By Lambert Strether of Corrente. An earlier version published at Corrente.
Summarizing the Medicaid clawback issue, Paul Craig Roberts has a new post that explains what can happen to your estate if you’re over 55 and ObamaCare forces you into Medicaid because your income is under 138% of the Federal poverty level:
In violation of moral philosopher John Rawls’ second principle of justice [q.v.], some of the poorest Americans will pay the highest cost of health care as they, and they alone, are subject to having the family home and any other assets they might possess confiscated by the state in order to reimburse Obamacare for the cost of their medical expenses….
OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased Medicaid patients for medical services received in a nursing home or other long-term care institution, home- and community-based services and related hospital and prescription drug services regardless of age. It also allows, at state option, recovery for all services used in the Medicaid state plan at age 55 or older. At minimum, states must pursue recovery from the probate estate which includes property that passes to heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. …
[A] For cash-strapped states, recovery provides an income stream, and with the expansion of Medicaid states will be in dire need of money, particularly in the current economy [especially when the Feds no longer pick up the full Medicaid tab in 2017].
Obamacare revises Medicaid regulations in order to make more Americans eligible for Medicaid. Revised regulations include an increase in age and income limitations, and the asset test no longer applies. Prior to these revisions, applicants were not eligible for Medicaid if they had more than a specific dollar amount in assets. But, under Obamacare, those who likely own a home or have savings set aside–for example, early retirees or people who have lost their jobs and, as a result, are in a low income bracket–will find themselves in Medicaid, and their assets will be looted by the government when they die for medical services used at age 55 and up. …
[B] Estate recovery was not an unintended consequence of Obamacare. The House Ways & Means Committee and The House Energy & Commerce Committee share jurisdiction over health care, including Medicare and Medicaid, and both worked extensively on Obamacare. So, don’t bother thinking that the members of these committees didn’t know that estate recovery would impact millions of Americans who would be tossed into Medicaid. The asset test was dropped and the age limit was increased explicitly in order to expand Medicaid. Yet, did We the People hear any concern about estate recovery? Certainly not in the many floor speeches given by Democrats as well as Republicans or from the media.
Obama stated during his 2008 presidential campaign that transparency would be the leverage needed to ensure that people stay involved in the national health care reform process. The expansion of Medicaid was part of the process. [C] Did Obama or your representatives tell you that Medicaid, depending on your age, is a loan subject to deferred payment by your estate? Did they tell you the government subsidy for a private plan at an exchange is a loan, that must be repaid if your income increases? Transparency was highly selective. The bait was shown but not the hook.
(I’ve bracketed and lettered [A], [B], and [C] three points I want to refer back to later.) So, it looks like the issue of Medicaid clawback is starting to get some traction, since there’s pushback.
Before we get to our old friend Nancy Metcalf of Consumer Reports, let’s consider the case of Michael Hiltzik in the LA Times. I know reporters don’t write the headlines, but sheesh:
Today’s overblown Obamacare fear: Will Medicaid take my house?
The prospect of asset seizures raises people’s hackles [way to trivialize there, dude!*], especially since under the Affordable Care Act, those earning less than 138% of the poverty level may be offered no choice for subsidized health insurance except Medicaid. (Again, that’s in states that have expanded Medicaid.)
“May be offered” is not true. ObamaCare apologists consistently present Medicaid as a choice; it isn’t. If you fall below the poverty line, you get tossed in the Medicaid bucket, case closed. Although Hiltzik lists some exceptions to asset seizure, this seems to be his key line of defense:
Family members can also file for hardship waivers.
Medicaid officials say that most [which?] states are sensitive to the political ramifications of being seen [by whom?] as grasping after the assets of low-income families, so waiver requests tend to be [what does that mean?] treated pretty liberally [which means?].
Which doesn’t mean that the waiver rules are clear:
State Medicaid officials have been asking the federal government to clarify the recovery rules for their new enrollees for weeks, Salo says. The Dept. of Health and Human Services has promised to provide them, but hasn’t done so yet. The hope, Salo says, is for broader discretion to decide when to dun, and when not to dun.
So, to summarize, the putatively liberal Hiltzik believes that:
1) It’s OK to force poor 55+ people into a program
2) that can seize their estate
3) even though the estates of people who are not poor and 55+ are not subject to seizure, but
4) the seizures won’t really happen
5) at least not a whole lot
6) because that would look bad politically, and
7) there will in any case be waivers, even if
8) waivers will be granted on a case-by-case basis,
9) using rules that aren’t really clear,
10) and are subject to discretion.
What could go wrong? Forget Hiltzil throws poor people under the bus with points #1 – #3; we’re used to getting the big “Fuck you!” from Democrats anyhow; look at the food stamp cuts and the unemployment #FAIL. And forget the “Trust us! There will be waivers!” of #7 – #10; I mean, just because poor 55+ people have to go through a time-consuming and degrading process doesn’t necessarily imply there will be bad outcomes, right?
Just look at #6, and consider the realpolitik: First, Democrats planned Medicaid clawback (point [B], above); it was baked into ObamaCare, from the start, by its drafters. The realpolitik decisions have already been made! Second, Democrats had to know that states need money (point [A], above), they really need money; ObamaCare was passed in 2009, when the economy was even worse than it is now. State budget requirements will trump a news cycle or two of bad optics every so often about the no-good kids of some old codger losing the only hope of inheritance they ever had. Finally, does Hiltzik really believe the political class is going to rally to the defense of poor 55+ people when a good “progressive” like himself throws them under the bus? And, oh yeah: The onus is on the consumer citizen to file for the waiver! Wouldn’t it make more sense to change policy at the national level?
Turning to Consumer Reports (from the loathesome Nancy Metcalf), it gets worse. Yes, it’s possible!
Will Medicaid take my house when I die?
In theory, it could. But it seems unlikely, and you should enroll anyway.
There is no “anyway” for which Metcalf will not recommend that “you should enroll.”
But the fact remains that unless they come to their senses (or the federal government tells them to stop), of the 25 states plus the District of Columbia that are expanding Medicaid to cover all low-income households, at least 10 [California, Colorado, Iowa, Massachusetts, Nevada, New Jersey, New York, North Dakota, Ohio, and Rhode Island] are planning to try to get their money back when beneficiaries die. I know this [NC readers have known this since at least June 3, 2013] because I’ve spent the last couple of weeks chasing down information from those states and have heard back from all but three of them. …
What’s happening in those 10 states is beyond unfair, because younger Medicaid beneficiaries will face no such threat, and neither will people who get tax credits to lower the cost of premiums for private coverage they’ve purchased through their state’s Health Insurance Marketplace. …
All true, and now Metcalf’s bottom line:
I have serious doubts that states will really follow through on this once the public figures out what’s going on. My evidence comes from the state of Washington, which had been advising its newly enrolled Medicaid recipients that if they were 55 or older, the state “may recover from your estate assets you own at the time of death.” That is, until the Seattle Times wrote articles about it and people started refusing to sign up for Medicaid. The state Medicaid agency issued an emergency rule rescinding the policy at warp speed.
But even if your state doesn’t change its mind, there will probably be ways to protect your heirs, according to Morris Klein, a Maryland lawyer who serves on the public policy steering committee of the National Academy of Elder Law Attorneys. Since each state runs estate recovery slightly differently, you should consult an elder law attorney.
Yeah, like a 55+ on Medicaid — probably disemployed, and certainly poor — has the loose cash lying around to consult a lawyer. And, just like Hiltzik, Metcalf puts the onus on the consumer citizen? What’s wrong with these people?
But I really want to focus on that one line: “I have serious doubts that states will really follow through on this once the public figures out what’s going on.” Never mind the question of how a Senior Project Editor for Health at Consumer Reports gets to play political pundit; is she likely to be right? Quite possibly not.
First, and leaving aside the two points made above — [A] the states have every financial incentive not to change, and [B] both Metcalf and Hiltzik assume poor 55+ people have more political clout than they do, and that “progressive” Lady Bountifuls will come to their assistance — as far as I know, Oregon and, to be fair, Washington, and Wisconsin, are the only states to have revised their rules (Wisconsin’s repealing only “some of the worst” provisions). But how about some states with population? California? Certainly not, or the LA Times’s Hiltzik would have mentioned them. New York? Medicaid clawback is definitely in place.
Second, the AARP doesn’t agree with Metcalf.** They’re playing wait and see:
Elaine Ryan, AARP’s vice president of state advocacy and strategy integration, says the senior group is not lobbying for state changes to the Medicaid Estate Recovery Programs — at least not yet. “This is all so new and we’re still trying to unpack how the different states apply the recovery rules,” she said. “We’re still looking at what makes sense.”
Whatever that means. (Heck, since AARP is now in the insurance business, maybe they’ll sell insurance to poor 55+ people on Medicaid clawbacks!)
Third, the Feds don’t agree with Metcalf, because they still haven’t issued any regulations:
Advocates are pressing the Obama administration to specify that new Medicaid recipients nationally should not be subject to asset recovery.
Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said, “We recognize [the] importance of this issue and will provide states with additional guidance in this area soon.”
(That was January 23, so “soon” doesn’t mean in days or weeks.)
Finally, and as usual with ObamaCare, we have no good data:
Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.
Which Metcalf, oddly, or not, is not researching. You’d think as long as she had the Medicaid office on the phone….
So, basically, unless you live in Oregon or Washington, losing your house to Medicaid estate clawback is a crapshoot (unless you live in New York, in which case you’ve certainly lost, unless the Feds come through). And despite Hiltzik and Metcalf’s blithe assurance, the political class hasn’t come through with what looks like a no-brainer that would help poor 55+ people. Not the AARP, not CMS, not the biggest states, and certainly not Congress.
Like Hiltzik, Metcalf claims the political process is going to mitigate Medicaid clawback, and just like Hiltzik, she does everything in her power to minimize the problem (and their editors do everything they can, through their insulting headlines, to marginalize those who advocate for those drawing attention to it).
At this point, we’re used to the crap ObamaCare apologists shovel out. But Metcalf’s behavior is particularly reprehensible. Let’s look at Consumer Reports’ Mission Statement which, presumably, a Consumer Reports Project Editor like Metcalf is supposed to adhere to:
Consumer Reports is a national nonprofit organization with one and only one mission: to take the side of consumers wherever they may need it. We test products, call out unfair business practices, and help consumers navigate complicated services such as insurance, credit cards, and phone and cable companies. We are strictly nonpartisan and we don’t take money or ads from industry.*** You may know us best through our iconic publication, Consumer Reports magazine.
Let’s try to defuse the situation by imaginging that we aren’t dealing with ObamaCare, but dealing with (another defective) product: The Ford Pinto. Let’s compare what CR says its mission is to what Metcalf recommends:
| Consumer Reports Mission | Metcalf’s Recommendation |
| Take the side of consumers: | Buy |
| Test products: | Buy |
| Unfair business practices: | Buy |
| Navigate complicated services: | Buy |
“Iconic” “Consuumer Reports,” my sweet Aunt Fanny. These people are so in the tank, and so evidently have no personal worries about any of this.
NOTE * Off topic, but note that the concern for passing on one’s estate to one’s children — which is why this issue is getting traction — gives the lie to the Boomer hate peddled by the Peterson crowd.
NOTE ** Here’s AARP’s assurance:
“I would inquire about the application of [Medicaid asset recovery], but I wouldn’t succumb to the fear of rules you don’t understand as a reason you wouldn’t become covered under Medicaid,” [Elaine Ryan, a vice president at AARP] said.
Sure, I’d totally bet the house on rules I don’t understand (or understood all to well). Wouldn’t you? What could go wrong?
NOTE *** Out of curiosity, how about foundations? Non-profits?
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One solution is to keep your parents out of the nursing home, which any child ought to do anyway. That way you not only get the money, you earn it, too.
That isn’t a solution for 55-64 year olds forced into using Medicaid for ordinary medical care, which is what this post is about.
If a person is above age 55, the clawback can go after assets for all medical costs. It is not limited to costs incurred for nursing homes. This means doctor visits, hospitalization, etc. At age 65, medicare covers those routine items.
Even worse, as a post here recently noted, those states that have privatized medicaid are entitled to recover the entire amounts of premiums paid by the state to the medicaid insurer, regardless of whether the person ever makes a claim.
Below 55, the recovery is limited to costs for nursing home care when there is no realistic chance the beneficiary will leave the home.
looking for old post on medicaid clawbacks to reimburse states who have privatized medicaid– i live in new york thanks andy
Why is it only over 55? Is it because they know older people are being laid off and not able to get another job in their field? That they are being are being forced into very low paying jobs so qualify for Medicaid?
All those homes left to take from the former middle class.
Assume those taking Medicaid will be branded as welfare cheats by every politician right of center (and that’s just about all of them) if they have so much more than the clothes on their backs. Take this as the starting point of the conversation when considering clawbacks.
Heard a report on NPR today about a family where the wife, husband and kid all have different insurance carriers due to the ACA. Only in America.
Sharing (bandwith/commons/resources) and compassion have become illegal in Murika.
Profit Uber Alles
How come the poor 55+ people ObamaCare forces into Medicaid can’t leave the house and the estate to the kids, like the middle class and the rich can?
The middle class has been obsoleted. They won’t be leaving much.
Don’t think of Obamacare as an insurance. See it for what it is: a rent-extraction mechanism. Enrollees aren’t beneficiaries. They’re marginal strip mines. TPTB needed a lot of them to make any money.
Slightly off topic but, speaking of rent-extraction, just heard a snippet on NPR on my lunchtime drive quoting someone from the pharmaceutical industry who opined that the industry could solve the superbug problem if the government would just give the industry $3 billion in research funding to develop . . . wait for it . . . new antibiotics! So: Make billions setting the stage for a global pandemic through irresponsible antibiotic sales to the subsidy-bloated factory farm complex, then get paid $3 billion to solve the problem you created. Sweet!
When any “analysis” or “recommendation” uses the word PROBABLY, just round-file it and move on.
“One solution is to keep your parents out of the nursing home”
A better solution might be to just leave the country….
http://blogs.reuters.com/anya-schiffrin/2014/02/12/the-french-way-of-cancer-treatment/
Well … sorry to say I’m 55. Lets say I was sick. And since I’ve got everything in trust I’ve got no income. SO … I could go wrack up a huge bill with medicaid and thus shield my estate. Unless of course there was clawback.
Sometimes there are other sides of the story.
So are you in favor of the state recovering Medicaid expenses on all estates of citizens that have insufficient income to participate in the subsidized insurance exchanges, or is there some way you would decide winners and losers, other than age? I imagine the majority of persons that will be effected have little other than their homes and modest savings for assets. Do you have any sympathy for what goes along with “wracking up” a huge Medicaid bill?
‘Consumer Reports is a national nonprofit organization with one and only one mission: to take the side of consumers.’
When Consumers Research (the predecessor of Consumer Reports) was founded in 1927, its mission of naming names of products that are overpriced, inferior in quality, or sold with misleading advertising was repeatedly criticized as communist, especially during the depression years when business was struggling and CR were seen as foot-draggers.
Accusations that Consumers Research served as a communist front always seemed ridiculous. Now they appear more credible, as the organization uses its own false advertorials to peddle godless Obamunism to the masses.
Yep, looks like CR is running on brand fumes like so much else these days. (“Godless Obamunism” was ironic, right?)
Do you read Jim Haygood’s comments regularly? I don’t think he’s capable of irony. I’d bet he really does think that Obama is a communist and the CR is in that same communist boat.
Geez, all the more reason for single-payer…sliding scale comes out of your taxes…but no! had to protect the precious health insurance “industry”.
MY Mother in law passed in July from Cancer and in May gave my son $100 as a gift at his Law school graduation. Was only on Medicaid her last month – used Medcare and gap insurance prior to that. Prior to gettign sick she had given away her jewelry to my daughters the last few years – nothing expensive, trinkets really but they mean the world to them. Medicaid is demanding that my children return these to the state. Father in law hanging by thread in Nursing home they are trying to get his house now and warned us not to take any of the furniture out of the house. Yes. Really.
‘Til the pips squeak. How pleasant.
Horrible!!!
What state please?
Their home state is Ky and where their property is located; NC is the state exacting their pound of flesh…
we brought them to NC to live with us as long as was possible…they resided in KY
DolleyMadison ~
Have a real appraiser come in and give you an appraisal for the furniture. (Mostly used furniture (except collectible/show pieces) isn’t very desirable for resale.) If you then take the furniture (which will almost certainly be of greater value to you than the appraisal), they should be limited to the appraisal amount if they create fuss.
Is there any record of what furniture you owned? (if it was say insured it’s estimated value might be recorded). If not there is no way in heck I’d obey the law. Prove I did something wrong. Prove exactly x pieces of furniture are missing, go ahead prove it mfers.
Elder care attorneys assist their clients with “Medicaid asset protection” (see online) strategies which are designed to enable elderly folks to pass their property to their children and get Medicaid to pay for their custodial nursing home care. Of course, this works only for people who know about it and who, with the help of their attorney, plan ahead in accordance with Medicaid’s rules which specify certain time requirements, varying state by state.
It amazes me that more people aren’t outraged by this issue. People are FORCED into a Medicaid healthcare system that then can come and take everything you own upon your death. It’s one thing to do that if you have no other option, but then again, you should be able to choose to live or die on your own choice.
Talk about death taxes. Can you imagine if the govt came after the wealthy who wereforced to offshore taxable income with this scheme? I can see them going to the family and saying “Your dad was forced to offshore millions in taxable income, so we are coming to ge tthat money now that he is dead. Yes, we will take whatever we feel is necessary to recoup that offshored taxable income.” The GOP and spineless Democrats would change that law in a hurry to favor the wealthy/ Feed the rich and starve the poor. SOP.
People would be more outraged if the MSM reported on any of this. The answer to your question (and a good one) is at least partly explained by this post; propaganda outlets (meaning information related to the well being of corporations) such as this so called consumer reporting agency are doing their damnedest to keep the claw-back horror as well kept a secret as possible. It’s a real news blackout.
What NC has started to make clear is that this abomination of asset stripping our elderly is intentionally built into the ACA. What is really being hidden from the public is that this isn’t simply a tragic part of getting past the “rough spots” of ACA. This was intentionally built into it by some of the coldest, most callous, criminally mined people -of all political stripes- ever to lead a country, as a way for states to extract the last possessions off it’s most vulnerable citizens.
Another reason for lack of outrage is that folks are simply overwhelmed. They know the ships sinking, or intuit that things are very serious, and just want to blank out. And yet another reason is that people are scared sh*tless this will happen to them. If you’ve ever been involved in layoffs, you’ll notice that all of a sudden half the people are studiously ignoring the other half, terrified beyond human decency at the prospect of being caught up in it.
By (and a good one) I meant, “and your question was a good one”.
Just as a curiosity: is there anyone who supports the ACA you think that isn’t a shill for Obama? I read this site everyday and I am still not sure what you want to happen: yes, I think you want universal health care, as I do, but absent that- what? I get the sense that you feel the ACA has no redeeming value in any manner. Would you have preferred the status quo in the absence of universal health care?
The ACA is a troubled program to say the least but I watched and read everything possible about its passage and I honestly don’t know that universal health care had any chance of passage. Hence in my mind, this is an improvement; small but still…the status quo was not acceptable.
Just as a curiosity: is there anyone who supports the ACA you think that isn’t a shill for Obama?
Your first sentence says it all. It is simply a cheap shot bit of sarcasm put in the form of a question when you obviously have no intention of asking a question but rather simply of making an insinuation based on your own prejudices (that happen to consist of exactly the same shallow propaganda as the White House is selling: “Don’t let the perfect be the enemy of the good”). And that explains the rest of your comment as well: a shallow set of propaganda induced assumptions about ACA that no amount of facts presented on NC will penetrate.
I read this site everyday[…]
You might try reading it with your eyes open for a change (not to mention all the unspecified material you brag about related to the ACA). NC has reported on numerous “good items” within the ACA, but it has reported them as factually as possible which often means pointing out that they are not so good as they initially seemed or that they are so deeply flawed by other conditions as to be useless. Yes the overall conclusions and “bias” is deeply negative but that flows from the facts surrounding the ACA. You are simply blaming the messenger for telling the truth and implying that NC should be as [patriotically] willing to observe conventional propaganda as you are.
Very well put. The fact that the last horrible thing was horrible doesn’t make the new horrible thing any less horrible.
The ACA will help some people, and make them better off. Other people, LIKE ME, are being made worse off. Your benefit doesn’t balance My expense: get it? Especially when the benefits go to the relatively well-off, while the bad parts inevitably fall hardest on the poor.
I wasn’t able to afford health insurance under the old system; under the new system I still can’t afford insurance AND I’ll get fined for it. If you really think that’s an improvement…well…
Would you have preferred the status quo in the absence of universal health care?
First off, ObamaCare is anything but a universal system. Even by their own estimates, ObamaCare will pick up less than half of the uninsured. But assuming you actually meant “in the absence of ObamaCare”, as a former health insurance insider, my answer is “Yes”. The only reason why the insurance industry allowed ObamaCare in the first place is because they understood they were pricing themselves right out of the business. It was getting to the point where it would be too expensive for employers and individuals to tolerate insurance as the middleman; hence the REQUIREMENT people purchase insurance. It was either legislate their permanent existence (which ObamaCare does), or go out of the business entirely.
On the other hand, given five or so years, the insurers, sans ObamaCare, would have self destructed, and we would have gotten a real health system. As it stands, we’ve simply extended this crap we call healthcare by another 20 years. As the bodies pile up.
I think it’s just about a draw on whether we are better off with or without Obamacare. Yes some more people get heatlhcare (not everyone with insurance does but some will). On the other hand we are forced to buy a corporate product, a horrible precedent and horrible in it’s own right (they can you know increase the penalties above the current relatively small penalties).
I live in Michigan where you can’t BUY a job – particularly if you have been unemployed more than six months, are over the age of 50, or both. I lost my job through no fault of my own, have run through my 401(k), had to file for bankruptcy protection and lost my home to foreclosure. All I have left is what I earn through my three part-time jobs (no benefits, of course).
Being in such dire straights, I finally sucked it up and applied for SNAP benefits about a year ago. And while the benefits are helpful, they are not the panacea the political class would have the populace believe. My SNAP benefit was cut in January which equated to the loss of 5 1/2 meals each month. And while missing a few meals at the cost of $2.01 each certainly won’t kill me, I am grateful that I don’t have children to feed. Now, Debbie Stabenow has negotiated yet another $9 billion cut that will likely equate to an additional loss of 9-10 meals for me and others like me.
I tell you all of this so you can understand how I ended up in the position I find myself in now: I have become subject to the Medicaid Asset Recovery Program because I am a SNAP recipient.
Last week, I received a letter from the state informing me that I had seven days to enroll in one of Michigan’s five managed care plans available in my county – including getting the form back to Lansing by mail. And if I fail to get the form to them in a timely fashion, seven days in this case, the state will choose one for me.
Needless to say, I am STEAMED! If I earned 139% of the poverty rate, I would not only receive subsidies – but said subsidies would not subject my assets to confiscation upon my death. And I would be allowed to opt out of Obamacare and pay the penalty! How is it that I arbitrarily lost my right to equal protection when I fell below 138% of the federal poverty? Or when I reached the age group of 55 – 64? Where are my rights? Who will speak for me and all the others in the same position? Have they picked the bones of the former middle class so clean that they now seek to further impoverish the impoverished???
Because I am a SNAP recipient I am being FORCED into their rent extraction mechanism con game. There is no opt out option for me – TPTB have already decided that they are more than happy to take any assets I may have upon my death. If it is left up to me, I do not plan to stay in this downward cycle of poverty. But what incentive do I have to ‘pull myself up by my bootstraps’ as they are so fond of saying, if they are going steal all of my hard earned assets to reimburse the state for something I don’t want, won’t use and can’t opt out of?
My plan is to move to Texas, a state that did not embrace the federal expansion of Medicaid, before TPTB start dismantling what little is left of my future. My hope is I will have better luck securing and keeping a job for the next ten years. I no longer hold out hope of a career path. Just a job will do. Hopefully, one with benefits.
You know, I played by their rules, have an advanced degree and worked my way to what I perceived to be the top of my field. For what? I have experience, skills and credentials and can still work circles around younger, less experienced workers. . .but that and $2.50 will get you a cup of coffee in the state of Michigan.
This is terrible. It’s like we have watched the building collapse and people jump from windows, and now we are watching the exact same thing happen to the country and people such as yourself in it. I hope things look up for you personally in Texas. It seems to be the perfect place for paradoxes.
This is horrible. Beyond horrible.
I think that long-term care is still subject to the estate clawback provision in the State of Oregon.
There could have been a political compromise where the state “obeys” federal law and collects Medicaid expenses through assisted living expenditures and ignores the actual health care provision and/or they’ll means test which individual estates to collect from during probate. I don’t really know and I’m not sure they do either.
In any case local activists are trying to mobilize support for a national bill that would make all medical expenses exempt.
Washington state’s Medicaid long-term care is still subject to the estate clawback provision because it’s federal law. They used to clawback for everything. That’s what they changed.
“I would inquire about the application of [Medicaid asset recovery], but I wouldn’t succumb to the fear of rules you don’t understand as a reason you wouldn’t become covered under Medicaid,” [Elaine Ryan, a vice president at AARP] said.
Exactly what I would expect from an organization that pretends to advocate for the elderly while selling them insurance through United Health Group – a corporate member of the Campaign to Fix the Debt.
This why I’m not a member of AARP. The administration of this organization has only it’s self-interest (money) under the guise of lobbying for those over the age of fifty.
The issue is that the estates of people on Medicaid are required to pay full freight for medical care — assuming there are any assets in the estate. In most cases, heretofore, there haven’t been many assets in the estates of Medicaid recipients, so, in those cases, there is very limited or no recovery.
Neverthess, the estates are charged for every dime Medicaid paid on the recipients’ behalf prior to their death.
With many more people added to the Medicaid rolls due to low incomes, but without an assets test, some of them will see their assets plundered to pay back Medicaid after their die — due to a law that’s been in place for decades, and in those states that have expanded Medicaid eligibility, they have no choice in the matter.
The other side of that coin is that Medicaid recipients pay little or nothing out of pocket for medical care while they live, whereas Obamacare
victimsusers pay deductibles, co-pays, and premiums that can amount to a heap of cash out of pocket every year.They don’t get charged the full costs of their care, though (at least not after their deductible is met) and their estates are not dunned for recovery.
The answer, of course, is Single Payer Universal Coverage, which neither requires enormous up front payments nor back end “recovery,” and which provides medical care at little or no charge at the point of service.
Unfortunately, no one in the whole wide world has ever figured out how to do this, and every indication is that it is an insoluble problem.
As I have said before, low income citizens should have the option of buying the the same subsidized policies as those available to the lowest eligible income group, at the very least.
That would be marginally fairer, since, as you say, universal care is impossible in our bastion of capitalism. None of that Marxist stuff for us.
Exactly!,,,,how is it possible to be too poor to participate in a government entitlement program…? “I’m sorry you don’t make enough to qualify for foodstamps!”
What’s an insoluble problem? Having the government pay for healthcare? That’s easy. Just print the money. Seriously, can you think of a better reason to print money? Because the only reason not to is that it might make it harder for the rich to figure out which one of them is winning.
But you see no one has ever figured this out in the history of the world.
So it can’t be done.
You see.
This has been going on forever (not that that makes it ok). My maternal gandma died in the early nineties after having spent her last couple years in the nursing home. The great state of MT saw fit to claw-back everything she had which, thankfully, wasn’t much.
This horrendous quote from Hiltzik sums up pretty much everything that’s wrong with our society:
Not the moral or ethical ramifications of grabbing the assets of the poor, no–the political ramifications. And not even the ramifications of doing something perverse, but the ramifications of being seen doing it. So I suppose it follows that if states could either hide their grasping of assets or come up with a convincing political spin to put on their grasping, they’d just go ahead and do it.
Well guess what? They’ve been doing it for decades and no one has seemed to notice and there sure haven’t been any political ramifications. In fact, downplaying the problem as Hiltzik and Metcalf do serves to ensure that there won’t be…which they probably understand all too well (thank Goddess we’ve got Naked Capitalism, Mr. Roberts, et al to push in the other direction).
This pattern where appearances trump reality has become so ubiquitous that no one (pundits particularly) even notices it in their speech anymore; If you were to call them on it, they would stare at you blankly (it would take brain surgery for Dick Gregory to get it). The Senate insists on protecting the appearance of propriety. It is critical to the committee that it’s relations with the public be seen as frank and open..
It’s like hearing someone scrape their fingernail down a blackboard, but to the media being seen as is as good or better than the fuss and muss of being period.
The thing is the reason why they think the law is ok (it may not be enforced) is an absolutely abhorrent reason. Laws with arbitrary enforcement are not better, they are tyranny pure and simple.
Take two hypotheticals:
1) the law is enforced on everyone who gets medicaid at 55+ (barring a trust or some legal means of avoiding it)
2) the law is enforced or not depending on political pressure
While #1 harms a larger number of people #2 will almost certainly be more discriminatory, arbitrary and unfair. The law will be enforced if they don’t like your face, your race (bank on this one – just watch the law be enforced on minorities more than whites – because arbitrary laws always are), your politics (old so and so dying in the nursing home was once an activist – take it all) etc..
#2 is not in any real sense better except in the extent of the carnage, and if you can ghettoize the carnage you can also perpetuate it MANY MANY more years, because such “targeted strikes” generate less resistance. #1 is aweful and #2 is not morally better. Shame on these people who somehow think bad laws are ok if they are arbitrarily enforced.
@Lambert–I don’t know if this is an example of the scenario you were mentioning, but I noticed this on Zillow today, and have never noticed one prior to today. (Maybe they’ve been there all along, and I’ve just not noticed?)
http://www.zillow.com/homedetails/1716-Old-Ferry-Rd-Grimstead-VA-23064/2108860038_zpid/
“This home is a forced Medicaid Sale. Price is same as County Assessment. Medicaid requires house to be listed for the exact amount as Assessment. Lots of room for the money. Being sold ‘AS IS, WHERE IS’. Non-negotiable. Beautiful hardwood floors. Nice size rooms. Just needs cosmetic upgrade. Shop/Garage were used as a Beauty Parlor for many years. Trailer in rear of property is not property of Seller. Gas Logs in Sun Room. Furniture negotiable. “
Sounds like it, and what a great research idea….
@Lambert–It’s amazing what one can find out on “the Zillow!”
I just now did a quickie search for Zillows in Virginia –filtering for nothing except “Medicaid,” and got 15 hits in various stages of “listing status,” including that one above. (I haven’t checked any other states, though.)
So, I have emailed Metcalf. I am sure it will make no difference, but I did it. Here is a copy of the email:
Dear Ms. Metcalf,
I have been embarrassed for some years to subscribe to Consumer Reports, because its reviews are so heavily tilted towards products for the wealthiest. Americans who have a typical income get short, or no, shrift. However, your article on Medicaid clawbacks is actually shameful. Consumer Reports has now officially thrown the weakest members of society, under the bus, and shown a total contempt for the vast majority who cannot afford legal advice. It is hard to choose what part of your article is most ugly; this is certainly an option:
“But even if your state doesn’t change its mind, there will probably be ways to protect your heirs, according to Morris Klein, a Maryland lawyer who serves on the public policy steering committee of the National Academy of Elder Law Attorneys. Since each state runs estate recovery slightly differently, you should consult an elder law attorney.”
I suppose that you think that along with obtaining costly legal advice, a 55 year old who is forced onto Medicaid (and not even given the option of purchasing insurance with the subsidies that the wealthier will get!) should also eat cake (from Whole Foods, no doubt).
If you would like to read a good description of just how nasty your article is, here you go: http://www.nakedcapitalism.com/2014/02/consumer-reports-shills-obamacare-pooh-poohs-medicaid-clawbacks-bizarre-assumption-theyll-waived.html#comment-1867479