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In New Jersey Spotlight News, I put in a plea that New Jersey's new state-based exchange GetCoveredNJ, and the coming "get covered" outreach during Open Enrollment, give due emphasis to Medicaid:
GetCoveredNJ and state officials should avoid repeating a mistake endemic to state exchanges: overemphasizing the private-plan marketplace at the expense of Medicaid (NJ FamilyCare)...
From the ACA’s passage in 2010 to the present, the private-plan marketplace has sucked up all the political passion. But the Medicaid expansion has insured far more people who would otherwise be uninsured. In New Jersey, as of September, 597,000 enrollees in NJ FamilyCare were rendered eligible by ACA criteria. About 175,000 New Jerseyans were subsidized in the private-plan marketplace...
Gov. Murphy and the state Legislature have used financial judo to fund improvements in the state’s health insurance marketplace, capturing funds that previously went to the federal government to finance enrollment assistance, advertising and supplementary subsidies. To best protect New Jerseyans from becoming uninsured during the current crisis, however, they need to focus equal energy on maximizing Medicaid enrollment.
As is frequently the case, I am finding a serious omission in this blog with avoidance of the fact that Medicaid estate recovery will make the picking up of expanded Medicaid, in New Jersey, exactly the wrong thing for people with substantial assets to lose.
ReplyDelete(People eligible for expanded Medicaid--income to 138% FPL with no asset test--are not eligible for subsidized on-exchange coverage due to ACA rules, but can pay full price for an unsubsidized ACA on-exchange plan, if they can afford it. This will be the best choice for many, such as early retirees, and other people with saved assets, and avoids a real financial bomb.)
In particular, note these:
Here is the NJ Medicaid estate recovery document: https://www.state.nj.us/humanservices/dmahs/clients/The_NJ_Medicaid_Program_and_Estate_Recovery_What_You_Should_Know.pdf where the first paragraph states clearly that NJ is one of the 10-14 states that does the estate recovery on all Medicaids (including ACA expanded Medicaid) for people 55 and over.
I also note that NJ currently uses the Federal ACA exchange, which provides NO notification of the recovery. (Adobe p. 8 here: https://marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf Nothing is stated.)
This blog did mention the issue once, last year (https://xpostfactoid.blogspot.com/2019/06/aca-medicaid-expansion-lien-on-me.html), which is good. But the failure to mention it in repeated blog articles about the importance of expanded Medicaid during COVID is conspicuous, and seems to be consistent with the press keeping quiet on the matter, to not further point out weaknesses of the current ACA.
(People unfamiliar with the issue: see the Wikipedia article on Medicaid estate recovery, which I put the information in on. You can't trust me (since you don't know me), or Wikipedia, but the on-line links verify all information. (That's where I quickly pulled the NJ estate recovery document, for instance.)
Norman, you're right, I should spotlight this more consistently. There is a bill hanging fire to end the liens for those not in long-term care, and getting it passed is on the agenda of the NJ for Health Care Coalition, but we need to push harder. Liens on those rendered eligible for Medicaid by the ACA expansion are a travesty.
ReplyDeleteThanks for your response.
DeleteI didn't know there was a bill in NJ.
There is, in MA, currently a pair of bills (https://malegislature.gov/Bills/191/S734 and https://malegislature.gov/Bills/191/H1197) stuck in the legislature under the state's "any citizen can sponsor bills" provisions.
However, they're incredibly unpublicized, and I assume unlikely to pass.
In MA, I do know the issue is virtually unpublicized, in particular, with the Boston Globe consistently avoiding the issue, despite me and a few other people requesting they cover it. I believe the Globe has never mentioned it.
Occasionally, a small paper picks up something, like this press release from a Rep. Comerford: https://www.thesomervilletimes.com/archives/101299 , where it states, not to be found at the Globe: "Current federal law requires MassHealth (the Commonwealth’s Medicaid program) collect its costs from estates of members who received long-term care services in nursing homes. Massachusetts is among one of the few states that goes beyond this mandate and collects money from all MassHealth recipients over age 55, regardless of whether they were in a nursing home."
My understanding is Rep. Barber, who has a background in health policy analysis, actually, may eventually try to stop the estate recovery on non-LTC. (Working with a state Sen. Comerford.) I'm not sure this is likely, since the issue is so under-publicized.
(The press attention on the issue has been limited, especially at the national level. The Washington Post mentioned it once, in 2014, the NY Times, I believe, has never mentioned it. Unfortunately, I believe this is a clear case of press bias, trying to keep quiet about defects in the current ACA. The issue of what gets covered in the press is indeed worth paying attention to. I am afraid the press biases pointed out by the demagogue DJT have some basis in truth!
(As well, my own experience at sticking in a section on "Problems" in the Wikipedia ACA article seem to have been met by similar censorship by two possibly politically motivated "editors" voting againstthe one me. This was it: https://web.archive.org/web/20190827024946/https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Problems before it was somewhat defanged Sept 2019, and then pulled entirely July 2020, by two other "editors", despite no mistakes ever having been found.)
One other comment on the issue.
DeleteGiven the Medicaid estate recovery on ACA expanded Medicaid and other Medicaids for people 55 and over in 10-14 states, obviously those states, if trying to be as helpful as possible to people, and not wanting to give some of them a financial bomb, should conspicuously point out the estate recovery in the ACA application process, e.g. state that in the letter that people get telling them to apply.
The letter, rather than leave people to have to find estate lawyers before applying for for the ACA, should state: "since an expensive illness with ACA expanded Medicaid, if you were 55 or older, could wind up in your losing the ability to pass on like a million dollars in assets, you should consider the option of paying full price for on-exchange unsubsidized insurance if you can afford it, and may have assets to lose at your death."
MA doesn't do this. I assume NJ does not, either. Because it will cause rage. (So they choose to keep it quiet, with either inconspicuous notice, or no notice (in NJ, since the Federal application has no warning, the only possible notice is after a person has the Medicaid and has the financial exposure.)
(MN, an exception, actually, was ethical enough to provide conspicuous notice on the application, and as well, the Medicaid agency sent explicit letters to people with expanded Medicaid saying "we have a claim on your future estate". The publicity and outrage generated led to MN stopping its recovery on non-LTC in about 2017. Obviously, other states like NJ and MA are choosing the very unethical keeping it quiet, with a big financial bomb in the future for the unsuspecting. Bad, bad, government! There is no other way to describe the leaving of the notice so inconspicuous.)