There is much justified discussion going on in New Hampshire within the Expanded Medicaid debate. For quite a while, the Democratic majority of the House has tried its best to bring Medicaid Expansion into the Granite State. After a long and heated debate, the NH House recently voted to support Medicaid Expansion. The Senate will be next to take up this issue in 2014.
It is important to understand with Medicaid Expansion, you do not have to qualify by being disabled AND financially impoverished as with original Medicaid. Having an approximate income under $35,000 for family of four will put you on the rolls. The question to ask is this: if someone is able to work, would this change in Medicaid, discourage them from looking for employment? It is a viable question – “free” is hard to beat. Medicaid was originally intended as a safety net for those who were unable to work AND poor. This new definition will be a huge challenge for healthcare in any state which joins the expansion.
However, there is another reason to be cautious with Medicaid Expansion. In 1993, Congress passed an omnibus budget bill that required states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older. The 1993 federal law also gave states the option to recover all other Medicaid expenses. While the Affordable Care Act (Obamacare) did nothing to change existing federal law, it did expand the number of people who are eligible for Medicaid by dropping the two criteria. Hence, there will be many more people on Medicaid between the ages of 55 and 65, and, therefore, potentially more estates on the hook for Medicaid expenses after the beneficiary passes. This little caveat is called the Estate Recovery Program. This means that once a person dies, the government can seek 100% reimbursement from the person’s estate for all the services the person received while they were on the program. This is similar to a reverse mortgage; however, the government is the beneficiary. Medicaid can put a lien on your home while you are still living, then when the home is put up for sale, Medicaid will seek reimbursement from the proceeds. Now, there are a few exceptions to this. Medicaid won’t seek reimbursement if a spouse is still living in the home after the person dies, if there is a child under the age of 21 living in the home, or a disabled child.
Remember, with this new expansion, newly eligible people between the ages of 55-65 only have to pass an income level test. Other assets will not be taken into account. For example, new retirees who may have a low “income” could still have significant assets. They may own a home(s), or have annuities or other financial resources. However, they will still be eligible for Medicaid. Was this what Medicaid was intended for? And with the Estate Recovery Program in play, do people really understand what this may mean for them?
I am not so sure. Folks should check into all this information before choosing to move toward Medicaid Expansion. Do we really want NH to be part of this federal insurance program, especially since it has not been clearly defined for our citizens? Other states have signed on – why don’t we wait to see how that works out for them before making it law in NH. Sometimes, it is important to watch and wait. This, in my opinion, is one of those times.
