DCG posted: " Yakima Herald: It wasn’t the moonlight, holiday season
euphoria or family pressure that made Sofia Prins and Gary Balhorn, both
62, suddenly decide to get married. It was the fine print. As fine print is
wont to do, it had buried itself in a long f" Respond to this post by
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<http://fellowshipoftheminds.com/author/dcgere/> Fine print with expanded
Medicaid jolts many middle-age
adults<http://fellowshipoftheminds.com/2013/12/17/fine-print-with-expanded-medicaid-jolts-many-middle-age-adults/>
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DCG <http://fellowshipoftheminds.com/author/dcgere/>
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Yakima
Herald<http://www.yakimaherald.com/news/yhr/monday/1758591-8/fine-print-with-expanded-medicaid-jolts-many-middle-age>:
It wasn’t the moonlight, holiday season euphoria or family pressure that
made Sofia Prins and Gary Balhorn, both 62, suddenly decide to get married.
It was the fine print.
As fine print is wont to do, it had buried itself in a long form —
Balhorn’s application for free health insurance through the expanded state
Medicaid program. As the paperwork lay on the dining-room table in Port
Townsend, Prins began reading.
She was shocked: *If you’re 55 or over, Medicaid can come back after you’re
dead and bill your estate for ordinary health care expenses*.
The way Prins saw it, *that meant health insurance via Medicaid is hardly
“free” for Washington residents 55 or older*. It’s a loan, one whose
payback requirements aren’t well advertised. And it penalizes people who,
despite having a low income, have managed to keep a home or some savings
they hope to pass to heirs, Prins said.
With an estimated 223,000 adults seeking health insurance headed toward
Washington’s expanded Medicaid program over the next three years, the
state’s estate-recovery rules, which allow collection of nearly all medical
expenses, have come under fire.
*Medicaid, in keeping with federal policy, has long tapped into
estates.*But because most low-income adults without disabilities could
not qualify
for typical medical coverage through Medicaid, recovery primarily involved
expenses for nursing homes and other long-term care.
*The federal Affordable Care Act (ACA) changed that.* Now many more
low-income residents will qualify for Medicaid, called Apple Health in
Washington state.
But if they qualify for Medicaid, they’re not eligible for tax credits to
subsidize a private health plan under the ACA, which requires all adults to
have health insurance by March 31.
Prins, an artist, and Balhorn, a retired fisherman-turned-tango instructor,
separately qualified for health insurance through Medicaid based on their
sole incomes. *But if they were married, they calculated, they could “just
squeak by” with enough income to qualify for a subsidized health plan* —
and avoid any encumbrance on the home they hope to leave to Prins’ two sons.
“We’re happy to be getting married,” Prins said last week. “Unfortunately
not everyone has such an elegant solution to the problem.”
For Washington state, the solution has been much more complicated. Over the
past month, as lawmakers began hearing from worried and angry constituents,
state officials began exploring what it would take to fix this collision of
state rules with the ACA.
Late Friday, Gov. Jay Inslee’s office and the state Medicaid office said *they
plan to draft an emergency rule to limit estate recovery to long-term care
and related medical expenses*. They hope to be able to change the rules
before coverage begins Jan. 1.
Fixing the problem will cost the state about $3 million a year, said Dr.
Bob Crittenden, Inslee’s senior health policy adviser, but it’s the right
thing to do.
*“There was no intent on the part of the ACA to do estate recovery on
people going into Medicaid (for health insurance),”* Crittenden said. “The
idea was to expand coverage.”
People in their 50s and 60s make up about 30 percent of the adults who have
signed up for health insurance through Washington’s exchange marketplace,
and about *18 percent of adults who have enrolled in health insurance
through Apple Health (Medicaid).*
*Some 55- to 64-year-olds, who may have taken early retirement or who were
laid off during the recession, have found themselves plunged into a
low-income bracket.* Unlike Medicaid recipients in the past — who were
required to reduce their assets to qualify — they’re more likely to have a
home or other assets.
For health coverage through Medicaid, income is now the only financial
requirement.
At first, Prins *was pleased at the prospect of free coverage*.
But the more she thought about the fine print, the more upset she got. Why
was this provision only for people age 55 and older? Why should those
insured by Medicaid have to pay back health expenses from their estates
when people with just a bit more income who get federal subsidies don’t? *Why
didn’t she and Balhorn know about this before getting to the application
stage?*
As Prins began searching for answers, she found that* even those trained to
help people sign up for insurance under the ACA weren’t aware of this
provision*, nor were some government officials.
Around the country, the issue has sizzled away in blogs and commentaries
from both right and left. The National Women’s Law Center noted the ACA and
its regulations prohibit age discrimination in programs such as Medicare
and Medicaid.
Dr. Jane Orient, executive director of the politically conservative
Association of American Physicians and Surgeons, writing in the The
Washington Times, called the recovery provision “a cash cow for states to
milk the poor and the middle class.”
“People will think this is wonderful, this is free insurance,” Orient said
in an interview. *“They don’t realize it’s really a loan, and is secured by
any property they have.”*
Even states that are now limiting estate recovery, she warned, can change
the rules again if budget problems become more intense.
One reason this snafu has become so troublesome is that* ACA rules appear
to give those who qualify for Medicaid little choice but to accept the
coverage*.
People cannot receive a tax credit to subsidize their purchase of a private
health plan if their income qualifies them for Medicaid, said Bethany Frey,
spokeswoman for the Washington Health Benefit Exchange.
But they could buy a health plan without a tax credit, she added.
For someone age 55 to 64 at the Medicaid income level — below $15,856 a
year — it’s quite a jump from free Medicaid health insurance to an
unsubsidized individual plan. *Premiums in King County for an age 60
non-tobacco user for the most modest plan run from $451 to $859 per month.*
It’s not the first time federal and state rules have clashed, and local
officials now find themselves on the hook to ensure that the new law
doesn’t create hardship.
In Oregon, state officials changed estate-recovery rules last month.
Recovery will no longer apply to health benefits for those 55 and over, the
Oregon Health Authority said, although the state will collect expenses for
long-term care.
On Friday, Washington Medicaid Director MaryAnne Lindeblad *promised to
draft an emergency rule very soon*. The state also must revise the plan
filed with federal authorities, but Lindeblad said she doesn’t expect
problems or appeals of the rule.
As for Prins and Balhorn, they’re good with their choice.
Instead of paying $577 a month apiece for an unsubsidized private plan or
worrying about losing their assets after death, as a married couple they’ll
pay $76 a month for a midlevel “silver” plan with a tax credit. “Since
we’ve been in an established relationship and love each other, the decision
to get married was pretty easy,” Prins said.
Sunday, they made a big fruit salad, dressed in tango clothing and were
married in their home. Afterward, they danced to their favorite tango music
and toasted each other with orange juice and a dash of cranberry.
“I’d be very happy if the governor actually makes this change possible,”
Prins said late last week. “And I’m very happy to be getting married!”
DCG
*DCG <http://fellowshipoftheminds.com/author/dcgere/>* | December 17,
2013 at 3:45 am | Tags:
Medicaid<http://fellowshipoftheminds.com/?tag=medicaid>| Categories:
Health
Care <http://fellowshipoftheminds.com/?cat=20052>,
Obamacare<http://fellowshipoftheminds.com/?cat=15633789>| URL:
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