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Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death
As thousands of state residents enroll in Washington’s expanded Medicaid program, many will be surprised at fine print: After you’re dead, your estate can be billed for ordinary health-care expenses. State officials are scrambling to change the rule.
By Carol M. Ostrom
Seattle Times health reporter
Sofia Prins and Gary Balhorn, both 62, decided to marry so they wouldn’t have to get health insurance individually through Medicaid, which could bill their estates after death. The Port Townsend couple’s joint income is too high for Medicaid but low enough for tax credits.
It wasn’t the moonlight, holiday-season euphoria or family pressure that made Sofia 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.
With an estimated 223,000 adults seeking health insurance headed toward Washington’s expanded Medicaid program over the next three years, the state’s estate-recovery rules, which allow collection of nearly all medical expenses, have come under fire.
Medicaid, in keeping with federal policy, has long tapped into estates. But because most low-income adults without disabilities could not qualify for typical medical coverage through Medicaid, recovery primarily involved expenses for nursing homes and other long-term care.
The federal Affordable Care Act (ACA) changed that. Now many more low-income residents will qualify for Medicaid, called Apple Health in Washington state.
But if they qualify for Medicaid, they’re not eligible for tax credits to subsidize a private health plan under the ACA, which requires all adults to have health insurance by March 31.
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.
“We’re happy to be getting married,†Prins said last week. “Unfortunately not everyone has such an elegant solution to the problem.â€
For Washington state, the solution has been much more complicated.
As thousands of state residents enroll in Washington’s expanded Medicaid program, many will be surprised at fine print: After you’re dead, your estate can be billed for ordinary health-care expenses. State officials are scrambling to change the rule.
By Carol M. Ostrom
Seattle Times health reporter
Sofia Prins and Gary Balhorn, both 62, decided to marry so they wouldn’t have to get health insurance individually through Medicaid, which could bill their estates after death. The Port Townsend couple’s joint income is too high for Medicaid but low enough for tax credits.
It wasn’t the moonlight, holiday-season euphoria or family pressure that made Sofia 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.
With an estimated 223,000 adults seeking health insurance headed toward Washington’s expanded Medicaid program over the next three years, the state’s estate-recovery rules, which allow collection of nearly all medical expenses, have come under fire.
Medicaid, in keeping with federal policy, has long tapped into estates. But because most low-income adults without disabilities could not qualify for typical medical coverage through Medicaid, recovery primarily involved expenses for nursing homes and other long-term care.
The federal Affordable Care Act (ACA) changed that. Now many more low-income residents will qualify for Medicaid, called Apple Health in Washington state.
But if they qualify for Medicaid, they’re not eligible for tax credits to subsidize a private health plan under the ACA, which requires all adults to have health insurance by March 31.
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.
“We’re happy to be getting married,†Prins said last week. “Unfortunately not everyone has such an elegant solution to the problem.â€
For Washington state, the solution has been much more complicated.
http://http://seattletimes.com/html/...coveryxml.html
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