MISH'S
Global Economic
Trend Analysis

Recent Posts

Taxpayer Friendly Sites

Alphabetical Links

Saturday, August 30, 2014 12:49 PM


Obamacare Fine Print: Beware the Medicaid and Medi-Cal Clawbacks and Liens


Obamacare greatly expanded Medicaid coverage, but there is a hidden gotcha that may come back and haunt your heirs for benefits you receive from age 55-64.

This is not new news, but few read and understand the "fine print".

In a warning about the "fine print" and in response to Moral Dilemma: Should a Libertarian Who Does Not Need Food Stamps, but Qualifies for Them, Take Them? reader "TL" writes ...

Hello Mish,

Your friend Steven may want to carefully research taking Medi-Cal benefits.

Medi-Cal, and many other state Medicaid programs include a ‘claw-back’ provision for recovery of costs incurred by the state to provide medical care.  While there is much variation in particulars from one state to another, the bottom line is these costs include a monthly ‘administrative fee’

The ‘claw-back’ mechanism functions via the state placing ‘liens’ on individual assets at the point the Medicaid recipient reaches age 55, then recovers the money at the point the Medicaid recipient dies by ‘seizing’ the money from the estate.

When first put into effect, these ‘claw-back’ provisions were primarily intended to recover costs to the state of providing long term nursing home care for older recipients. 

ObamaCare’s expanded Medicaid has, of course, now waived the assets portion of the ‘means test’.  But under current law, those assets are subject to ‘claw-back’. 

At the moment, the monthly ‘administrative fee’ amount for Medi-Cal is $611.  Those who sign up for Medicaid may not be doing themselves any favors.
Medi-Cal Clawbacks and Liens

The California Healthcare Foundation explains the rules in Estate Recovery Under Medi-Cal
Medi-Cal estate recovery refers to state action to reclaim certain Medi-Cal costs from the estates of beneficiaries after their death. This program, which has been in place for decades, has received renewed attention from policymakers because of reports that some individuals newly eligible for Medi-Cal as expanded under the Affordable Care Act (ACA) may not enroll for fear that their house and assets could later be seized.

... States also have the option to take a more expansive approach and seek recovery of costs for other covered services, not just LTSS, provided to beneficiaries age 55 and older. California has chosen this option and seeks recovery of Medi-Cal costs for all covered services provided to beneficiaries age 55 and over, with the exception of personal care services provided through the state’s In-Home Supportive Services (IHSS) program.  California has elected to use property liens to protect its claim in cases where the beneficiary was permanently institutionalized and not expected to return home. Medi-Cal places a lien against the beneficiary’s property while the beneficiary is still alive so it can seek recovery when the individual passes away or when the property is sold. 
Medicaid Fine Print

The Seattle Times discusses the fine print in Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death
With an estimated 223,000 adults seeking health insurance headed toward Washington’s expanded Medicaid program over the next three years, the state’s estate-recovery rules, which allow collection of nearly all medical expenses, have come under fire.

Medicaid, in keeping with federal policy, has long tapped into estates. But because most low-income adults without disabilities could not qualify for typical medical coverage through Medicaid, recovery primarily involved expenses for nursing homes and other long-term care.

The federal Affordable Care Act (ACA) changed that. Now many more low-income residents will qualify for Medicaid, called Apple Health in Washington state.

But if they qualify for Medicaid, they’re not eligible for tax credits to subsidize a private health plan under the ACA, which requires all adults to have health insurance by March 31.

Unclear rules

One reason this snafu has become so troublesome is that ACA rules appear to give those who qualify for Medicaid little choice but to accept the coverage.

People cannot receive a tax credit to subsidize their purchase of a private health plan if their income qualifies them for Medicaid, said Bethany Frey, spokeswoman for the Washington Health Benefit Exchange.
Obama Care "Final Payment"

Paul Craig Roberts chimes in with Obamacare: The Final Payment–Raiding the Assets of Low-Income and Poor Americans

Kevin Knauss highlights Expanded Medi-Cal costs $611 per member per month

California Math

Under California recovery rules, $611 per month for 10 years (age 55-64), amounts to $73,320 (minimum) that would come from the estate.

Those signing up thinking Medicaid is free, better learn the rules.

It appears that Steven who gets now foods stamps is also trapped in a Medi-Cal program with claw-back rules, when he would simply prefer his medical old plan, at his old rate.

Obamacare gotchas keep piling on.

Mike "Mish" Shedlock
http://globaleconomicanalysis.blogspot.com

Friday, August 29, 2014 9:53 PM


Moral Dilemma: Should a Libertarian Who Does Not Need Food Stamps, but Qualifies for Them, Take Them?


Here's the moral dilemma of the day:

Suppose you are a staunch Libertarian, doing reasonably well and you don't need food stamps. Yet, under perverse rules, you qualify for them. Should you take them?

Reader Steven faces that exact question. Steven writes ...

Hi Mish

In response to your article 40% of U.S. on Welfare; Obamacare Expands Welfare by 23 Million; More on Welfare Than Full-Time-Employed I confess my own moral dilemma.

I am the beneficiary of trusts left to me by my parents. They are not huge, but they sustain me and my children. I prefer to spend time with my kids rather than pursue regular employment.

Until the beginning of this year, I was purchasing my own health insurance under a high deductible plan, that cost nearly $300 per month. It had risen steadily from $169 when I first obtained it two years ago. On December 31, my plan was essentially made illegal, with another plan costing nearly $600 put in its place.

I didn't have that much of a medical budget so I cancelled the plan. Three months later and in desperation for coverage, I spoke with an insurance agent who was sure, based on what I was telling her, that I would not qualify for Obamacere subsidies, but I would qualify for Medicaid which was a "better' program as it covers more services. She told me to march down to Medicaid with all my documentation and apply for coverage, which I did.

Because my trusts make all the money, my personal income is well below poverty line. Nevertheless I live quite comfortably. All the same, they eliminated the asset test for both Medicaid and food stamps, and am now receiving both.

I told my social worker the truth. I do not want to deal with a benefits fraud rap.

Because I have two dependent teens in my home, I now receive almost $500 per month for food in addition to the Medicaid coverage, which is pretty convenient. You should see the look on the cashiers' faces when, after paying for my food with the EBT card, I then pay for the non-food items with an American Express card, or even my black Visa card.

On the minus side, there are very few doctors in San Francisco worth visiting who accept Medi-Cal. I have yet to choose a doctor or a plan, and have been on the phone with state assemblymen and the Medi-cal ombudsman seeking better healthcare alternatives.

I wish I could just go back to my old, lousy plan that didn't pay for more than half of anything but which was accepted almost everywhere.

As a Libertarian, I face a moral dilemma. Should I accept benefits I don't really need?

In the case of Medicaid, I have to, or else live without coverage and/or be penalized by the IRS. But in regards to free food money, I am in a quandary.

This is also is a great story, which is why I am relating it to you now. Nothing says "broken" more than a welfare system that gives trust fund kids EBT cards.

Thanks for your awesome blog. I read it regularly.

Steven
Do What's Best For Your Family

My advice is simple: In general, you should do what is best for you and your family as long as it is legal.

I offered the same advice in regards to "Walking Away".


Comments from a Staunch Libertarian

I pinged Steven's question off Pater Tenebrarum at the Acting Man blog. Pater is one of the staunchest libertarians one could possibly find.

Pater replies ...
Ayn Rand has once addressed this question in the context of "should you accept research grants from the government". Essentially, her point is this: If the government has taken your taxes, you have every right to receive some restitution. Why should only the supporters of redistribution and statism get something, and you be left nothing but a paying victim?

So if your correct libertarian viewpoint is that you have been robbed, then getting something back is nothing but you claiming back some of what has been looted from you. You weren't in agreement with your wealth being appropriated by force, so it is only fair to get some restitution, however small.
Take the Money and Run

There is no moral dilemma. Take the money and run.

Mike "Mish" Shedlock
http://globaleconomicanalysis.blogspot.com

11:46 AM


"Economic Pilot in Reverse": US Consumer Spending Unexpectedly Dips; Zero for 79


Mainstream media headlines in the last two days offer an amusing look at GDP forecasts.

GDP Stronger Than Expected

Yesterday, the Financial Times reported US Rebound Stronger than First Thought.

The US economy’s second quarter bounce was stronger than previously thought, with the official annualised growth estimate increased from 4 per cent to 4.2 per cent.

The revision is more evidence of robust underlying growth in the world’s biggest economy as it swung back from a weather affected 2.1 per cent fall in the first quarter.
"Economic Pilot in Reverse"

Today, the Wall Street Journal reported U.S. Consumer Spending Declines 0.1% in July.
Consumer spending fell in July and income growth was weak, signs that cautious consumers could restrain economic growth in the second half of the year.

Personal spending, which measures what Americans pay for everything from sneakers to doctor visits, declined a seasonally adjusted 0.1% in July from a month earlier, the Commerce Department said Friday. It was the first time spending fell in a month since January.

Personal income, reflecting income from wages, investment, and government aid, rose 0.2% in July—the smallest monthly increase of the year.

"Looks like the pilot threw the economy's engines into reverse at the start of the third quarter," said Chris Rupkey, chief financial economist at Bank of Tokyo-Mitsubishi UFJ. Forecasts that the economy would grow at a strong 3% clip in the third quarter "look increasingly unrealistic if consumers don't return to the shops and malls."

Economists surveyed by The Wall Street Journal had predicted personal spending would increase 0.1% and incomes would rise 0.3% in July.

Barclays lowered its forecast for third-quarter growth by a half-percentage point to a 2.2% pace. Goldman Sachs economists lowered their estimate to a 3.1% annual rate from a 3.3% pace.
Diving Into the Numbers

Please consider Personal Income and Outlays: July 2014 by the BEA.
Personal income increased $28.6 billion, or 0.2 percent, and disposable personal income (DPI) increased $17.7 billion, or 0.1 percent, in July, according to the Bureau of Economic Analysis.  Personal consumption expenditures (PCE) decreased $13.6 billion, or 0.1 percent. In June, personal income increased $67.1 billion, or 0.5 percent, DPI increased $62.9 billion, or 0.5 percent, and PCE increased $50.5 billion, or 0.4 percent, based on revised estimates.
Real PCE Highlights

  • Real PCE -- PCE adjusted to remove price changes -- decreased 0.2 percent in July, in contrast to an increase of 0.2 percent in June.
  • Purchases of durable goods decreased 0.6 percent, in contrast to an increase of 0.5 percent.  Purchases of motor vehicles and parts accounted for most of the July decrease. 
  • Purchases of nondurable goods decreased 0.2 percent in July, in contrast to an increase of 0.3 percent in June. 
  • Purchases of services decreased 0.1 percent, in contrast to an increase of 0.1 percent.
  • The price index for PCE increased 0.1 percent in July, compared with an increase of 0.2 percent in June. 
  • The PCE price index, excluding food and energy, increased 0.1 percent in July, the same increase as in June.

Zero for 79

Bloomberg reports U.S. Consumer Spending Falls for First Time in Six Months.
Consumer spending in the U.S. unexpectedly dropped in July for the first time in six months, a sign households are lagging behind as wages fail to accelerate.

Household purchases decreased 0.1 percent after increasing 0.4 percent in June, Commerce Department figures showed today in Washington. None of the 79 economists in a Bloomberg survey projected a decrease.

Rounding out the differences between GDP analysis yesterday and today, ZeroHedge reports Here Come the Q3 GDP Downgrades.

Growth Engine

By the way, and in contrast to widespread economic thought, consumer spending is not the "engine of economic growth". Savings, investment, and production are.

Mike "Mish" Shedlock
http://globaleconomicanalysis.blogspot.com

Last 10 Posts


Copyright 2009 Mike Shedlock. All Rights Reserved.
View My Stats