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....