The Good Part of Medicaid
Originally, Medicaid filled the gap if Americans could not afford healthcare insurance.
Today, Medicaid is filling the gap if people lost income and/or healthcare insurance during the pandemic. If below FPL or 138% FPL, people qualify for Medicaid. Others who were already in the ACA healthcare exchanges qualify for larger subsidies. Those not qualified for either were left stranded by president trump. in 2020
Newly elected President Biden is creating an opportunity for those not qualifying for Medicaid and lost their insurance to enroll in the ACA. Biden will open up healthcare exchanges so those who lost their jobs can enroll in new healthcare plans.
Meanwhile, Medicaid enrollment increased ~4 million from February 2020 due to Covid.
What Happens if You are 55 and Using Medicaid
First, lets answer a question. “Does the Affordable Care Act allow states to confiscate the estates of seniors on Medicaid when they die?”
The opponents of the ACA coined a commentary taking things out of context and citing, The Affordable Care Act confiscates the estates of seniors who were on Medicaid when they die.
History has it that all states had an option since Medicaid began in 1965 to recover some Medicaid costs from recipients after they died as Health and Human Services explained in a 2005 policy brief.
– In 1965, it was optional and states could only recoup Medicaid costs spent on those 65 years or older.
– It changed in 1993, when Congress passed the Omnibus Budget Reconciliation Act of 1993 budget bill requiring states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older.
The 1993 Omnibus Budget Reconciliation Act also gave states the option to recover all other Medicaid expenses.
Participants or Beneficiaries Eligible For Medicaid Benefits H. R. 2264-63
‘‘(3) ACQUISITION BY STATES OF RIGHTS OF THIRD PARTIES.— A group health plan shall provide that, to the extent that payment has been made under a State plan for medical assistance approved under title XIX of the Social Security Act in any case in which a group health plan has a legal liability to make payment for items or services constituting such assistance, payment for benefits under the plan will be made in accordance with any State law which provides that the State has acquired the rights with respect to a participant to such payment for such items or services.”
Now Comes The ACA
The ACA expanded Medicaid to include nearly all non-disabled adults under age 65 with household incomes “up to 138% FPL ($36,570 for a family of four in 2021 and $17,740 for a single person), which would make millions of currently uninsured adults newly eligible for the program,” the Kaiser Family Foundation says in 2012.
The ACA mandated the Medicaid expansion and later the U.S. Supreme Court ruled states can opt out. Thirty-nine states opted-in to the ACA. States which opted-out maintained Medicare at 100% FPL leaving those between 100% and 138% without healthcare insurance. The ACA rules require people must be on Medicaid if under 138% FPL
And Republicans would not work with the Obama administration on any bill to change the ACA in 2016.
Eliminates Assets Test from Eligibility Requirements
As the American Public Health Association explains,
Medicaid eligibility “is complicated, and varies from state to state. It involves calculations of income and assets, as well as ‘disregards’ of income and assets that vary for different populations.”
The ACA created an “additional set of rules” based on income, specifically Modified Adjusted Gross Income. “[I]mportantly, it doesn’t count assets,” says the APHA.
What Happens as A Result ?
The Omnibus Budget Reconciliation Act of 1993 requires states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older.
And those now under 138% FPL and eligible for Medicaid under the ACA expansion and not eligible for government subsidies to buy private insurance on state or federal health exchanges must accept Medicaid.
The Western Center for Journalism blog item says the individual mandate provision of the ACA will “force” people into Medicaid and then “strip” them of their assets after they die.
The Western Center for Journalism blog:
“ After this despicable plot was exposed by The Seattle Times, a number of states have vowed to change estate recovery rules as revised by ObamaCare.” (Again, the estate recovery rules were not “revised by Obamacare.”)
What Needs to Be Done?
Asset deductions for homes and or savings should be established for those below 138% FPL.