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ObamaCare Clusterfuck: After 55, Medicaid is a loan you pay back from your estate

Jeebus, it's like they're doing everything possible so that you don't make it under the wire to 65, isn't it? Here's the text of a 2010 letter on NJ letterhead ("MEDICAID COMMUNICATION NO. 10-08", PDF attached below) helpfully supplied by reader SW:

The Division of Medical Assistance and Health Services (DMAHS) is reinforcing and updating guidelines that were issued in Medicaid Communication No. 00-16, dated August 10, 2000, governing the recovery of correctly paid Medicaid benefits from the estates of deceased Medicaid clients or former Medicaid clients. The following is a list of important points to remember when determining eligibility and discussing this topic with applicants, clients, authorized representatives and families:
• Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form.
• DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time.
• Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery.
• The estates of deceased clients who were enrolled in various Title XIX Waiver Programs (such as ACCAP, GLOBAL Options, CCW, etc.) ARE subject to recovery. The only current exceptions are HCEP and JACC, which are State- funded programs through other State Departments.
• The client’s primary residence, while exempt for eligibility purposes, is considered part of the client’s estate, and therefore is subject to recovery. It is also important to reinforce with applicants, clients and families that any interest that the client had in any property at the time of death will be considered part of the decedent’s estate, and therefore subject to recovery.
• Annuities are required to be disclosed upon application and recertification for Medicaid. For those annuities which are determined not to be subject to asset liquidation, the State of New Jersey must be named as the remainder beneficiary in the first/primary position for the total amount of medical assistance paid on their behalf. In the case where there is a community spouse and/or a minor or disabled child, the State must be named in the second/secondary position as remainder beneficiary. The State or its eligibility agencies shall require verification of the State being irrevocably named as the remainder beneficiary in the correct position and the State needs to be notified of any contractual changes in the annuities’ income or principal. The remaining benefits of an annuity not subject to liquidation prior to eligibility determination are payable to the State (primary or secondary position) regardless of the age of provided services
• “Estate” for Medicaid recovery purposes is now defined by law to include any real or personal property and any assets in which the client had any legal title or interest at the time of death. Included for your reference is a copy of the pertinent regulation. Please note that the definition of “estate” appears at N.J.A.C. 10:49-14.1(e)2 and is quite comprehensive; also note that the term “other arrangements” used in that subsection includes testamentary trusts and annuities.
• Please remember that in the process of estate recovery, DMAHS will file a lien against the estate to recover all payments for services received on or after age 55 (except for annuities).
• No distribution can be made to heirs or creditors from the estate other than for reasonable funeral expenses, costs associated with the administration of the estate, debts owed to the Office of the Public Guardian for Elderly Adults, and claims with preference under federal or state law (e.g., IRS liens) that may be superior to Medicaid’s (e.g. filed prior in time) without first satisfying the Medicaid program’s lien.

And what's so reprehensible about ObamaCare is that they force you into Medicaid. No options if that's how the eligibility plays out; if you want to risk a piece-of-crap policy so you can pass on your house to your kids, you can't do that. Yet another path to downward mobility! Of course, this only applies to the poorest, ObamaCare being ObamaCare.

NOTE Yet one more reason why single payer Medicare for All is the only fair solution.

UPDATE Adding, I'd certainly be interesting in publishing any other (authentic) documents readers have available; the contact form is at top right. And although this PDF is from NJ, it reads to me like they are passing along a Federal policy. Readers will correct me....

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Rainbow Girl's picture
Submitted by Rainbow Girl on

"Of course, this only applies to the poorest, ObamaCare being ObamaCare."

At Day 1, yes. The insidiousness of ObamaCare -- if you start connecting dots here and there -- is how it seems engineered (in various details and mechanisms) to funnel people downwards, e.g., to Medicaid "by default." So the current "poors" who aren't yet the "poorest" and who knows how many sort of middle class Americans will find themselves slowly but surely funnelled down into the ObamaCare Impoverishment Matrix. This is signature Third Way sh*t.

Plus I'm waiting for an announcement at the end of January 2014 that repeals the "pay the penalty" option to paying for the Russian Roulette Exchange Products. Because Acceleration of Process (to impoverish as many people as possible as fast as possible, that being the goal of ObamaCare).

Splashoil's picture
Submitted by Splashoil on

Key words to research are "Medicaid estate recovery" +your favorite of the 50 states. Certain enthusiast sites keep fluffing the urgency of expanding Medicaid, and how evil R governors are preventing that. I have found the same stuff so far for Washington, Arizona, and now NJ. Be sure to get the official pdf's and link to them to avoid any unnecessary accusations from the team.
http://www.dailykos.com/comments/1219838/50586127

jo6pac's picture
Submitted by jo6pac on

just 0 and friends doing their best to finish off the working poor and what left of the middle class. It's been his goal since hanging out with the smartest guys in the room at the beginning of his senate run.

Splashoil's picture
Submitted by Splashoil on

Lambert just lit my light bulb. It's rather dim, but now I understand the big push for the Medicaid expansion. It is about us, 50 and up! A managed care Medicaid is the perfect place for the maximum extraction and would keep folks out the profitable insurance pools. Add in the clawback and it's a two-fer.
This explains the plaintive articles put up on the enthusiast sites which ignore this issue and tell you Medicare for all will never happen. All about the rents baby! Got to keep the cages,
I mean buckets separate because they are all specialized.
Time to go pull more weeds.

Rainbow Girl's picture
Submitted by Rainbow Girl on

"It is about us, 50 and up! A managed care Medicaid is the perfect place for the maximum extraction and would keep folks out the profitable insurance pools. Add in the clawback and it's a two-fer."

Grotesque.

But if you point this out to any "progressive" friend or colleague who has job-insurance or their partners' job-insurance they think you are off the reservation CT. And they go back to their iPad texting and browsing. It's tiring after awhile.

Alexa's picture
Submitted by Alexa on

These points can't be stressed enough.

If this doesn't wake up the "senior" (over 55) population--nothing will. ;-)

When I post on this topic, I try to stress the fact that any unemployed senior (single one, that is, since the IRS goes by household income) could be forced into Medicaid after a 30-day stint of unemployment without an income).

And, this would also very likely affect a low income couple--if they wind up with only one minimum wage job.

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Submitted by lambert on

This:

When I post on this topic, I try to stress the fact that any unemployed senior (single one, that is, since the IRS goes by household income) could be forced into Medicaid after a 30-day stint of unemployment without an income).

Can you break that down for me step by step? Yes, one would have to report a change in one's employment status, but does a coverage change at the exchanges kick in after 30 days? And what about disemployment insurance? Does that count toward income? I should write a post on that and keep hammering.

And yes, the 50+ are right in the cross-hairs.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Rainbow Girl's picture
Submitted by Rainbow Girl on

I think you get shoved into Medicaid without your consent only if you enter the FrankenSystem of the Obama Exchanges and the computer spits out that you have to go to Medicaid. Because Your Data Says So.

Also, I would bring down your age number for a threshhold to be "alert" to age 45 as many people in their 40s are losing their full time jobs and becoming either long term unemployed or long term underemployed and bereft of employer insurance, and therefore, facing the same fork in the road as the over 55s. i.e.: ObamaCare This Way -- No ObamaCare (Penalty $$$) That Way.

Rainbow Girl's picture
Submitted by Rainbow Girl on

... but you're exactly right about 55 years old being the Age Alert so far as the *estate recovery provisions* are concerned -- and that is key. Though I also view being shoved into Medicaid (which is looking like it's being transformed into a sort of Sub Bronze Super Loser private insurance HMO) as a grounds for concern for anyone under 55 facing that prospect.

Alexa's picture
Submitted by Alexa on

I'm leaving the real "official stuff" up to you guys, and am mostly basing my understanding on the piece "ObamaCare: A Deception."

(I can't link to the piece because I'm on a different computer, and can't make the address bar come up in order to copy and paste it. Sorry!)

Here's an excerpt (which I believe jibes with RG's understanding above):

The fact that the asset test was dropped is very important, but before we look at why, you must first understand that if an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.”

Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market.

[The italicized portion confuses me--why the use of the word "if" you are allowed to opt out? Does this mean that it varies from state to state? Or was it just sloppy writing (which is do all the time, LOL!]

Just so you’re clear on this: the ACA stipulates that the system will ensure that if any individual applying to an Exchange is found to be eligible for Medicaid or a state children’s health insurance program (CHIP), the individual will be enrolled in such a plan.

The statement above mentions the ability to "pay a fine" to avoid being enrolled in Medicaid.

I don't know if that applies only during one's initial evaluation, or if it also applies if one is in a Health Exchange, loses a job resulting in one's income falling below 138% of FPL.

Some states were supposedly looking at allowing its beneficiaries to stay enrolled in a plan from one annual enrollment period to another, in order to avoid having so many beneficiaries "bounce around."

I think that Lambert posted a blog on this topic some time ago.

That would make more sense than allowing a beneficiary to "bounce back and forth" between an Exchange and Medicaid.

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Rainbow Girl's picture
Submitted by Rainbow Girl on

My take from the PC Roberts piece (and the parts you quoted above) is that the exchange "system" (algorithm? data matrix? Wizard of Obama?) will tell you -- at the application stage -- that you are eligible for Medicaid because your 'numbers" say so. At that point, it sounds like, you can get out of the Exchange, say "no thanks" to Medicaid and pay a penalty for not being insured or go and try buying a policy on the non-exchange private market.

A second scenario occurs if when you applied you were eligible for subsidies for a Bronze or Silver plan -- whatever -- and you get on that buggy, but a few months in your circumstances change such that suddenly you fall out of the subsidy system into Medicaid (i.e., your income is so low that you're below poverty level, or something similar). At *that* juncture -- as I read Roberts's explanation -- you get enrolled in Medicaid automatically, without your consent. I don't know if you then get to ditch Medicaid by saying "no thanks" I'll pay a penalty and look for solutions outside the ObamaCare-Medicaid tent.

Submitted by lambert on

... of how exactly disemployment gets you tossed into the Medicaid bucket (after not having been there). IIRC you have to file your change of employment status with the IRS, and that triggers a re-evaluation of your status... But in 30 days?

I understand that how you get tossed into the Medicaid bucket initially.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Rainbow Girl's picture
Submitted by Rainbow Girl on

... the mechanics of the unemployment-to-Medicaid route ... I had totally missed that in previous coverage. I mean, how many people realize that if they suddenly become unemployed they have this affirmative obligation to specifically alert the IRS (and presumably some very specific office within the IRS). This sounds like a huge trap that could result in people unwittingly remaining in some subsidized Loser Policy for months -- if they don't immediately report unemployment to the Matrix -- and then of course being tagged to pay back subsidies they shouldn't have gotten -- precisely at a time when they have bupkis in their pocket (collecting unemployment which, of course, is bloody taxable).

Presumably another way that Matrix would learn of one's new status as unemployed is if there's a linkup between state unemployment IT systems and the Federal Hub -- that way, once a person applies for unemployment, the info travels "real time" to the Matrix which presumably then would automatically reprogram you as a Medicaid Bucket person.

Really. ObamaCare (like the current Private Insurance "Health Care" System) is 99.999 percent unrelated to delivering health care, and 99.9999 related to shoving people in and out of buckets that will constantly change back and forth causing suffering and damage simply on that level. Forgetting about the high cost of useless products that leave you de fact with no health care. (That's the remaining 0.00000000001 percent of ObamaCare.)

Rainbow Girl's picture
Submitted by Rainbow Girl on

Splashoil: spot on!

Alexa's picture
Submitted by Alexa on

not on my computer, and can't access any of my bookmarks. (And I won't have it back until the end of next week, or the next week). That's why I can't even figure out how to copy a URL address--I'm using IE--which I haven't used in years.

So, I'd just "Bing" it.

I've seen the info here (I thought). It seems that it would almost have to coincide with the billing period for paying one's premium. But I don't "know" that.

My impression is that they want everyone insured in one of their "appropriate" plans, at all times. And to achieve this, we would all need to report our status immediately (I would think), so that we would not miss paying our health insurance premiums.

I thought that the CounterPunch piece mentions that they have system "checks" to try and catch missed payments, change in status, built into the "Exchange system."

I haven't read anything about UI, but I can't imagine that it would not be counted as income.

In some states, the UI stipends are so pitiful, they probably would not amount to enough to keep someone out of Medicaid. But I've never read anything on the treatment of UI as income.

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Submitted by hipparchia on

And although this PDF is from NJ, it reads to me like they are passing along a Federal policy.

it's federal law, that's why, and has been since 1993. from the "legislative history" section of this article:

Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child. Twelve states report having had an estate recovery program in effect before 1990 that was based on the original Medicaid law.2 While some of the features of these early programs have been documented, their scope and impact on Medicaid recipients, especially as compared to states without such programs, have not.3

and

Fueled by well-publicized and well-researched reports claiming that, “Estate recovery programs provide a cost effective way to offset state and Federal costs, while promoting more equitable treatment of Medicaid recipients,”4 Congress included a provision in the Omnibus Budget Reconciliation Act of 1993 (OBRA ‘93)5 that required states to implement a Medicaid estate recovery program.6

1993... hmmm... that would be the same administration that brought us welfare "reform."

Submitted by hipparchia on

gotta love the last line in this paragraph (from a continuation of the previous link):

CONCLUSION

Medicaid estate recovery gets to the heart of the issue of who should pay for long-term care -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including those remaining after death. Amounts collected from Medicaid recipients' estates are not insignificant in absolute terms. They do, however, pale next to total Medicaid spending for long-term care. This is not surprising, given that Medicaid is available only to those with very limited resources. Nevertheless, the wide state-to-state variation in recovery rates and estate recovery practices suggests that program efficiency could be improved and greater amounts could be recovered.

Rainbow Girl's picture
Submitted by Rainbow Girl on

For shyster collection bucket shops enlisted to "ramp up" collections in Medicaid Estate Recovery Actions. Again, as with pay day lending, foreclosure repossessions, etc, the policy is to unleash the rabidest specimens on the most vulnerable. Knee-breakers of America Rejoice!

Submitted by hipparchia on

thank you democrats!

Legislative history[edit]

Ultimately every Republican in Congress voted against the bill, as did a number of Democrats. Vice President Al Gore broke a tie in the Senate on both the Senate bill and the conference report. The House bill passed 219-213 on Thursday, May 27, 1993.[1] The House passed the conference report on Thursday, August 5, 1993, by a vote of 218 to 216 (217 Democrats and 1 independent (Sanders (I-VT)) voting in favor; 41 Democrats and 175 Republicans voting against).[2] The Senate passed the conference report on the last day before their month's vacation, on Friday, August 6, 1993, by a vote of 51 to 50 (50 Democrats plus Vice President Gore voting in favor, 6 Democrats (Lautenberg (D-NJ), Bryan (D-NV), Nunn (D-GA), Johnston (D-LA), Boren (D-OK), and Shelby (D-AL) now (R-AL)) and 44 Republicans voting against). President Clinton signed the bill on August 10, 1993.

http://en.wikipedia.org/wiki/Omnibus_Budget_Reconciliation_Act_of_1993

Submitted by lambert on

[genuflects]

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Alexa's picture
Submitted by Alexa on

LEGISLATIVE HISTORY

Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child. Twelve states report having had an estate recovery program in effect before 1990 that was based on the original Medicaid law.2

While some of the features of these early programs have been documented, their scope and impact on Medicaid recipients, especially as compared to states without such programs, have not.3

The 1965 Medicaid law also gave states permission to impose liens on property in the estates of deceased Medicaid recipients.

Post-death liens prevent the estate from being settled and the property distributed to the recipient’s heirs before all claims against it, including Medicaid’s, are satisfied.

Fueled by well-publicized and well-researched reports claiming that, “Estate recovery programs provide a cost effective way to offset state and Federal costs, while promoting more equitable treatment of Medicaid recipients,”4 Congress included a provision in the Omnibus Budget Reconciliation Act of 1993 (OBRA ‘93)5 that required states to implement a Medicaid estate recovery program.6

Apparently, there is no such thing as a liberal Dem when a Democratic President is in power.

And,

WHAT IS A MEDICAID RECOVERABLE ESTATE?

OBRA ‘93 requires states to recover, at a minimum, all property and assets13 that pass from a deceased person to his or her heirs under state probate law, which governs both property conveyed by will and property of persons who die intestate.14

A state’s ability to recover from probate estates depends in some measure on Medicaid’s standing vis-à-vis other claimants. The order of payment of debt is established under state law. Mortgages, unpaid tax or public utility bills, child support arrears, burial costs, or other debts may be paid before the Medicaid lien and reduce the amount that is actually recovered.

States may use the narrow Federal definition of “estate” and limit Medicaid estate recoveries to only those assets that pass through probate.

Alternatively, they may choose to define “estate” in a broader context, which enables them to recover from some or all property that bypasses probate.

Such property includes assets that pass directly to a survivor, heir or assignee through joint tenancy, rights of survivorship, life estates, living trusts, annuity remainder payments, or life insurance payouts.

As is true of probate estates, most such arrangements operate under other, non-Medicaid laws that define rights and responsibilities in the disposition of bank accounts or other liquid investments, real estate ownership, life insurance policies, etc.

BTW--this does apply to young children--if institutionalized.

OVERVIEW OF THE MEDICAID ESTATE RECOVERY MANDATE

Whose estates are affected?
•Persons who received Medicaid services after age 55; and
Persons who, regardless of age, were determined under procedures established by the state to be permanently institutionalized.

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Rangoon78's picture
Submitted by Rangoon78 on

A lawer sowcializing in this:

Prior to 1993, Medi-Cal could assert an estate recovery claim against only an estate subject to probate in the courts. Back then, a revocable trust or a joint tenancy deed was enough to defeat a Medi-Cal estate claim. In October 1993 the federal government enacted new laws that extended Medi-Cal estate claims to an "expanded estate" including assets held in joint tenancy or in revocable trusts.http://www.lentillem.com/columns/2013/2/19/column-of-the-week-medi-cal-e...

splashy9's picture
Submitted by splashy9 on

The key thing here is that states are "allowed" to do this.

Which states are more likely to do it? The more liberal states, or the more conservative states, considering that those that get Medicaid are on the low end of income?

I'm thinking the conservative ones are more likely to do it, because they pretty much always side with taking from the lower income people as much as possible, while the more liberal ones are more likely to think that's wrong to do.

Single payer is a better deal.

"A little knowledge is a dangerous thing. So is a lot." - Albert Einstein

Alexa's picture
Submitted by Alexa on

programs--the state of Oregon supposedly was the "model" for the Clinton-era MERP revisions.

I believe that this is contained in Hipp's excerpts.

Actually, many conservative Repubs and Dems voted against the revision to lower the age to 55 and up. Here's an excerpt from Hipp's post:

thank you democrats!

Legislative history[edit]

Ultimately every Republican in Congress voted against the bill, as did a number of Democrats. Vice President Al Gore broke a tie in the Senate on both the Senate bill and the conference report.

The House bill passed 219-213 on Thursday, May 27, 1993.[1] The House passed the conference report on Thursday, August 5, 1993, by a vote of 218 to 216 (217 Democrats and 1 independent (Sanders (I-VT)) voting in favor; 41 Democrats and 175 Republicans voting against).[2] The Senate passed the conference report on the last day before their month's vacation, on Friday, August 6, 1993, by a vote of 51 to 50 (50 Democrats plus Vice President Gore voting in favor, 6 Democrats (Lautenberg (D-NJ), Bryan (D-NV), Nunn (D-GA), Johnston (D-LA), Boren (D-OK), and Shelby (D-AL) now (R-AL)) and 44 Republicans voting against).

President Clinton signed the bill on August 10, 1993.

Note that all the House Dems that voted against the bill are "fiscal conservatives" (either Blue Dog or corporatist). Guess this make one of the VERY few times that I would come down on the same side as them, on an economic policy. ;-)

Apologize in advance for typos. This laptop is giving me fits.

Does anyone have a clue how to make the url address bar "show up" in IE?

Can't find it in "help" or via search engine (so far)!

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Alexa's picture
Submitted by Alexa on

From this website: U.S. Department of Health and Human Services, Medicaid Estate Recovery Collections.

COLLECTIONS BY STATE

Amounts collected by individual states are show in Table 1 and Table 2 below. Collections resulting from estate recovery activities vary widely from state to state, and changes in the amounts collected by individual states over time are highly irregular.

2004 High and Low State Collection Rates

•The three states that recouped the largest share of their nursing home spending are Arizona (10.4%),* Oregon (5.8%), and Idaho (4.5%).

•Five additional states recouped >2.0% of nursing home spending: Iowa (2.9%), Minnesota (2.8%), Wyoming (2.7%), Maine (2.5%), and Massachusetts (2.0%).

•Three states reported minimal recoveries (rounding out to 0%): Louisiana, New Mexico, and Utah.

[Note: Two are ultra-conservative states.]

•Four states did not report any estate recoveries: Alaska, Georgia, Michigan, and Texas.

[Three either conservative or libertarian-leaning (Alaska).]

* Arizona's estate recovery collections, as a percentage of nursing home spending, are not comparable to any other state because comprehensive prepaid managed care contracts dominate that state's Medicaid program. Nursing home care provided under these contracts is not identified separately for reporting purposes.

Most of the higher recovery states have more mature programs and long experience with estate recovery.

Changes in Collection Rates Between 2002 and 2004*

•National collections rose by over $40 million (12.4%).

•State-specific changes in collections were roughly similar to the average change nationally in only four states: California, Massachusetts, New York and South Dakota

Though their rates of increase were close to the national average (12-13%), the increases in funds they collected comprised nearly one-third (30.1%) of the total increase in national collections. Similarly, their share of total collections in 2004 was just under one-third (30.0%)
.
•All other state collections between 2002 and 2004 departed significantly from the national average.

•Thirty-five states increased their collections between 2002 and 2004. The five states with the highest percent increases were Kentucky (184.7%), Louisiana (100.0%), New Mexico (100.0%), Wyoming (90.8%), and Tennessee (85.1%).

•Twelve states collected less in 2004 than in 2002. The five with the largest percent decreases were: Utah (-97.7%), Pennsylvania (-74.7%), West Virginia (-64.6%), Nevada (-64.3%) and Mississippi (-57.4%).

•Factors explaining volatile rates of change within a given state over time are speculative and include: programs in early and unsettled states of implementation; gains or declines in a small number of relatively large estates (which can have disproportionate effects on rates of change, especially in smaller states); and errors or inconsistencies in reporting.
* See Table 1, Table 2, and Table 3.

Hope someone can find a more recent article regarding MERP "recovery rates."

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Alexa's picture
Submitted by Alexa on

I can activate (for lack of better word) some toolbars, but can't find anything at all about how to copy and paste the urls.

I actually can see the url address at the top of the IE Browser, BUT for some reason, I am unable to highlight and then do to "Copy" under "Edit"--so, I cannot copy and paste a link.

Can't imagine what step I'm leaving out!

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Alexa's picture
Submitted by Alexa on

I tried both your resources.

The "Copy and Paste Files" option was already selected.

I had to use the Control + C shortcut, in order to "copy the url."

Thanks SO MUCH!

So, for DCblogger:

Warner Amendment

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Alexa's picture
Submitted by Alexa on

Deception," the OBRA statute is the established "law" for MERP.

I'm sorry that I cannot link to the piece. It easily "Bings" up by its title, though.

It's approximately 30 pages--well worth reading

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Alexa's picture
Submitted by Alexa on

on this issue.

He proposed an amendment in March 2013 to either repeal, or drastically scale back the "death tax" (estate tax), in a fiscally-neutral way.

I've posted his amendment at several blogs (don't remember if I did here). Again, can't post links for now.

Why there was not outcry over this, don't know. Passed by a vote of 97-0 (as I recall).

Yeah--they're really looking out for "the little guy!"

This vote was taken the same day that Sanders proposed exempting "VA Disability" from the Chained CPI. I was researching that vote, when I found the Warner amendment at Thomas.

Funny how the one "voice vote" amendment that Sanders proposed made headlines--but nary a peep about Warner's roll call vote amendment, that passed overwhelmingly.

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Alexa's picture
Submitted by Alexa on

Sorry--obviously got THAT confused! Can't do links until I get my own computer back. But you should be able to find the roll call vote, bill, etc., at Thomas.

Here's a blurb about the Warner Amendment. Sorry that IE won't allow me to post a link.

Amendment to Repeal or Reduce Estate Taxes

S. Amendment 693 presented to S. Con. Res. 8 and introduced by Sen. Mark R. Warner, D-Va., establishes a deficit-neutral reserve fund relating to the reduction or repeal of the estate tax, accomplished in a fiscally responsible manner. The legislation presented to S. Con. Res. 8 would not increase the deficit within the 10-year period ending in 2023.

See Warner, Mark R., Warner Amendment Would Repeal or Reduce Estate Tax, 2013 TNT 58-40 Taxanalysts.com (March 22, 2013).

Posted by Anne E. Brown, Esq., Associate Editor, Wealth Strategies Journal

Roll Call Vote on Warner #693 (estate tax); Mar 22, ’13 8:34 PM

8:33pm The Senate began a roll call vote on Warner amendment #693 (estate tax); Agreed to: 80-19 (Yea/Nay).

Bill Summary & Status
113th Congress (2013 - 2014)
S.AMDT.693

S.AMDT.693
Amends: S.CON.RES.8
Sponsor: Sen Warner, Mark R. [VA] (submitted 3/22/2013) (proposed 3/22/2013)

AMENDMENT PURPOSE: To repeal or reduce the estate tax, but only if done in a fiscally responsible way.

TEXT OF AMENDMENT AS SUBMITTED: CR S2367

STATUS:

3/22/2013: Amendment SA 693 proposed by Senator Murray for Senator Warner. (consideration: CR S2283-2292; text: CR S2283)

3/22/2013: Amendment SA 693 agreed to in Senate by Yea-Nay Vote. 80 - 19. Record Vote Number: 66.

Hope this helps. We're under severe storm warnings until midnight, and have lost electricity twice, so I'm making this short.

Go to "Thomas" for the actual amendment--it was VERY short. And you can get the "roll call" vote there.

This was passed the same day that Sanders got a resolution passed (by voice vote) to exempt military disability (VA) from the Chained CPI.

What galls me is that that the Sanders Amendment made the "front page" of DKos and many progressive blogs, but had I not been trying to check out details of that, I would not have seen anything about the Warner amendment (SA 693).

Sorry that I got the "vote" so confused. I haven't read this amendment in almost three months. Should have checked it out first. ;-)

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Rainbow Girl's picture
Submitted by Rainbow Girl on

Big of Bernie to seek a carve out for VA disability as opposed to a carve out for *everyone* affected potentially by CPI.

What a worm of a socialist.

(Sorry to jump in on this side issue, but I hadn't known about this particular "intervention" by Not-the-Second-Coming-of-Eugene-V-Debs Bernie Sanders. Worm.)

Rainbow Girl's picture
Submitted by Rainbow Girl on

Alexa -- thank you for the very illuminating juxtaposition of the wholeharted Democratic support to grab the estates of needy citizens who received assistance from Medicaid and equally wholehearted Democratic support for nixing an inheritance tax that would hurt the Rich People Who Pay for Democratic Congressional Service.

This is so outrageous. Even more outrageous is that it appears here at Corrente, thanks to you, but No. Where. Else.

This is a scandal that should be plastered all over every Obot "Progresso" DLC website across the interwebs.

chezmadame's picture
Submitted by chezmadame on

I'm confused about who determines what's recoverable. Is it up to individual states?

(B) In the case of an individual who was 55 years of age or older when the individual received such medical assistance,the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of—
(i) nursing facility services, home and community-based services, and related hospital and prescription drug services,
OR
(ii) at the option of the State, any items or services under the State plan (but not including medical assistance for medicare cost-sharing or for benefits described in section 1902(a)(10)(E)).

Alexa's picture
Submitted by Alexa on

BEFORE the ACA, wasn't the MERP implemented by the states, following "federal guidelines?"

Just as the Medicaid program itself, sounds like the states had some "leeway" in the actual implementation, even though under President Clinton the MERP program was "tightened up," and the MERP was extended to those Medicaid beneficiaries age 55 and older.

I would think that the "Medicaid Expansion" called for in the ACA, will most likely serve to cause some states to "beef up" their recovery programs.

BTW, received a Tweet regarding Mississippi's inability to find insurers to offer ANY insurance in scores of "counties"--the poorest in the state. And, this state also isn't offering expanded Medicaid. If anyone is anxious to read this, I believe that it was from Kaiser Health News.

HHS refused to discuss this issue, or similar circumstances in other states, according to the article. Don't know how to post a link in IE. Will try to relocate and post this Tweet when I get my computer and Firefox.

What a debacle. I've heard many Democratic callers to C-Span who clearly think that they are going to get "free healthcare" when the ACA is implemented.

I believe that the "blowback" at the election polls will be unlike anything we've seen in years.

And I suspect that more than a few of the voters who reportedly waited 7 to 8 hours in line, to vote in 2012, did so because of their belief in this program, and their desperate need for health insurance.

What a rude awakening 2014 will be for them!

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Rainbow Girl's picture
Submitted by Rainbow Girl on

The text of the quoted 1993 OBRA law expanding the estates subject to Medicaid recovery actions (thanks Clinton, Bernie Sanders, & Democratic Company) doesn't say anything about lowering the age to 55. So was the age lowered to 55 in this 1993 OBRA law or was it lowered in Obama's ACA? Anybody know?

Submitted by hipparchia on

i did finally find the full report in one piece: http://aspe.dhhs.gov/daltcp/reports/estaterec.pdf

when medicaid was first enacted:

Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child. Twelve states report having had an estate recovery program in effect before 1990 that was based on the original Medicaid law.

obra 1993:

Recoveries may only be made from the estates of deceased recipients who were 55 or older when they received Medicaid benefits or who, regardless of age, were permanently institutionalized.

that report is dated april 2005, so no you can't blame obama for this one.

when the federal govt first began requiring states to pursue estate recovery, enforcement was lax and michigan was the last holdout, not getting their merp plan approved until 2011! from http://dolorescoulterlaw.com/Brochures/Doc%20Files/Medicaid%20Estate%20R...

In 1993 Congress amended Title XIX of the Social Security Act to require every state that receives federal Medicaid funding (and all states do so) to implement an estate recovery program. 42 USC 1396p(b). The amendment was part of the Omnibus Budget and Reconciliation Act (OBRA 93), PL 103-66, Section 13612. Prior to the 1993 amendment estate recovery was an optional component of a state’s Medicaid program. OBRA 93 specified certain minimum requirements for an estate recovery program, but also gave the states some options to expand the scope of its estate recovery program beyond the minimum requirements. Despite the change in the law, the federal agency that administers the Medicaid program, formerly the Health Care Financing Administration, now the Centers for Medicare and Medicaid (CMS), did not vigorously enforce the requirement. As of January, 2007, every state except Michigan had adopted an estate recovery program. On August 24, 2007 CMS sent a letter, to the Department of Community Health (DCH) giving the state until September 30, 2007 to enact necessary legislation to implement an estate recovery program or face monetary sanctions. On September 30, 2007 Governor Granholm signed PA 74, amending the Social Welfare Act. MCL 400.112g – 400.112k.

hatismom's picture
Submitted by hatismom on

I am just getting involved in this conversation.........and I am wondering who else out there is now facing the Estate Recovery rules. I have communicated, and continue to communicate with our legislators on this subject. I live in Washington State. I honestly wonder if anything can be changed (however Oregon appears to have corrected the 55-64 issue?) My husband and I have signed up for Medicaid, as we do not qualify for any subsidies until we figure out how to add to our countable income. What awful discrimination against people 55-64. Why not 45-54 year olds? Either everyone under 65 is affected by the Estate Recovery or no one. I have been trying to find someone to talk to at the Washington State Health Care Authority to find our actual $$ amounts they will be "keeping track of"......yeah, right....good luck with that. We have 3 options......1) forced onto Medicaid, 2) buy our own coverage......we are 59 and 60, and the premiums easily exceed $1500/month for the two of us, or 3) opt out completely, and pay the fines. My husband has some health issues so for the near term we are choosing Medicaid. We may be able to figure out how to increase our income, but it will take some months. Anything under $21,500 (ish) forces us onto Medicaid. We live in an area that is VERY rural.....good luck finding jobs in our age group to add to the bottom line at this point, when unemployment is pretty awful in our area. I am not whining, mind you....I just hope everyone out there is fully aware of the laws, and is willing to communicate with your legislators. How come just this one age group is being held "accountable"? One reason we went ahead with this, even for a few weeks, is to see the "welcome package" we receive from the State....and the managed care group who will be in charge of our "managed care".

Alexa's picture
Submitted by Alexa on

one of the most aggressive MERPs (along with Oregon and Minnesota, IIRC).

It's sort of ironic that some of the most liberal states have traditionally had some of the most "broad" Medicaid estate recovery laws, although from what I've read, with the implementation of the ACA, many states are now expanding their laws.

I've read that one is supposed to be advised of the ramifications of this program? Were you?

If not, I'd insist that I receive some information on the terms of it.

If you were to post either a brief blog or Quick Hit, other commenters would have "a place" to easier share information with you. In the meantime, we can post comments to your attention, which is a little less convenient to track.

Again, gook luck. Personally, I'd be "on the horn" getting some rules and regulations about their program, tomorrow morning.

Have you seen this link?.

Washington State MERP

(Hopefully, there is a better website than this one!)

Alexa

“If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

[Avatar Photo Credit: Conflagrate, jurvetson's photostream, flickr]

Submitted by lambert on

But if you really want help/feedback/comments, the best way to donthat is to write a blog post. Click blog on the top menu.

Comments drop off the screen pretty quickly

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi