    Oh yeah, I wish I had an estate... but I'm not nearly wealthy or fortunate enough to even say that much.  I pay a private landlord to remain sheltered.  So yeah, it's up to you if you take the assistance offered by medicaid.  

    •  You're required to have insurance. (1+ / 0-)
      Recommended by:
      raines

      If the virtual calculator says "medicaid", it appears as if there's no way to choose a non-medicaid plan. Note the word, "appears".

      "The right is correct on one thing...we really are a bunch of easily outraged nitpickers."

      by potato on Thu Nov 07, 2013 at 07:09:16 AM PST

      [ Parent ]

  •  It seems like it only applies to the nursing (1+ / 0-)
    Recommended by:
    NotGeorgeWill

    homes fees.

  •  Medicaid Estate Recovery was enacted in 1993 (2+ / 0-)
    Recommended by:
    Mary Mike, RBinDLH

    and it has nothing to do with the Affordable Care Act - beyond the expansion that makes more people eligible in the participating states.

    If you have anything of value you want to leave to an heir and you enroll in Medicaid you should have a lawyer. The same is true if you stand to inherit anything of value from someone who's enrolled in Medicaid.  In California, an estate worth more than X has to go through probate court to be distributed, a process that should be done by a lawyer anyway.

    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.

    California has unusual language in its estate recovery statute.  The 1993 federal law says that funds paid to a nursing home for long term care are eligible for recovery.  I would fight like hell if California tried to recover the cost of any other type of care.  

    ACA subsidies are paid to the insurer and they can't be collected in estate recovery under current law.

    There is no existence without doubt.

    by Mark Lippman on Wed Nov 06, 2013 at 09:52:20 PM PST

    •  Understand your remarks, but the brochure that was (0+ / 0-)

      sent to this household had nothing to do with MediCaid, and everything to do with MediCal, the insurance program that poor people are offered by their local Social Services when they apply for relief.

      I'll repeat part of my earlier entry - Here is what it says in the brochure, sent by Health and Human Services:

      "When a Medi-Cal beneficiary is 55 years of age or older at the time of death, the State will collect from his/her estate the cost of Medi-Cal services received including insurance premiums paid an d payments made to managed care on or after the 55th "birthday."

      My spouse and I weren't applying for any benefits relating to being in  a nursing home. (Neither of us even envision being in a nursing home for another decade at least.) We were applying and receiving MediCal.

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

      by Truedelphi on Wed Nov 06, 2013 at 10:03:24 PM PST

      [ Parent ]

  •  Real. Medicaid everywhere as far as I know. (1+ / 0-)
    Recommended by:
    offgrid

    Many people so poor on medicaid don't worry as much as some about financial legacy as they can barely make ends meet and heat their homes and have enough food. Focus is on the immediate pressing need.

    Perhaps people who own property outright and have no mortgage or rent can be less poor and be on Medicaid. Or people who live with family, I suppose.

    My cousin's brother killed self. He had land but had been on Medicaid. My cousin couldn't inherit his land because he could not pay Medicaid what his brother's estate owed the state. If my cousin had the cash himself he could have paid up and kept the land. Instead he had to sell the land and pay back the Medicaid. He had a little left after that.

    •  Sorry to hear yr cousin's story. (2+ / 0-)
      Recommended by:
      splashy, tommymet

      I have had several neighbors who
      Were living comfortably. And then one or the other of the couple got cancer.

      Or some other set back.

      And they wouldn't apply for any programs on account of not wanting to lose their lovely home, that they bought and paid for  to the State of California.

      Right now that wouldn't be a problem, I guess, as the house could be sold (The RealE market is alive and well, once more, in my resort area.)

      But in the years immediate after the housing collapse,. people had something they had spent their lives working for, and could lose it due to one illness.

      No other "industrialized" civilized nation does this to its people.

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

      by Truedelphi on Wed Nov 06, 2013 at 10:18:47 PM PST

      [ Parent ]

      •  thanks. But losing their home... (2+ / 0-)
        Recommended by:
        tommymet, beverlywoods

        I've heard about spending down for Medicaid eligibility as elders enter nursing homes. But on the other hand I don't understand the asset test.

        I know disabled people on Medicare and Medicaid who have assets--IRA for example. A lot of people work of course then become disabled so many have assets from before. They don't have to spend down as far as I know. At least in my state. Thank goodness.

        Anyway, Americans work so F-ing hard, more than other industrialized "democratic" "first-world" countries. Statistics prove that our productivity is highest and has gone up in recent decades. We have so little to show for it largely compared to others. Yes we have that annoying "AMerican is greatest country in the world" thing, but in this way we are. Sadly we work the hardest (some measure we surpassed Japan), have the least time off, have the worst healthcare and our longevity and quality of life markers are similar to some developing nations. We suffer needlessly and most don't even know it. Struggling people drink Republican koolaide. It is so sad to see them.

        I think if more people knew how Europeans lived...knew them visited saw, they'd demand more. Our populace doesn't get it. So they vote Republican and shoot selves in feet.

        Majority of our people are more stressed out than Europeans about money and health because we have such a weak safetynet that drops so many.

  •  The problem I see with this (5+ / 0-)

    Is that at there is a standard working here that is different than for any other government service. You don't have to repay most government benefits. Corporations sure as hell don't repay their subsidies if the jobs they promise don't come through. Only the very poor are expected to give up everything they own in order to get benefits needed to survive. As a result, they have no chance of passing along that little house they worked so hard for to their children, and those children have even less chance of moving out of poverty. It's a completely different standard just for those who have the least.

    If I find myself in that situation, you better believe I will do everything in my power to get my assets to my kids rather than let the government take it so they can give Exxon another subsidy.

    Be bold. Be courageous. Americans are counting on you. Gabby Giffords.

    by Leftleaner on Wed Nov 06, 2013 at 10:22:57 PM PST

  •  Millers trust requires this in Indiana (0+ / 0-)

    We just helped Granny get set up with Millers trust since she made 130$ over Medicaid qualifications. In her paperwork it says all funds in trust go back to state when she dies

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