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This is an outrage! It is also age discrimination and the federal government has risen to a new low. I am sick of these blood sucking vampires who probably never experienced poverty a day in their entire lives. I never voted for this kind of thing, do they just make up their own rules?
And what's going to happen if they try and enforce this? Are people going to start dying at home so their loved ones can hide or dispose of their bodies so the Feds don't know they've died? The ramifications of this terribly inhumane act are beyond comprehension.
Whatever happened to 'Occupy Wall Street' and the 99% standing up to the disgusting greediness of the one percent?
If gouging the poor and middle class for money so the wealthy can get richer continues, this country is headed for disaster and probably one hell of a revolution. I don't know about anyone else but I HAVE HAD IT!

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Comment Preferences

  •  Adella - a summary of the Act would be helpful (12+ / 0-)

    so people could understand its ramifications and why you are upset.

    Do I understand correctly that the recovery concepts are significantly different from state to state?

    "let's talk about that"

    by VClib on Tue Mar 04, 2014 at 07:38:14 PM PST

    •  Yes. It was done to avoid fraud (1+ / 0-)
      Recommended by:
      VClib

      and is mainly used when there has been long stays in nursing homes.

      It usually just applies to taking real estate, the home when the spouse or other dependents have died.

      the law needs to be adjusted so that it is clear that it doesn't mean to include the new Medicaid health plans for non nursing home costs.

      It actually would be beneficial if it led to more people staying out of nursing homes with a lot of home care help — which is the trend.

      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 Wed Mar 05, 2014 at 10:55:06 AM PST

      [ Parent ]

      •  Well now that there is no asset test for (1+ / 0-)
        Recommended by:
        beverlywoods

        Medicaid the issue it more complex, but the fact that the practice varies so much from state to state is troubling. In any event it all should be very transparent, whatever the rules. No one entering a nursing home, or their family and heirs, should have any surprises after the fact.

        "let's talk about that"

        by VClib on Wed Mar 05, 2014 at 02:59:36 PM PST

        [ Parent ]

        •  agreed! (0+ / 0-)

          But Medicaid was grafted onto existing state provisions for providing health care for medical indigent persons. So we are stuck with the 51 different systems.  The best way to get to a single payer system is to get the federal government to take over all the financing —— and then raising the maximum for coverage every so often.

          For example here in ABQ NM a big chunk of our property tax is denominated as hospital tax which is to go to our local tertiary hospital. I'm trying to track down the actual endpoint of that tax.

           

          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 Fri Mar 07, 2014 at 03:09:58 PM PST

          [ Parent ]

  •  I hadn't realized that we hit a million uid's. Nt (2+ / 0-)
    Recommended by:
    Brooke In Seattle, Pluto

    Most of the people taking a hard line against us are firmly convinced that they are the last defenders of civilization... The last stronghold of mother, God, home and apple pie and they're full of shit! David Crosby, Journey Thru the Past.

    by Mike S on Tue Mar 04, 2014 at 07:39:30 PM PST

  •  Hello (8+ / 0-)

    Adella, if I'm not mistaken, you joined DailyKos this evening and have now posted your first diary.

    It is helpful when diarists explain the context, especially if the topic is one that many readers will be unfamiliar with.

    Perhaps you could start with a plain description of the law you're talking about and how it works. Links to sites with more detailed information are appreciated by those who would like to read more.

    I can see you're upset, but, since you've provided no information to speak of, I haven't got a clue whether I would agree with anything you said.

    •  It's one of the things the GOP has been throwing (6+ / 0-)

      against the wall trying to tie it to the ACA.

      Most of the people taking a hard line against us are firmly convinced that they are the last defenders of civilization... The last stronghold of mother, God, home and apple pie and they're full of shit! David Crosby, Journey Thru the Past.

      by Mike S on Tue Mar 04, 2014 at 07:51:29 PM PST

      [ Parent ]

      •  From the link. (15+ / 0-)
        FULL ANSWER
        The Seattle Times published an article on Dec. 15, under the headline “Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death,” that said: “If you’re 55 or over, Medicaid can come back after you’re dead and bill your estate for ordinary health-care expenses.” The Times is right that the state of Washington has this power, but it was not in the “fine print” of the Affordable Care Act (as the story itself makes clear).
        All states have had the option since Medicaid began in 1965 to recover some Medicaid costs from recipients after they die, as the Department of Health and Human Services explains in a 2005 policy brief. In 1965, it was optional and states could only recoup Medicaid costs spent on those 65 years or older. That changed in 1993, when Congress passed an omnibus budget bill that required states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older. The 1993 federal law also gave states the option to recover all other Medicaid expenses.
        The Affordable Care Act did nothing to change existing federal law. It did, however, expand the number of people who are eligible for Medicaid, so there will be more people on Medicaid between the ages of 55 and 65, and, therefore, potentially more estates on the hook for Medicaid expenses after the beneficiary dies.

        Most of the people taking a hard line against us are firmly convinced that they are the last defenders of civilization... The last stronghold of mother, God, home and apple pie and they're full of shit! David Crosby, Journey Thru the Past.

        by Mike S on Tue Mar 04, 2014 at 07:54:16 PM PST

        [ Parent ]

        •  And the Seattle Times is wrong; (3+ / 0-)
          Recommended by:
          gramofsam1, cazcee, samddobermann

          Medicaid's estate recovery program began in 1965, when Medicaid was passed, on a limited basis (that is, states had the option of enacting an estate recovery program, since Medicaid is a state/federal program).  In 1993, however, federal law expanded the recovery program by requiring every state to participate in recouping Medicaid expenditures from Medicaid recipient estates (with a few exceptions) after the recipient dies.  There is a very good rundown of the program (in plain English) here.  The ACA did not change anything about the recovery act, and if people did not know that it existed, it's probably because they had never had to deal with someone whose nursing home and home health care expenses had to be covered by Medicaid before they died.  This law is not one that anyone has to deal with on a regular basis.

          This recovery program doesn't anger, outrage or even bother me one bit, Adella, and if you look into the details, I don't see how you could be bothered by it either.  It is only fair that money spent on end-of-life care by Medicaid should be paid back if the deceased's estate has the assets to do so but the assets could not be liquidated at the time the expenditures were needed.  I frankly don't know why you're so upset unless you simply do not understand how the law works.

          Maybe it would help you to think of Medicaid expenditures for nursing home and end-of-life care as a loan from Medicaid to the person needing the care.  Just like any other loan, it must be paid back out of the estate of the recipient once the recipient dies.  There is nothing unfair about such an arrangement.

          "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

          by SueDe on Wed Mar 05, 2014 at 04:59:55 AM PST

          [ Parent ]

          •  I agree- I see nothing unfair (3+ / 0-)
            Recommended by:
            koosah, MarEng, samddobermann

            about the concept either.
            I've known people who went to great lengths and hired attorneys to "protect" the assets of their family members who were in end-of-life care paid for by Medicaid. To me that's equivalent to trying to cheat on your taxes.
            No one is guaranteed an inheritance, and if Medicaid pays for years of care for a loved one, imo the response should be gratitude.

          •  Also any surviving spouse gets (1+ / 0-)
            Recommended by:
            SueDe

            to live in any home until their death.

            The law can be an incentive in helping people stay in their homes with in home 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 Wed Mar 05, 2014 at 11:01:09 AM PST

            [ Parent ]

  •  Asdf (3+ / 0-)

    Adela:

    1. A diary should not consist of pure venom with no content or context.

    2. If the title of the bill means what it seems to mean, I fully support it.

    3. Only the poorest qualify for MEDICAID. They have little or no tangible estates. If there are funds to seize, then they should not be in the program to begin with.

    The best way to tell a Democrat from a Republican is to present someone requiring food and shelter. The Democrat will want them housed and fed, even if they be faking need. The Republican will gladly see them starve until all doubt is removed.

    by GayIthacan on Tue Mar 04, 2014 at 07:49:56 PM PST

    •  #3 is no longer true under the ACA. (7+ / 0-)

      The ACA abolished the asset test for most people newly applying for Medicaid (though not for some other applicants, such as those needing Medicaid for longterm nursing home care). Plenty of people have more than $2,000 in assets but little or no income. They're being put into Medicaid -- often contrary to their wishes -- and, if they're over 55, are subject to estate recovery.

      Those who receive Medicaid under 55 -- no estate recovery, regardless of assets.
      Those who make just enough income to stay out of Medicaid and get heavily subsidized for health insurance -- no estate recovery regardless of assets, even though they may actually receive much higher taxpayer-paid benefits by way of the subsidies.

      Not a helpful diary setup to discuss it, but a genuine issue in some states. You can read about it in the diaries of beverlywoods, such as here and her followups.

      •  You can still refuse treatment. (0+ / 0-)
        They're being put into Medicaid -- often contrary to their wishes -- and, if they're over 55, are subject to estate recovery.
        Medicaid can't recover costs you refused to incur.
        •  Turns out that's not true either, at least (2+ / 0-)
          Recommended by:
          Orj ozeppi, VClib

          in some states -- the recovery would be of a monthly capitation fee paid on your behalf, whether you ever see a doctor or not.

          You'd have to stay out of the system entirely (not sign up with Medicaid at all), at which point you incur the penalty for not having insurance. (In theory, anyway -- as with estate recovery itself, it's not clear what will actually happen in such circumstances.) I think that's the wrong choice for an individual, but it's clear that the propaganda capitalizing on this genuine inequity is keeping people from pursuing coverage and care. That's fixable by states, as we've seen from those fixing it. In normal times, it would be fixable at the federal level, and I imagine CMS will go as far as it can to do so but won't be able to get rid of the underlying legislation until there's a Congress that wants to make ACA work.

            •  I'm not keeping track, though I think (1+ / 0-)
              Recommended by:
              VClib

              beverlywoods may be. There's a fair amount of misinformation out there, and some good information that seems to be in flux. (E.g., Arizona is clearly a state where recoverable capitation payments of more than $3,000/mo can exceed actual costs of services rendered -- they say so explicitly -- but probably isn't, as sometimes reported, one that would recover when someone received no services at all.)

              To me, this aspect is the least of the real problems, but a big part of the propaganda problem. I don't see why we would want people between 55 and 65 avoiding medical care, but that's what the current jumble of estate recovery regulations is producing. Again, I believe such people are foolish to avoid Medicaid to preserve an estate that will very likely be gone anyway unless they follow the plan and "die quickly" but they are doing so. And some of these people are able and willing to pay for an exchange plan. They just don't how to make themselves look like their income is precisely high enough to entitle them to free money.

    •  Interaction Between Laws (5+ / 0-)

      The ACA requires persons to enroll in Medicaid if they meet certain income requirements, irrespective of whatever assets they may have.  It is entirely possible to have a low income, but still have substantial assets (such as a paid-for home) which Medicaid estate recovery can put at risk...the rules for estate recovery vary from state to state, with some states being reasonable, and others essentially charging a "capitation fee" back to the Medicaid policy holder, independent of the extent to which the policy holder actually used medical services paid by Medicaid.

      There have been some other diaries on this issue in the past few months (see, for example, beverlywoods' diary, another beverlywoods' diary, and dudufisher's diary)

      •  Asdf (0+ / 0-)

        I am on Medicaid myself, so I know about exempted assets.

        My support of said bill is contingent on honoring current exemption rules, of course.

        If it proposes seizing previously protected homesteads, then I vehemently oppose that provision, of course.

        But the brevity and lack of content in the diary leaves that issue in limbo. : D

        The best way to tell a Democrat from a Republican is to present someone requiring food and shelter. The Democrat will want them housed and fed, even if they be faking need. The Republican will gladly see them starve until all doubt is removed.

        by GayIthacan on Wed Mar 05, 2014 at 06:17:51 AM PST

        [ Parent ]

  •  Umm, Obama has nothing to do with this issue (2+ / 0-)
    Recommended by:
    worldlotus, Skyye

    other than not putting an end to it, just as no President since the inception under Johnson has either.

    Basically Medicaid, when arranging for LONG-TERM care AKA a Nursing Home .... IMPOVERISH's the victim, er, Patient.

    You are allowed $500 total in assets and $50 stipend a month ... all assets beyond that are sold off and your Social Security and pension income go to the Medicaid program.

    Then you sit and rot in a nursing home, in generally squalled pathetic conditions because, well, Republicans and most Democrats fucking suck.

    There are teams of lawyers who try to devise trusts that can protect assets but basically for most ordinary Americans, if the need arises for a Nursing Home .... everything you ever owned is taken from you, your home your money your income, sold off to pay for the insane $400+ PER DAY cost that the State pays the For Profit Nursing home industry to warehouse the elderly.

    But the obscenity that is the Medicaid nursing home business has nothing to do with Obama or the ACA, it's been around for decades.

    Worse, most states will pay a CAREGIVER to help elderly remain in their homes HOWEVER they will not pay FAMILY MEMBERS to be full time caregivers. So if you would prefer to do that, and care for a family member you have to quit your job and go on welfare and food stamps to be able to have the time needed to be a full time caregiver .... while a TOTAL STRANGER they'd pay $1,000 - 2,000 per month depending on the State.

    •  You are not completely right.......... (3+ / 0-)
      Recommended by:
      koosah, Skyye, samddobermann

      Jester when you say "they will not pay FAMIY MEMBERS to be full time caregivers."

      My Dad died in 2006 and since my Mom lived in a rural area (in their paid-for home) and did not want to move to the city; we expanded the house and my wife and I moved in. The deal was that all housing costs were to be paid from Mom's funds in exchange for out help.

      We were in the home with Mom until she got to be too much for us the handle and she was moved to assisted living in the city in 2011. Her condition quickly worsened and she was later moved to skilled nursing with Medicaid paying most of the bill.

      Under our state's Medicaid law if a child lives with a parent and provides care for over 2 years prior to them having to go into Medicaid-paid nursing care; the parent can deed over the house to that child and MEDICAID CANNOT GO AFTER THE PROPERTY TO OFFSET THE PARENT'S MEDICAID BILLS.

      While not direct payment at the time care was given; I was more than happy to get title to my parents house without Medicaid having a claim on the property.

      The mass of men lead lives of quiet desperation--HDT

      by cazcee on Wed Mar 05, 2014 at 06:25:22 AM PST

      [ Parent ]

      •  One Caveat.... the child caregiver cannot ... (0+ / 0-)

        ... have income over 125% of the Federal Poverty Level.

        We've been through this with lawyers, inside and out. This is the specific mechanism we are using to keep my father at home and his asset (his home) safe.

        And it is CHILD, not grandchild or niece, etc. So another adult American has to DESTITUTE themselves just to hold a thumb in the dike. God forbid you do anything to earn more than the poverty level, the 2 year clock resets.

        For MOST Americans their home is their primary "estate" and inheritance to pass on to your children/grandchildren.

        Our Medicaid state is designed to steal that last great thing from the citizen before they die, the thing they worked a lifetime for. So if your parents don't "go quickly" and are poor to middle-class and have a home, the US Government is going to eventually steal it. This is the "system" we have allowed to unfold.

        •  Best not to have Medicaid or (0+ / 0-)

          any government program pay for nursing home care.

          They can just pay out of pocket or take a mortgage on a home to pay all the expenses.

          Is that your plan Jester?

          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 Wed Mar 05, 2014 at 11:08:35 AM PST

          [ Parent ]

        •  Wrong on the 125%............. (0+ / 0-)

          in my state; my retirement income was well over 400% of the poverty level. Further, my comment said "If a child lives with a parent."

          Medicaid rules do vary state to state. I said "under my state's Medicaid law;" implying that It may not apply other cases. I am sorry your state is not so cognizant of what estates mean to families.

          The point is that everyone in this situation needs to research the rules for their state. While I did go through a (very expensive) lawyer; I found out about the caregiver provision in my own online research. The lawyer prepared the necessary legal documents and filings with Medicaid.

          The mass of men lead lives of quiet desperation--HDT

          by cazcee on Wed Mar 05, 2014 at 07:48:01 PM PST

          [ Parent ]

  •  Here's what the diarist was complaining about (1+ / 0-)
    Recommended by:
    Skyye

    ObamaCare expands the eligibility for Medicaid, and makes it no longer dependent on assets. However, when you die, the government can go after your estate for all your medical costs from the last 10 years of your life (assuming that you're 65 or older when you die). If someone is eligible for Medicaid, they can't get a subsidy for any other insurance.

    "Victory means exit strategy, and it's important for the president to explain to us what the exit strategy is." - George W Bush

    by jfern on Tue Mar 04, 2014 at 11:43:01 PM PST

    •  So the old law needs to be adjusted. (0+ / 0-)

      Better get a bunch of Dems elected because the Repubs would never allow modification of the law.

      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 Wed Mar 05, 2014 at 11:09:48 AM PST

      [ Parent ]

      •  It varies state by state (1+ / 0-)
        Recommended by:
        beverlywoods

        Also the last time the Democrats modified the federal law, in 1993, they made it worse.

        "Victory means exit strategy, and it's important for the president to explain to us what the exit strategy is." - George W Bush

        by jfern on Wed Mar 05, 2014 at 02:38:56 PM PST

        [ Parent ]

        •  Yup; the Clintons did much damage (0+ / 0-)

          and remember Hillary was the "co-President;" Bill's little helper in the next door office.

          Then later they "reformed" welfare in a very harsh way.

          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 Fri Mar 07, 2014 at 02:44:58 PM PST

          [ Parent ]

    •  it's not the last 10 years of your life (0+ / 0-)

      It's costs for Medicaid that you were enrolled in between ages 55-64. These costs go into a bill that never expires, and can be applied against your estate and other assets when you die.

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

      by beverlywoods on Thu Mar 06, 2014 at 05:28:05 AM PST

      [ Parent ]

  •  It becomes relevant to wider group of people. (1+ / 0-)
    Recommended by:
    beverlywoods

    And remember, many of the newest members qualifying for the label "poor" are working and may have a house they are buying.  If you die before your spouse, can the state confiscate that house for repayment or at the least put a lien against the house's future sale?  

    BTW, Oregon and a couple of other states have opted out of applying estate recovery to the expanded Medicaid recipients.  I apologize, but the diary escapes me that recently explained this situation.  I regrettably failed to hotlist it.

    Somebody told me that you had a boyfriend who looked like a girlfriend that I had in February of last year.

    by koosah on Wed Mar 05, 2014 at 05:14:58 AM PST

    •  In my state Medicaid cannot ........... (2+ / 0-)
      Recommended by:
      koosah, samddobermann

      take the property or any of a spouse's income until the spouse's death.  If the Medicaid patient is the primary income producer; the spouse must be allow money to live on from the patient's income.

      The mass of men lead lives of quiet desperation--HDT

      by cazcee on Wed Mar 05, 2014 at 06:30:33 AM PST

      [ Parent ]

  •  Some links to the law your are referring (0+ / 0-)

    to would be helpful to your readers, as many commenters have pointed out.

    Perhaps the info in this little box will help:

    Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.
    click on the links to find useful info about writing diaries and even finding folks in the community to help you...

    good luck.

    Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

    by a gilas girl on Wed Mar 05, 2014 at 08:33:01 AM PST

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