OMG- Medicaid Estate Recovery

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    Aug 16, 2016 7:31 PM GMT
    It pisses me off that my grandparents, our family legacy and heirs, could lose everything because the US governments Medicaid program tries to 'recover medical costs' by seizing property thru probate court, maybe this should be a part of Medicaid's restructuring? Whatever you do older gay men, stay away from probate court if you want to keep your estate in tact. Obviously my grandparents didn't plan well, didn't understand this law, knew of ways to avoid probate court and that the state government could take advantage of old people like this. These Medicaid, Medicare programs are under the old paradigm, an overhaul is needed if medical care cant be "free" to those who need it, such as the elderly, without having to exchange property for medical care, this is complete bullshit icon_evil.gif




    Medicaid Estate Recovery
    https://aspe.hhs.gov/basic-report/medicaid-estate-recovery

    Medicaid imposes stringent limits on income and assets of recipients, consistent with its mission to provide a health care safety net for the poor and for those whose personal resources are insufficient to pay the full cost of care. In order to fulfill this mission, Medicaid also recovers expenses paid on behalf of recipients from their estates under certain circumstances. Medicaid is the largest source of funds for institutional long-term care expenses. It pays nearly half of the total amount spent on nursing homes, followed, respectively, by out-of-pocket funds of long-term care consumers, Medicare, private long-term care insurance, and other public and private funding sources.1

    Unless they are among the minority who have long-term care insurance, individuals contemplating paying thousands of dollars out-of-pocket every month for long-term nursing home care face the possibility of exhausting all available assets and using up their lifetime savings before being able to qualify for Medicaid. Not surprisingly, a web search on Medicaid estate planning yields thousands of results offering advice on a variety of strategies to qualify for Medicaid while preserving assets and savings for heirs

    Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child. Twelve states report having had an estate recovery program in effect before 1990 that was based on the original Medicaid law.2 While some of the features of these early programs have been documented, their scope and impact on Medicaid recipients, especially as compared to states without such programs, have not.3

    The 1965 Medicaid law also gave states permission to impose liens on property in the estates of deceased Medicaid recipients. Post-death liens prevent the estate from being settled and the property distributed to the recipients heirs before all claims against it, including Medicaids, are satisfied.

    Fueled by well-publicized and well-researched reports claiming that, Estate recovery programs provide a cost effective way to offset state and Federal costs, while promoting more equitable treatment of Medicaid recipients,4 Congress included a provision in the Omnibus Budget Reconciliation Act of 1993 (OBRA 93)5 that required states to implement a Medicaid estate recovery program
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    Aug 16, 2016 7:39 PM GMT
    Wouldn't grandparents be covered under Medicare, due to their ages? Not Medicaid? I'm puzzled.
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    Aug 16, 2016 7:47 PM GMT
    Art_Deco saidWouldn't grandparents be covered under Medicare, due to their ages? Not Medicaid? I'm puzzled.


    Not if your grandparents or sibling taking care of them couldn't afford the Medicare/Medical insurance premiums
    Medicaid is not insurance

    Suicide is probably the better option rather than giving up your hard earned assets to pay for the natural aging process icon_confused.gif



    The main features of the OBRA 93 Medicaid estate recovery mandate are
    States must pursue recovering costs for medical assistance consisting of:
    •Nursing home or other long-term institutional services;
    •Home- and community-based services;
    •Hospital and prescription drug services provided while the recipient was receiving nursing facility or home- and community-based services; and
    •At State option, any other items covered by the Medicaid State Plan.

    At a minimum, states must recover from assets that pass through probate (which is governed by state law). At a maximum, states may recover any assets of the deceased recipient


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    Aug 16, 2016 7:54 PM GMT
    There is no premiums for Medicare unless they are paying Medigap. There is no premiums for Medicaid because that is for poor people who have not reach eligibility for Medicare.

    Your family did not plan this well. They need to talk to a social Security lawyer.
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    Aug 16, 2016 8:09 PM GMT
    Medicare is essentially a companion to Social Security, when you reach that age. Medicaid is primarily for low income younger people not eligible for Social Security, who qualify for assistance.

    Social Security is actually a government insurance program we pay into with our paychecks, not welfare. That becomes payable when we reach retirement age. We EARN Social Security, it's no gift or charity. The benefit amounts scaled to income earned during our lifetimes.
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    Aug 16, 2016 8:10 PM GMT
    woodsmen saidThere is no premiums for Medicare unless they are paying Medigap. There is no premiums for Medicaid because that is for poor people who have not reach eligibility for Medicare.

    Your family did not plan this well. They need to talk to a social Security lawyer.


    My grandmother never 'earned an income' and was not eligible for SS, she was collecting on my deceased grandfathers SS and or pension which wasn't enough to cover nursing home, I suppose she herself didn't qualify for Medicare


    Is Medicare free?

    Most Medicare beneficiaries will pay $104.90 in 2015 for the Part B premium. Some people may pay more if their income is above a certain amount. If you are receiving Social Security, Railroad Retirement Board, or federal retirement benefits, your Part B premium will be deducted directly from your monthly benefit.




    PROS AND CONS OF ESTATE RECOVERY

    Proponents of more extensive and aggressive Medicaid estate recoveries argue that Medicaid is a chronically strapped program for the poor, and that estate recovery shifts some of the burden of paying for long-term care from the taxpayer to the estates of deceased recipients. States can then spend their share of recovered funds to preserve or expand their Medicaid coverage of services for needy populations,38 although they are not required to do so.

    Opponents of Medicaid recoveries argue that the practice is unfair in that it mainly affects people of very modest means, while sparing those who are able to access advice on estate planning techniques that shelter assets. Further, it clashes with broadly held cultural values on the sanctity of intergenerational legacies.39 Others argue that the threat of estate recovery causes people to forego Medicaid funded services when they need them or discourages adult children from seeking Medicaid for an ill parent, whose health or functional abilities may deteriorate as a result. This avoidable decline in health status may lead to higher medical costs later on.40

    CONCLUSION

    Retirement is increasingly financed by personal savings, as defined-benefit pension programs are replaced by defined-contribution programs such as IRA and 401(k) savings plans. For this reason, personal financial planning for retirement has become imperative, even for persons of very modest means. Greater life expectancy, combined with the prospect of declining abilities and possible future needs for high-cost long-term care,41 has made more and more people turn to financial planners for advice on how to make limited funds last for an uncertain duration. Further impetus for obtaining professional advance planning assistance is provided by the complex tax implications of financial decisions and the natural desire to leave a financial legacy to loved ones.

    As financial planning for retirement grows in extent and sophistication, more and more such plans will take into account the future possibility of needing to pay for long-term care. Good choices in estate planning require a clear and accurate understanding of the various options for financing long-term care services, including qualifying for Medicaid and accepting -- or avoiding -- the consequences of Medicaid estate recovery.42 However, if a better understanding of Medicaid rules results in more people sheltering more assets and increased dependence on this taxpayer-funded program, then Medicaid -- a perennial and major budget concern for state and Federal governments -- will inevitably pay an ever increasing share of the nations long-term care costs
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    Aug 16, 2016 8:14 PM GMT
    Art_Deco saidMedicare is essentially a companion to Social Security, when you reach that age. Medicaid is primarily for low income younger people not eligible for Social Security.

    Social Security is actually a government insurance program we pay into with our paychecks, not welfare. That becomes payable when we reach retirement age. We EARN Social Security, it's no gift or charity. The benefit amounts scaled to income earned during our lifetimes.





    My grandmother never 'earned an income' and was not eligible for SS, she was collecting on my deceased grandfathers SS and or pension which wasn't enough to cover nursing home, I suppose she herself didn't qualify for Medicare, her only choice was Medicaid (or suicide)

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    Aug 16, 2016 10:22 PM GMT
    This is not really new - (except maybe for more vigorous enforcement requirements). It has been the law for a long time.

    Medicare has never paid for nursing home care. Medicaid, does, if one is poor enough by government standards, which means if one has few assets. Rules are different in different states). An elderly person can own a house, and still get medicaid to pay for nursing home care. But, Medicaid puts a lien on the house, and gets its money back when the person on medicaid dies. Most elderly people, if they anticipate having to go on Medicaid, give money or house away to children (IF they trust them - and unfortunately, many children cannot be trusted to day.) If one gives away the assets enough years before one goes on Medicaid, the assets are safe. If not, then Medicaid withholds payment under some formula, until the equivalent amount of given away assets are used up. It is useful to consult a lawyer who actually specializes in medicaid reimbursement planning - (There really is such a specialty).

    No free lunch for the almost poor in the USA - especially in healthcare. And Obamacare made it worse - putting people on Medicaid against their will, so their heirs will have this problem when they die, when they did not have the problem before.
  • metta

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    Aug 16, 2016 10:27 PM GMT
    In California, it is not Medicaid that provides long term care. It is MediCal that pays for it. I went to a social security office because my sisters wanted me to see about signing up my mom for it even though my mom always said that she did not want MediCal for that very reason. The very first sentence out of their mouth when I went in the office was they will come after her home/assets after she dies to get reimbursed for it. I didn't ask them...that was the first thing they said to me as I was sitting down. One of my sisters thinks that they are just saying that. I don't think so. I never signed her up. We are paying for her care out of pocket in her own home as she wanted.

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    Aug 16, 2016 10:29 PM GMT
    One thing that most people do not know about is that Medicare will pay for in-home care. So unless your grandmother's health is so debilitating that she needs to enter a nursing home, which I will never, there are alternatives.
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    Aug 17, 2016 1:06 AM GMT
    metta saidIn California, it is not Medicaid that provides long term care. It is MediCal that pays for it. I went to a social security office because my sisters wanted me to see about signing up my mom for it even though my mom always said that she did not want MediCal for that very reason. The very first sentence out of their mouth when I went in the office was they will come after her home/assets after she dies to get reimbursed for it. I didn't ask them...that was the first thing they said to me as I was sitting down. One of my sisters thinks that they are just saying that. I don't think so. I never signed her up. We are paying for her care out of pocket in her own home as she wanted.


    Wise move. "Medi-Cal" is the federal medicaid program in California. The same rules apply (There is some variation, state by state, on what is exempt from "recovery" from the patient's assets. If your mother is not getting either treatment or home care provided by Medi-Cal, there would be no reimbursement to be made.
  • metta

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    Aug 17, 2016 1:52 AM GMT
    ^
    She does not get any form of MediCal because I never even completed signing her up. I also found a place in Pasadena that lets people borrow hospital beds, wheel chairs, and other medical equipment for as long as needed without charge. They just need to be returned after use. I think this is only for LA County. https://www.convalescentaidsociety.com/

    I think that there are also legal ways to prevent it from happening, possibly through a living will trust, putting the assets long ago in a family members name, etc. But I would recommend seeing someone that specializes in that to make sure. My mom did not do any of that.
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    Aug 17, 2016 2:19 AM GMT
    HikerSkier saidThis is not really new - (except maybe for more vigorous enforcement requirements). It has been the law for a long time.

    Medicare has never paid for nursing home care. Medicaid, does, if one is poor enough by government standards, which means if one has few assets. Rules are different in different states). An elderly person can own a house, and still get medicaid to pay for nursing home care. But, Medicaid puts a lien on the house, and gets its money back when the person on medicaid dies. Most elderly people, if they anticipate having to go on Medicaid, give money or house away to children (IF they trust them - and unfortunately, many children cannot be trusted to day.) If one gives away the assets enough years before one goes on Medicaid, the assets are safe. If not, then Medicaid withholds payment under some formula, until the equivalent amount of given away assets are used up. It is useful to consult a lawyer who actually specializes in medicaid reimbursement planning - (There really is such a specialty).

    No free lunch for the almost poor in the USA - especially in healthcare. And Obamacare made it worse - putting people on Medicaid against their will, so their heirs will have this problem when they die, when they did not have the problem before.






    Well it looks like my moms two brothers (my uncles) messed up then, when deciding to put their mother, my grandmother into a nursing home without turning over or selling our grandparents property first. My one uncle decided to live in and take care of the property instead while grandmother was in a nursing home for at least 5 years, paid for by Medicaid. Grandma was living in the nursing home when she suddenly developed Sepsis from a perforated stomach, at 95, she was too weak to fight off the infection even on antibiotics. 2011, going in and out of consciousness, she died about the 3rd week in the hospital.

    The issue with her estate, heirs and this Medicaid care has just now come up in 2016, 5 years now after she passed. The state Medicaid fund has not yet filed a petition for any payment, from what I have read, its NOT mandatory that Medicaid collect anything. The federal government gives the option to each state if they want to try and collect anything but I do not think the federal government requires states to collect. Maybe each state does it on a case by case basis and the ability to pay. My one uncle who is early 60's, on disability, is still living there, is not with a walker, but I have to decide "to give up my portion of inheritance" or not, if I contest, then the state Medicaid program more than likely will "want to know" my uncles and my self personal, financial situations, we both could probably claim undue hardship. There is apparently still is a small mortgage too, after that, there wouldn't be much left over for any heir anyway icon_confused.gif

    Its very sad to see your family legacy and name dragged thru the mud, especially sad to see government get what the heirs should icon_mad.gif
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    Aug 17, 2016 2:26 AM GMT
    metta said^
    She does not get any form of MediCal because I never even completed signing her up. I also found a place in Pasadena that lets people borrow hospital beds, wheel chairs, and other medical equipment for as long as needed without charge. They just need to be returned after use. I think this is only for LA County. https://www.convalescentaidsociety.com/

    I think that there are also legal ways to prevent it from happening, possibly through a living will, putting the assets long ago in a family members name, etc. But I would recommend seeing someone that specializes in that to make sure. My mom did not do any of that.





    Interesting, there is at least 9 years between the time my grandma's Will was made, 1998 and the time she went into nursing home under Medicaid, 2007

    ^Is this a legal stipulation?
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    Aug 17, 2016 2:28 AM GMT
    ELNathB said
    Art_Deco said
    Medicare is essentially a companion to Social Security, when you reach that age. Medicaid is primarily for low income younger people not eligible for Social Security.

    Social Security is actually a government insurance program we pay into with our paychecks, not welfare. That becomes payable when we reach retirement age. We EARN Social Security, it's no gift or charity. The benefit amounts scaled to income earned during our lifetimes.

    My grandmother never 'earned an income' and was not eligible for SS, she was collecting on my deceased grandfathers SS and or pension which wasn't enough to cover nursing home, I suppose she herself didn't qualify for Medicare, her only choice was Medicaid (or suicide)

    Yes, a legally married spouse, and some dependents, can be eligible to receive Social Security benefits when the wage-earner dies.

    This is one of the reasons US gays & lesbians have fought for the right to legally marry. Without that status they were ineligible to receive SS benefits through their late spouse.
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    Aug 17, 2016 2:52 AM GMT
    Regarding nursing homes and other care facilities, this is a very problematic issue, involving many regulations over many US States. You can't state a single norm.

    I'm gonna fall back on many provisos here, because this tends to be a case-by-case basis. Even for military veterans it can be confusing. One day I'm told I'd be taken into essentially an "old soldiers home" when the time comes, and other times that I can't because I wasn't wounded in combat. Other times they said I'd be given a full military funeral with a casket, then told no, you just get a headstone.

    Well, my directions call for me to be cremated at my own expense, so I don't what they'd do. They can take my military headstone and shove it up their collective asses, for all I care.

    I have known examples, however, of people who go into a nursing home or an assisted care facility, and effectively have to sign over their entire estates to them. To the exclusion of any heirs. And when this person dies, the family discovers the estate has been drained. They get nothing. A nice racket, but all legal.

    So if you have a family member entering a long-term facility, do check the agreements first. You may find that your potential inheritance is being signed away.

    A difficult choice if that's the only way you can get them in there, for the care they need if not otherwise afforable. Just be aware of what may be going on.
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    Aug 17, 2016 2:53 AM GMT
    It would appear as long as my disabled uncle (child of any age of the Medicaid recipient) stays in the house, the state may not recover any money, this means we should not sell until the probate court has cleared Medicaid, this also means I HAVE TO give up my inheritance in order to keep the state from getting any money, I guess that is the point then in order to protect my grandparents investment icon_eek.gificon_confused.gificon_mad.gif

    This shit is fucked up icon_redface.gif



    From the Medicaid website, I didn't know any of this stuff!
    https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/estate-recovery.html


    Estate Recovery and Liens

    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.

    Under certain conditions, money remaining in a trust after a Medicaid enrollee has passed away may be used to reimburse Medicaid. States may not recover from the estate of a deceased Medicaid enrollee who is survived by a spouse, child under age 21, or blind or disabled child of any age. States are also required to establish procedures for waiving estate recovery when recovery would cause an undue hardship.

    States may impose liens for Medicaid benefits incorrectly paid pursuant to a court judgment. States may also impose liens on real property during the lifetime of a Medicaid enrollee who is permanently institutionalized, except when one of the following individuals resides in the home: the spouse, child under age 21, blind or disabled child of any age, or sibling who has an equity interest in the home. The states must remove the lien when the Medicaid enrollee is discharged from the facility and returns home.
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    Aug 17, 2016 2:55 AM GMT
    If it has been nine years, you really need to talk to a lawyer to understand your family rights whether too much time has passed for them to collect anything. I think lawyers call it Statute of Limitation or something like that. But then again, this is Medicaid and they are trying to stay solvent for the poor families by collecting assets. The wealthy GOP families have taken advantage this of this for a long time which is I think the reason Congress permits Medicaid to try to recover from the assets.
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    Aug 17, 2016 3:19 AM GMT
    Art_Deco saidRegarding nursing homes and other care facilities, this is a very problematic issue, involving many regulations over many US States. You can't state a single norm.

    I'm gonna fall back on many provisos here, because this tends to be a case-by-case basis. Even for military veterans it can be confusing. One day I'm told I'd be taken into essentially an "old soldiers home" when the time comes, and other times that I can't because I wasn't wounded in combat. Other times they said I'd be given a full military funeral with a casket, then told no, you just get a headstone.

    Well, my directions call for me to be cremated at my own expense, so I don't what they'd do. They can take my military headstone and shove it up their collective asses, for all I care.

    I have known examples, however, of people who go into a nursing home or an assisted care facility, and effectively have to sign over their entire estates to them. To the exclusion of any heirs. And when this person dies, the family discovers the estate has been drained. They get nothing. A nice racket, but all legal.

    So if you have a family member entering a long-term facility, do check the agreements first. You may find that your potential inheritance is being signed away.

    A difficult choice if that's the only way you can get them in there, for the care they need if not otherwise afforable. Just be aware of what may be going on.






    This 'racket' maybe "legal" but sure is immoral. A living Will and suicide would take the entire racket out of the picture. Growing old without money sucks, you are really used an abused by the system, gay men beware icon_evil.gif
  • metta

    Posts: 39169

    Aug 17, 2016 4:26 AM GMT
    ELNathB said
    metta said^
    She does not get any form of MediCal because I never even completed signing her up. I also found a place in Pasadena that lets people borrow hospital beds, wheel chairs, and other medical equipment for as long as needed without charge. They just need to be returned after use. I think this is only for LA County. https://www.convalescentaidsociety.com/

    I think that there are also legal ways to prevent it from happening, possibly through a living will trust, putting the assets long ago in a family members name, etc. But I would recommend seeing someone that specializes in that to make sure. My mom did not do any of that.





    Interesting, there is at least 9 years between the time my grandma's Will was made, 1998 and the time she went into nursing home under Medicaid, 2007

    ^Is this a legal stipulation?


    I'm sorry, I did not mean a living will. That is something totally different. I meant a trust (Living Trust). A trust would take the property out of the ownership of your grandmother and the trust would be a separate entity.
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    Aug 20, 2016 7:57 PM GMT
    PACE, a Medicare program that helps keep older people in their own homes, is allowing for-profit companies in. Tech and venture capital have expressed interest.

    http://www.nytimes.com/2016/08/21/business/as-the-for-profit-world-moves-into-an-elder-care-program-some-worry.html