Politics blog

State files emergency rule to shield new Medicaid enrollees from payback claims

OlympianDecember 31, 2013 

The Washington state Health Care Authority has filed an emergency rule that takes effect New Year’s Day and makes it clearer that the government won’t be going after the estates of new Medicaid enrollees for reimbursement of ordinary medical costs. 

Obamacare expanded eligibility for Medicaid to include childless adults who are not disabled. Some new enrollees had been worried by language in the fine print of their Medicaid enrollments, which indicated that they could be on the hook for reimbursement of Medicaid costs from their estates once they die.

There was anecdotal evidence this led some consumers to reject or reconsider coverage.

“I do believe we solved the problem for folks – it should address their concerns,’’ state Medicaid director MaryAnne Lindeblad said in an interview.

The language in the Medicaid rules dated back to 2004 and was written in the context of a time when childless adults under age 55 and who were not disabled were not able to qualify for Medicaid to cover ordinary medical costs.

The emergency rule was filed Monday with an intention for it to take effect immediately on Jan. 1, which is when expanded Medicaid coverage takes effect.

In a parallel move, Lindeblad said the state also is preparing to file for a clarifying change – retroactive to Jan. 1, 2014 – in its agreement with the Centers for Medicare & Medicaid Services that governs the state’s delivery of Medicaid services.

Lindeblad said the rule and law changes won’t bar the state from seeking reimbursement or recovery of long-term care costs from the estates of couples older than 55 who qualify for Medicaid. Such recoveries have been a long time state practice for nursing care – as well as a requirement of federal law. Lindeblad estimated long-term care recoveries were in excess of $20 million in 2012.

The new rule does deal with any unintended effect of the new Affordable Care Act, which had led some consumers to believe the state could also come after their estates after their deaths to recoup the costs of Medicaid coverage and other ordinary medical costs.

The Seattle Times reported earlier in December about the worry of some consumers, including a Port Townsend couple that married recently in order to boost their joint income and qualify for tax credits on private-sector health insurance. As individuals the couple earned too little to qualify for tax credits and would have been pushed into Medicaid, which they feared could go after their estates for the cost of Medicaid coverage.

That wasn’t the state’s intent. 

“If we had not made the change, it would have left the door open,’’ Lindeblad said.  “I hope that it clarifies and addresses the concerns of individuals. It should. Because the existing administrative code would have required us to at least look at expenses that are not necessarily long term care related.’’

Karen Rotter, a Rochester resident newly signed up for Medicaid, said she is feeling more comfortable about it now that the state appears to be making good on a promise made earlier in December to change the rules.

Rotter said she had gone to the health exchange to sign up for subsidized private insurance. But because her husband had lost his job they earned too little to qualify for tax credits and a private plan, so they were pushed into Medicaid.

And then she learned of language in the Medicaid agreement's fine print that could have allowed the state to recover from her and Dan Rotter’s estate – mainly a home along the Black River that they want to leave to their children.

“I felt deceived,’’ Rotter said of the contract's payback language. But after reconsidering her sign-up, she learned Lindeblad and Gov. Jay Inslee's staffers were all talking about changing the state law. 

“I’m feeling more confident now,” Rotter said Tuesday, having finally seen a copy of the emergency rule. Rotter, 61, said she and her husband had already made the decision, based on the Inslee administration's past statements, that they would “take our chances with it.”

“If this had the asset recovery on it we wouldn’t have done it,’’ Rotter said. “We wouldn’t put our children’s inheritance in jeopardy.’’

After all is said and done, though, Rotter said she is amazed that no one in state government caught that the language of the state’s long-standing Medicaid rules would have allowed broader recoveries. 

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