tag:blogger.com,1999:blog-8512362.post3351091525829861274..comments2024-03-10T13:59:19.230-04:00Comments on xpostfactoid: ACA Medicaid expansion: Lien on me?Andrew Sprunghttp://www.blogger.com/profile/17601269968798865106noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-8512362.post-3010066282100720122021-04-27T20:23:56.732-04:002021-04-27T20:23:56.732-04:00Norm, thank you for your feedback and focus on thi...Norm, thank you for your feedback and focus on this matter. I spoke to elder care attorney, who was willing to negotiate with the state. They wouldn’t even do that. My only hope is the Cryan bill in NJ. Or something happening at the federal level to abolish this nonsense. The text of Cryan bill actually says that non-LTSS will apply to all estates created since 1990s. I guess that means that they will have to refund those from who. they have already recovered. Not sure how this will work in practice. From my Mom, they have not recovered, it is a lien at this point. Incidentally, my Mom did not get Medicaid under ACA, but recovery is still unfair. <br />You are right, in Europe they pay for medical care to their citizens, not merely loan it out to those who have something to take from after death. <br />Surprisingly, there is little reaction to this from the public. I guess,there are two reasons. Most recipients don’t have any assets at all. And also, those who qualified for Medicaid expansion under ACA and do own their houses are alive and well, God bless them. They don’t understand what’s in store for their heirs once they pass on. My Mom certainly didn’t. I did, but I didn’t want to upset her, so I didn’t tell. It was too late to change anything anyhow. Leo Yhttps://www.blogger.com/profile/15180481733520892212noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-77425620526703793782021-04-14T16:57:33.826-04:002021-04-14T16:57:33.826-04:00More for Leo and any others, given the possibility...More for Leo and any others, given the possibility that this page from xpostfactoid may come up in search on that issue:<br /><br />The Obama administration knew there was a problem estate recovering on expanded Medicaid, and in Feb 2014, attempted to stop the states from estate recovering it.<br /><br />That is documented here:<br /><br />https://www.healthaffairs.org/do/10.1377/hblog20140224.037390/full/<br /><br />in Tim Jost's sharp Health Affairs "Following the ACA" blog. (I think Health Affairs has dropped the ball on the issue since, however.)<br /><br />Tim links to the letter requesting the states not estate recover expanded Medicaid and saying the administration would do everything in its power to stop it here:<br /><br />https://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-14-001.pdf<br /><br />stating precisely: <br /><br />"Due to the potential barrier to enrollment that future estate recovery may create for some individuals, CMS intends to thoroughly explore options and to use any available authorities to eliminate recovery of Medicaid benefits consisting of items or services other than long term care and related services in the case of individuals who are determined eligible for Medicaid benefits using the MAGI methodology." <br /><br />Actually, the reason given by the Obama administration, "potential barrier to enrollment that future estate recovery may create for some individuals" is one of several reasons, and the letter is lame for not stating the other reasons.<br /><br />The other reasons are:<br /><br />a)With the estate recovery, we're simply not giving everyone the option to get affordable real, not-a-loan health insurance like the rest of the developed world gives its people, or single-payer U.S. would.<br /><br />b)Certain people of lower income (but not dirt poor) had pre-existing-condition screened insurance at a relatively low premium pre-ACA. They dropped it owing to the ACA, and got expanded Medicaid. Realizing the recovery, they cannot now afford the only option they have for real insurance: unsubsidized on-exchange (with high-prices due to no pre-existing-condition screening, and since expanded Medicaid eligibility blocks subsidized on-exchange coverage by ACA rules.)<br /><br />c)The ACA becomes a dangerous contraption for people, as dropping below 138% FPL regardless of assets exposes one to liability possibly for all medical expenses paid out. (People with assets to lose are affected: unemployed, early retired, people without contracts for a few months, or taking a few months off.)<br /><br />So the reason the Obama administration gave, "some people won't sign up", sounds like they assumed all of the state Medicaid agencies are full of people who can't understand much, but they realized their job is to run around with clipboards and get people to sign up, so that's what they put in the letter.Norm Spierhttp://nasmusicsoft.comnoreply@blogger.comtag:blogger.com,1999:blog-8512362.post-12832563220999046362021-04-14T14:33:44.844-04:002021-04-14T14:33:44.844-04:00Leo Y and Andrew and others interested:
Back in e...Leo Y and Andrew and others interested:<br /><br />Back in early 2014, when the ACA main provisions went into effect, there was a tiny bit of coverage in the press of this issue. The NY Times I believe completely ignored it, but it was in the Washington Post once, here (Jan 2014):<br /><br />https://web.archive.org/web/20170213022927/https://www.washingtonpost.com/national/health-science/little-known-aspect-of-medicaid-now-causing-people-to-avoid-coverage/2014/01/23/deda52e2-794e-11e3-8963-b4b654bcc9b2_story.html<br /><br />It's interesting to look at the quote in that article from Matt Salo, the executive director of the National Association of Medicaid Directors (still in that position).<br /><br />' It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.<br /><br />“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.” '<br /><br /><br />Well, of course, he was wrong, and has made no public acknowledgement of that, as far as I can tell. <br /><br />(Because, through 2017, Minnesota held on fiercely to the estate recovery on expanded Medicaid, as the Rick Rayburn in MN experience, and quotes from the state officials in MN papers show us.<br /><br />Further, apparently New Jersey is explicitly threatening the people of NJ and I presume Leo. And as well, at least a total of 12 states appear to have recovery of expanded Medicaid in their recovery policies, 7 years after ACA main provisions, and perhaps 20 recover other non-long-term-care Medicaids.)<br /><br />(Some states that did recover expanded Medicaid in their estate recovery policies did amend their recovery policies not to recover that. These include NY, CT, OR, WA, CO in around 2014, and CA and MN around 2017. I have links to documentation of this in that Wikipedia article on Medicaid estate recovery that I expanded from a stub in 2019.)Norm Spierhttp://nasmusicsoft.comnoreply@blogger.comtag:blogger.com,1999:blog-8512362.post-34678721851904326882021-04-14T09:48:30.267-04:002021-04-14T09:48:30.267-04:00Hi Leo:
I am a guy who found out about the Medica...Hi Leo:<br /><br />I am a guy who found out about the Medicaid estate recovery on non-LTSS in 2019, not expecting such an absurdity.<br /><br />Post ACA, we would expect we all have the opportunity to get affordable REAL (not a loan) health insurance. (This is what happens in the rest of the developed world--no one gets just a loan until death for medical expenses, at least for non-long-term care. Not all developed countries have universal long-term-care insurance systems--some do, like Germany--but all have ordinary medical insurance systems that don't, for any people, offer just a loan.)<br /><br />The current system, in the roughly 12 states (including your blue NJ, and blue MA and MD as well) that estate recover non-long-term-care Medicaids (for people 55-64) completely messes up the ACA. In some cases, the state apparently recovers all medical expenses paid out--the person had no insurance at all. In other cases, a capitation, which is like a loan for premium.)<br /><br />It's an outrageous bungling of policy.<br /><br />(At the moment, people above 138% FPL get real insurance, highly and often 100% or otherwise highly subsidized from subsidized on-exchange plans. Below 138% FPL, and regardless of assets--there is no asset test on expanded Medicaid--people get expanded Medicaid and are blocked by that eligibility from subsidized on-exchange plans by ACA rules. It's actually common to get expanded Medicaid from the ACA for people with assets to lose, and they get taken by surprise, since estate recovery notice is missing on the Federal ACA application: https://marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf see adibe o, 8) and inconspicuous in other states.<br /><br />(Cases of people with lots of assets: pausing work for a few months--since expanded Medicaid eligibility is often determined monthly, self-employed without contracts for a few month, unemployed for a bit, early retired. All of these groups with substantial assets to lose get sucked in. As well as working poor, that we should be allowing to accumulate modest intergenerational wealth.)<br /><br />The New York Times seems to have never covered the issue. The Washington Post only once, in 2014. The press is being either incompetent here, or intentionally covering up.<br /><br /><br />Note Andrew has another post on this, calling for the repair:<br /><br />https://xpostfactoid.blogspot.com/2021/01/the-117th-congress-should-end-medicaid.html<br /><br />And also there is a good reference, from me, adding info to Wikipedia in 2019, when I first found out about the issue:<br /><br />https://en.wikipedia.org/wiki/Medicaid_Estate_Recovery_Program<br /><br />(assertions can be verified from the references, which are all online)<br /><br />Backed up, in case someone pulls content from the article:<br /><br />https://web.archive.org/web/20200701011813/https://en.wikipedia.org/wiki/Medicaid_Estate_Recovery_ProgramNorm Spierhttp://nasmusicsoft.comnoreply@blogger.comtag:blogger.com,1999:blog-8512362.post-79065971619979653842021-04-14T09:47:35.288-04:002021-04-14T09:47:35.288-04:00This comment has been removed by the author.Unknownhttps://www.blogger.com/profile/10090666959875212531noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-9309895568006898602021-04-13T20:49:04.457-04:002021-04-13T20:49:04.457-04:00I am really hoping NJ bill will pass. I wrote to S...I am really hoping NJ bill will pass. I wrote to Senator Cryan. My late Mom has a lien on her modest apartment, which eats up most of it. How is that fair? All non-LTSS Medicaid. Medicare spent a lot more on her, no recovery. Why should NJ recover more than federally mandated requirements and cause grief for what appears to be a drop in the bucket for the program?Leo Yhttps://www.blogger.com/profile/15180481733520892212noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-82195237435390938072020-08-20T00:43:32.809-04:002020-08-20T00:43:32.809-04:00Hi Bob,
Since learning about the issue last summe...Hi Bob,<br /><br />Since learning about the issue last summer, I have contacted and become a friend of your neighbor Rick, who is the fellow here that you mentioned:<br /><br />https://web.archive.org/web/20190806154942/https://www.mlstargazette.com/story/2017/05/18/news/minnesota-ma-estate-liens-put-to-final-rest/2269.html<br /><br />He has had some success in MN, as you and others point out.<br /><br />Still, he is worried the state will change back. Including, possibly, retroactively. (That is, though they didn't estate recover expanded Medicaid last year, perhaps they can decide retroactively to go after last year's expanded Medicaid capitations or all bills paid out.)<br /><br />He has good reason to worry about that. He pointed me to the CURRENT MN ACA Application (with help paying costs) <br /><br />https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6696-ENG<br /><br />and look what it says on adobe p. 21:<br /><br />"If anyone on this application is eligible for Medical Assistance, I have read and understand that the state may claim repayment for the<br />cost of medical care, or the cost of the premiums paid for care, from my estate or my spouse’s estate"<br /><br />As if they didn't stop estate recovery on expanded Medicaid!<br /><br />Notice also that they retain either option: recovery of a capitation premium, or of all medical expenses paid out.<br /><br />Recovery of all medical expenses paid out means the person NEVER HAD INSURANCE at all. (And recall, the grounds for the mandate, when it was in affect, was to make insurance work! Still, NJ and MA have a mandate, and do still do the recovery on non-LTC!)Norman Spiernoreply@blogger.comtag:blogger.com,1999:blog-8512362.post-55784242271414011242020-08-19T23:20:35.505-04:002020-08-19T23:20:35.505-04:00Your experience seems to be similar to mine.
I th...Your experience seems to be similar to mine.<br /><br />I thought I understood the ACA, but in 2019, I learned about the Medicaid estate recovery on ACA expanded Medicaid and other non-long-term-care Medicaids, still done in 10-14 states that have expanded Medicaid.<br /><br />I was shocked. <br /><br />About 20% of people get a Medicaid as their health insurance under the ACA and the prior traditional Medicaid system. In the states that still estate recover non-long-term-care expenses, those 55-64, about 4% of the population, don't have insurance. They have a loan for UNINSURED medical expenses. There is no insurance at all!<br /><br />(Not only do we have 9% uninsured at the moment, 1%-2% only due to failure to expand Medicaid in 12 states, but as well, in many states, the insured percent from the Census is phony--4% of the people have just a loan and no insurance!)<br /><br />I reacted to discovery of the problem by expanded the Wikipedia article on Medicaid estate recovery to include this aspect. (Facts reflect status last year: about 8 states did correct the problem, still leaving perhaps 10-14.)<br /><br />Note: The Wikipedia article is under contention, and may be removed, or the key content taken out. (Even though no mistakes have been found in the year since it has been up. Therefore, let me give the backup link to the Wayback Machine version:<br /><br />https://web.archive.org/web/20200701011813/https://en.wikipedia.org/wiki/Medicaid_Estate_Recovery_Program )<br /><br />Also note: I do try to publicize the issue as much as I can, often in the NY Times comments section. ( E.g. https://www.nytimes.com/interactive/2020/08/11/opinion/us-coronavirus-black-mortality.html#commentsContainer&permid=108573345:108581267 )<br /><br />Also, I did a page designed for MA, my own state, which (surprisingly) has the problem. http://nasmusicsoft.com/BlogMAEstateClawback1.html (Someone actually got a bill placed in the legislature to fix the issue, but it is not likely to pass.)<br /><br />Also, note:<br /><br />The ACA has other defects, including affordability. I tried adding a "Problems" section to the ACA article last summer, including 5 problems, with the Medicaid estate recovery as one of them.<br /><br />However, due to editor dispute, it was taken out a year later, and no longer appears.<br /><br />(This is a backup version of that: https://web.archive.org/web/20190827024946/https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Problems )<br /><br />In any case, since the issue has not been publicized since 2015, except in places where there was substantial activism, my assumption is the press is avoiding the issue intentionally, to not make the ACA look bad.<br /><br />Norman Spierhttp://nasmusicsoft.com/BlogACAConsumerProblems.htmlnoreply@blogger.comtag:blogger.com,1999:blog-8512362.post-50261552875517676932019-06-19T07:45:57.460-04:002019-06-19T07:45:57.460-04:00Thanks for the pointers. A neighbor of mine was pa...Thanks for the pointers. A neighbor of mine was partly responsible for the Minnesota exemption noted above.<br />This is a classic illustration of "programs just for the poor are poor programs." We need the clarity to accept the fact that Americans are aging, and some will need long term care, and either we force people to save for it (fat chance!), or we collect taxes to cover it. Germany added about 2% to their Social Security tax to have a public long term care insurance benefit.Bob Hertzhttps://www.blogger.com/profile/08889826739646491269noreply@blogger.com