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This Question and Answer appears on the Medicaid website. Does this mean if I am 55 yrs and over and on medicaid , I will have to pay them back out of my estate when I die? Please help! I don't understand this.
Will there be a lien (legal claim) placed on my estate (my assets) when I die?
If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
For individuals who received Medicaid under a MAGI eligibility group, the estate recovery is limited to the amount Medicaid paid for the cost of nursing facility services, home and community-based services, and related hospital and prescription drug services received on or after the individual’s 55th birthday.
Yes. (There's another recent Medicaid thread about this with some incorrect answers.)
Quote:
State Medicaid programs must recover certain Medicaid benefits paid on behalf of a Medicaid enrollee. For individuals age 55 or older, states are required to seek recovery of payments from the individual's estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States have the option to recover payments for all other Medicaid services provided to these individuals, except Medicare cost-sharing paid on behalf of Medicare Savings Program beneficiaries.
This Question and Answer appears on the Medicaid website. Does this mean if I am 55 yrs and over and on medicaid , I will have to pay them back out of my estate when I die? Please help! I don't understand this.
Will there be a lien (legal claim) placed on my estate (my assets) when I die?
If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
For individuals who received Medicaid under a MAGI eligibility group, the estate recovery is limited to the amount Medicaid paid for the cost of nursing facility services, home and community-based services, and related hospital and prescription drug services received on or after the individual’s 55th birthday.
"In order to receive Medicaid, an individual who is disabled or over the age of sixty four, can, in 2017, have non-exempt resources of no more than $14,850. In New York, an exempt irrevocable funeral trust, in any amount necessary to pay for the services, may replace the previously allowable $1,500 burial fund. However, the spouse of an individual in a nursing home who remains in the community can retain significantly higher amounts of resources and still not affect the nursing home spouse’s Medicaid eligibility. The resource rules for a community spouse are discussed below in the section on “Treatment of Income and Resources of Institutionalized Spouse and Community Spouse.”
Since Medicaid is essentially a type of welfare benefit in past there have been "abuses" so things were tightened up to help put an end to same.
Basically the federal government via states wants to prevent those who can or could pay for healthcare services from hiding, spending down or otherwise diverting income thus making a person seem insolvent enough to qualify for "assistance", when they otherwise would not.
The laws strike a balance in allowing for a surviving spouse or dependent to be provided for but at some point depending upon assets/sums involved the state will want some or all monies paid back.
Usual scheme was for a family or even person to spend down, transfer, or whatever funds so they can qualify for Medicaid. This is because Medicare does not pay for everything and unless one has taken out Medicap coverage you'll have to pony up.
Some persons or families would rather or want to see the house and other assets/wealth a parent or whomever has pass onto heirs, so they hatch up a scheme....
There is also an issue of fairness. If someone is on Medicaid for however long, then at 89 hits the lottery, it is seen as "fair" to have to pay back some or all of the Medicaid funds received.
If you have any assets and or are expecting to get some in future, the best advice is to seek out qualified and competent legal advice regarding estate and financial planning.
like our tax system your fair share of taxes is whatever you can legally get them down to using the tools and laws left in place to be used . the long term care medicaid system operates the same way .
states do not want to just take away those tools . they could . they could make look back forever if they wanted or 10 years or 20 years .
they could dis-allow trusts , loans , etc .
but they don't want to .
there was a now very famous case in CT . a woman exercised her right of spousal refusal and medicaid sued for recovery .
in a landmark ruling the judge in the highest court in ct ruled that he does not want a state filled with impoverished seniors because we have a poor long term care system in this country . he did not want to impoverish the stay at home spouse and now have two people on public assistance .
so he ordered medicaid and mrs jones to reach an agreeable amount to pay for car without destroying setting mrs jones life .
ny , florida and ct courts have now adopted that stance . our elder law attorney ,who is one of ny's most popular in that field told us he has almost no law suits . he is doing almost all negotiation .
ny state even went so far as to put a special version of medicaid in place called extended medicaid .
that version is coupled together with a ny state long term care partnership plan , which we have .
we took total asset protection , which means we took only 3 years insurance for a nursing home or it covers 6 years in home care or assisted living and then once the insurance is up we just send medicaid the bills . we just have to make sure that wherever we go on insurance will take medicaid once coverage ends .
all assets are exempt and have no look back . income limitations for the stay at home spouse are unlimited too , unlike regular medicaid .
we took the plan just for the perks , the 3 years coverage was really a moot point since we could cover that on our own . but those perks are worth taking the partnership plan for
This Question and Answer appears on the Medicaid website. Does this mean if I am 55 yrs and over and on medicaid , I will have to pay them back out of my estate when I die? Please help! I don't understand this.
Will there be a lien (legal claim) placed on my estate (my assets) when I die?
If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
For individuals who received Medicaid under a MAGI eligibility group, the estate recovery is limited to the amount Medicaid paid for the cost of nursing facility services, home and community-based services, and related hospital and prescription drug services received on or after the individual’s 55th birthday.
there are two forms of medicaid .
one form acts as medical insurance , ny we have expended medicaid for this purpose - there is no payback ,asset shifting or look backs . you qualify only by income regardless of assets .
I wouldn't be surprised if the "tools" which allow people of means to avoid payback are revised by many states, especially as federal discretionary funds are reduced. We'll just have to wait and see I guess.
states like ny, ct and florida are moving the other way . they realize that spouses who are impoverished will end up on the welfare rolls too .
they prefer one to two . they have been making it harder for medicaid to collect and with their partnership plans easier for those with resources to protect them and have medicaid pay all the bills .
we grabbed a policy for that reason . it is a great agreement with the state . .
one form acts as medical insurance , ny we have expended medicaid for this purpose - there is no payback ,asset shifting or look backs . you qualify only by income regardless of assets .
the other form is medicaid for long term care and that has income and asset limitations , as well as look backs , recovery , etc .
We discussed this on another thread but you are repeating incorrect information saying there is no payback for expanded Medicaid under ACA. That is not true.
An old law may create a headache for some of the 11 million Americans who gained health coverage through the Affordable Care Act's (ACA) Medicaid expansion.
The estate recovery law allows states to recover Medicaid costs for patients who are older than 55 when they die, although some limits apply, such as exceptions for the disabled and hardship exemptions for survivors. The law is taking some newly enrolled Medicaid patients by surprise, but it's also prompting a few states to push back on the practice, according to The Wall Street Journal.
One couple, Ruth and Rod Morgan, told the news magazine they had heard about the estate recovery act and asked about it when they signed up in California's Medicaid program, but they were told that it wasn't the case.
"And then weeks later, we got a letter in the mail saying, congratulations, congratulations! You qualified for Medi-Cal. And then on the back page, this little paragraph says that you are subject to estate recovery, and do not contact your social worker about this," Ruth Morgan told NewsHour.
i talked about the over age 55 exception in the other thread . it is likely a moot point since except for retirees with substantial assets the poor on medicaid will likely have no assets to worry about .it was put in place to give recourse to retirees who retire and live off cash so they can get medicaid until they are old enough for medicare. it is such a small segment of the population this over 55 rule apply's to as to be much ado about nothing.
it makes for wonderful political news but that is about it .
Last edited by mathjak107; 03-19-2017 at 02:29 AM..
i talked about the over age 55 exception in the other thread . it is likely a moot point since except for retirees with substantial assets the poor on medicaid will likely have no assets to worry about .it was put in place to give recourse to retirees who retire and live off cash so they can get medicaid until they are old enough for medicare. it is such a small segment of the population this over 55 rule apply's to as to be much ado about nothing.
it makes for wonderful political news but that is about it .
It's not a moot point since the OP of this thread is worried that Medicaid will try to get money out of his estate after his death. He obviously has assets. That's his concern. I quote the OP:
Quote:
This Question and Answer appears on the Medicaid website. Does this mean if I am 55 yrs and over and on medicaid , I will have to pay them back out of my estate when I die? Please help! I don't understand this.
Will there be a lien (legal claim) placed on my estate (my assets) when I die?
It is also not "much ado about nothing" if you are over 55 and forced into Medicaid by the government and thus have the threat that a lien will be placed on your assets after you die.
It also wasn't put in place "to give recourse to retirees who retire and live off cash so they can get Medicaid until they are old enough for Medicare". The law was put in place in 1993 long before expanded Medicaid. Until ACA, if you had enough cash assets to live off of for multiple years you would NOT have qualified for Medicaid. The law was never changed for ACA so it applies to the situation you described but it was not implemented over 20 years ago in anticipation of Obamacare.
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