A few days ago I published a diary called Medicaid Estate Recovery + ACA: Unintended Consequences?
I've learned a lot since then, some of it owing to helpful comments in that diary, and some of it from additional research which has brought to my attention blog posts by elderlaw attorneys and others dealing with this issue.
So here we go with Round 2 on Estate Recovery.
Our story so far: those who enroll in Medicaid through the ACA Medicaid Expansion will find that there is no limit on the assets they can have, as long as their income is low enough to qualify.
Unfortunately, there is also no limit to the amount that can be billed against the Medicaid recipient's assets by the state. And Estate Recovery seeks a 100% payback of whatever each state determines are expenses they want to recover for. In other words, if you are 55-64, and depending on what state you are in and what services you use, Medicaid may not be an insurance program: it is a loan.
While it seems a lot of people are under the impression that Estate Recovery is only for long term care, this is not the case in many states. Hat tip to Phoebe Loosinhouse, who provided this link in a comment in the previous diary:
For those who want to submerge themselves in a real wonkfest AARP Medicaid Estate Recovery, a 2004 Survey of State Programs and Practices.
According to an AARP chart, states that seek to recover ALL costs, possibly including "capitation charges" (more on that in a minute) include:
AL, AZ, CA, DE, FL, HI, IL, IN, IA, KY, ME, MD, MN, MT, NE, NH, NJ, NY, ND, OH, OK, OR, RI, TN, UT, VA.
So on to some interesting articles I have been reading. Here's one:
Estates could owe Medicaid in which Beth Duffy writes:
For the sake of the 15 million individuals expected to accept their states’ forms of Medicaid expansion health care programs commencing this autumn — including a projected 150,000 Iowans — I hope they ask, “Hey, does this mean my estate is subject to Medicaid rules and therefore must reimburse the government for my health care benefits when I die?”
And Professor Duffy concludes:
Will Iowa’s new federally mandated program perpetuate Medicaid’s status of “statutory loan program” subject to debt-obligation and estate reimbursement? If so, Medicaid expansion could unintentionally create a tragic new cycle of poverty.
If you're thinking that it should be easy and straightforward to get information on a state's Estate Recovery policies and procedures, guess again:
In Medicaid Estate Recovery Mystification, Attorney John Payne writes:
One of the core principles of government in the United States is transparency. Freedom of the press and laws that require government agencies to provide information to citizens on request are considered essential to keeping our bureaucrats, mandarins, syndics and pashas more honest than they might otherwise be. However, as in many states, Michigan Department of Human Services and Department of Community Health, which administer welfare programs, are exempt from the public notice and open meetings laws that govern other departments.
And now about those those pesky capitation charges:
Dr. Jane M. Orient writes in Medicaid is a tax on the estates of the poor:
In Arizona, where all Medicaid beneficiaries are enrolled in a managed-care plan, their estates could be repaying “benefits” even if the enrollee never actually received any goods or services. Information provided by the Arizona Health Care Cost Containment System (Arizona’s Medicaid program) explains that the program makes a monthly capitation payment of around $3,340 to “program contractors,” who arrange for services, if any. It warns, in bold print: “It is important to be aware that capitation payments can exceed the actual costs of services provided during the month.”
Dr. Orient concludes:
Medicaid, supposed to be a program to help the poor, has become a cash cow for multibillion-dollar, managed-care companies, who milk federal and state taxpayers. Expanding Medicaid to persons with modest assets will enable estate recovery to become a cash cow for states to milk the poor and the middle class.
Elderlaw attorney Jeffrey Marshall writes in: Medicaid Estate Recovery - A Medicaid Death Tax
In a curious exercise of age discrimination, the recovery program only applies to people who are over age 55. Essentially, estate recovery turns government financial help to frail seniors of modest means into a loan program with collection taking place at death. If Medicaid helped pay for any of your care, your estate will be forced to repay the government after you die.
Estate recovery is a Medicaid “death tax” imposed only on the elderly. The program has been referred to as “picking the bones of the poor,” and “sucking the last ounce of blood from the corpse.”
In case you're thinking: well, this isn't so bad - it won't affect you until you're dead, right? Not so fast.
Here's a piece by Carol J. Wessels, who is an attorney in Wisconsin: Will Medicaid Recipients Ever be Able to Sell Their Homes Under Wisconsin’s New Budget Law?
A summary of the Kafkaesque system she describes wouldn't make much sense. As with the rest of these articles, it's best to just go read the whole thing. At the end of it she asks:
This causes me to wonder why the state is taking such draconian steps against elderly individuals, just because they had the foresight to invest in the American Dream, a home. An individual who was less frugal, frittered money away and did not invest in a home, would receive the same Medicaid benefits, and not be penalized for being a homeowner. Even more offensive is that as far as I can tell, a homeowner can commit a crime and go to prison, receive food, housing and medical care there, which the State is required to provide, and still come out with no lien on their home. If I am wrong about that, I hope someone will point it out.
Said another way, should Wisconsin treat its frail elderly worse than criminals? I guess our legislature thinks so.
Thanks for reading. Let's keep the discussion going.