Fine print: State can seize your assets to pay for care after you’re forced into Medicaid by Obamacare

December 17, 2013

My, this is an unpleasant consequence of Obamacare. I’m not going to call it unintended because in its current form, it potentially earns a bunch of money for states, so I’m pretty sure that’s intentional. What I think is unintentional is anyone noticing this is what they’re up to.

But the Seattle Times noticed:

It wasn’t the moonlight, holiday-season euphoria or family pressure that made Sophia 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.

So, here’s the deal. There used to be a provision whereby the state could recuperate funds spent on a Medicaid patient post-55 years old from whatever assets he owned. So, a low-income individual in nursing home care after age 55 might pass away and his kids would find out the family home or car of whatever he had to his name had to be bought back from the state if they wanted it. It’s called estate recovery, and sounds pretty shady if it’s not boldly advertised as the terms for Medicaid enrollment, which is most definitely is not.

Before the Affordable Care Act’s Medicaid expansion, there weren’t that many people in Medicaid who had much in the way of assets for seizing. But now that Medicaid enrollment requirements have been relaxed, more people with assets but low income are joining the program or being forced into it. For instance, a couple in their 50s who, say, retired early after losing jobs in the bad economy may have assets but show a very low income. Under Obamacare, if their income is low enough to qualify for Medicaid, they must enroll in Medicaid unless they want to buy totally unsubsidized coverage in the now-inflated individual market. As teh Times notes, this is no small difference:

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.

The couple in the Times story was able to marry, combine their incomes, and get out of the Medicaid trap. Others will not be so lucky, and may not even read the fine print:

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.

For no one else in the world is it a-okay to give low-income people a loan that might endanger their family’s assets and not even clearly inform them they’re getting a loan.

This Daily Kos diarist has a nice write-up (I know) on the toll this could take on lower and middle-class people looking for relief and getting what amounts to a surprise predatory loan instead:

We haven’t had lots of people younger than 65 on Medicaid, because in most states simply earning less than the Federal Poverty Level did not qualify one for Medicaid.

And we haven’t had many people with lots of assets on Medicaid, because in most places you have to have less than around $2400 to your name before Medicaid will cover you. You can keep your house and your car, but Medicaid reserves the right to put liens on them and take them when you die.

But now we have the Affordable Care Act, and its expectation that everyone in the lower tier of income will end up in the Medicaid system. To accomplish this, they have dropped the asset test. So now we will have lots of people ages 55-64, who have assets but not a lot of income right now, for whatever reason, on Medicaid.

The kicker of it is, if you make the right amount to qualify for a subsidized health insurance plan, your costs are going to be shared and subsidized by the government. But if you go on Medicaid, you owe the entire amount that Medicaid spends on you from the day you turn 55…

How will this play out? No one knows, as far as I can tell. But it is easy to see how this could become a real problem. If someone is low income and goes on Medicaid, will Medicaid put a lien on their house? If they need to sell their house and move, will they then lose all their equity in paying off the lien? Will people get hit with bills and liens for many thousands of dollars, even if they were healthy and hardly ever went to the doctor?

The fact that this is being treated with seriousness at Kos is an indication of how large a liability it could be for this government program. Washington is scrambling to change the law. No doubt other states will start looking at their implementation of this part of Obamacare. But there will be people caught unaware that their houses effectively belong to the government because the government forced them into Medicaid coverage. You’re welcome!

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