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Outcomes Post Transition to ACA

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Possibly Misleading Labeling as "Insured"

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However, in comparing to other states and other countries, counted as insured for Massachusetts are the 24% of the population[1] covered with a form of Medicaid, including the Affordable Care Act's expanded Medicaid.

The state is one of a number that retain the option that has been granted by the Omnibus Budget Reconciliation Act of 1993 to do Medicaid Estate Recovery for non-long-term-care-related (non-LTCR) medical expenses for people 55 and over.[2][3][4][5] For people 55 and and over, with Medicaid, including the ACA's expanded Medicaid, medical expenses will be paid for the person, but their estate is legally obligated to pay back the full amount of those medical expenses when the person dies. In the view of some, people covered subject to estate recovery should be looked at as having not insurance, but rather a loan for medical expenses until death.[6][7][8][9][10][11] Thus, one might reasonably dispute the accuracy of the 97% insured number, because perhaps 4% of the population represented as insured are people 55 or older with some form of Medicaid or expanded Medicaid, which is subject to estate recovery of all medical expenses. It can therefore be argued that the uninsured rate is actually about 7% in Massachusetts.

Possibly Misleading Comparisons

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A number of other states don't do Medicaid Estate Recovery for non-long-term-care-related expenses.[5]Thus, for those states, the insurance coverage rate reported in tables[1] might be considered to accurately represent the insured rate, since it includes no people who have what some view as loans rather than insurance. Therefore the comparison to the Massachusetts uninsured rate, may be, in the view of some, considered misleading.[12]

Thus, for example, Minnesota has a 5% uninsured rate[1], but the state does not currently recover other than long-term-care Medicaid expenses.[13][14][5] So the comparison of insured, if people without what might be considered just a loan are removed, would be Minnesota: 5% uninsured, Massachusetts: 7% uninsured.

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The state (as of Aug 2019) is one of the states that maintains the policy of estate Recovery for non-long-term-care-related Medicaid and expanded Medicaid medical expenses for people 55 and over.[2][3].[4][5] Therefore, certain of the coverage offered in the state, including expanded Medicaid offered as part of the ACA on the MA Health Connector (which people with incomes up to 138% of the Federal Poverty Level usually receive[15]), may leave the holder's estate having to pay back full medical expenses that were paid out, as well as possible capitation charges whether or not medical services were actually used.

Some in the state consider this problematic, particularly since all Massachusetts residents are obligated to carry health insurance, or else pay a penalty.[16] A pair of bills have been introduced into the Massachusetts Legislature to stop non-long-term-care-related estate recovery, retroactively. The bills are S734[17] and H1197.[18]

(Since the passage of the ACA, objections were raised in multiple places across the country[5][19][20][21][22][23][24][25][26][27][28][29][30][31][32] with the practice of Medicaid Estate Recovery for non-long-term-care-related expenses. These were based generally on the view that much of the coverage provided by the ACA, which includes Medicaid and the ACA's expanded Medicaid, with such recovery, subjected all medical expenses paid out to eventually be paid back from the person's estate at death. Therefore, the affected ACA coverage might be considered to be a loan for medical expenses, rather than insurance.[6][7][8][9][10][11] The estate recovery of non-long-term-care-related medical expenses was thus considered problematic in how it interacted with the ACA, and in need of being stopped. Between 2013 and 2017, at least 7 states: NY, WA, OR, CT, CA, MN, and CO have modified regulations and laws to stop or limit non-long-term-care-related estate recovery.[5] Bills S734[17] and H1197[18] would do the same in Massachusetts.)

References

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  1. ^ a b c Cite error: The named reference :0 was invoked but never defined (see the help page).
  2. ^ a b "MA ACA application. See conditions (9) and (10) on adobe p. 22" (PDF). {{cite web}}: |archive-date= requires |archive-url= (help); Cite has empty unknown parameter: |dead-url= (help)
  3. ^ a b "MA Medicaid (MassHealth) Regulations. See section 515.011 for Estate Recovery Details" (PDF). {{cite web}}: |archive-date= requires |archive-url= (help); Cite has empty unknown parameter: |dead-url= (help)
  4. ^ a b "MassHealth Member Booklet, describes the varieties of MassHealth = Medicaid, for use in understanding the exceptions in the regulatons" (PDF). {{cite web}}: |archive-date= requires |archive-url= (help); Cite has empty unknown parameter: |dead-url= (help)
  5. ^ a b c d e f "Medicaid estate recovery", Wikipedia, 2019-08-06, retrieved 2019-08-06
  6. ^ a b Stein, Sam (2014-01-27). "Latest Obamacare Horror Provision Was Championed By ALEC". HuffPost. Retrieved 2019-08-27.
  7. ^ a b "Medical Assistance Estate Recovery". Marshall, Parker & Weber LLC. 2012-09-27. Retrieved 2019-08-27.
  8. ^ a b "Estate Recovery - It's Worse Than You Thought". Daily Kos. Retrieved 2019-08-27.
  9. ^ a b Ostrom, Carol M. (2013-12-16). "Expanded Medicaid's fine print holds surprise: 'payback' from estate after death". The Seattle Times. Retrieved 2019-08-27.
  10. ^ a b "Medicaid Estate Recovery + ACA: Unintended Consequences?". Daily Kos. Retrieved 2019-08-27.
  11. ^ a b "Medicaid Estate Recovery (American Association of Public Welfare Attorneys)" (PDF). 2019-08-26. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  12. ^ "Medicaid Estate Recovery (American Association of Public Welfare Attorneys)" (PDF). 2019-08-27. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  13. ^ joseph. kempf. "Estate recovery". Minnesota Department of Human Services. Retrieved 2019-08-06.
  14. ^ Gazette, Moose Lake Star. "Minnesota MA estate liens put to final rest". Moose Lake Star Gazette. Retrieved 2019-08-06.
  15. ^ "Medicaid expansion definition". healthinsurance.org. 2018-11-19. Retrieved 2019-08-27.
  16. ^ "The Individual Mandate Lives On In Mass. Here's A Look Ahead". www.wbur.org. Retrieved 2019-08-06.
  17. ^ a b "MA Bill S734". 2019-08-06. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  18. ^ a b "MA Bill H1197". 2019-08-06. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  19. ^ "Implementing Health Reform: Medicaid Asset Rules And The Affordable Care Act | Health Affairs". www.healthaffairs.org. doi:10.1377/hblog20140224.037390/full/. Retrieved 2019-08-27.
  20. ^ Ostrom, Carol M. (2013-12-16). "Expanded Medicaid's fine print holds surprise: 'payback' from estate after death". The Seattle Times. Retrieved 2019-08-27.
  21. ^ "Obamacare: The Final Payment--Raiding the Assets of Low-Income and Poor Americans - PaulCraigRoberts.org". www.paulcraigroberts.org. Retrieved 2019-08-27.
  22. ^ Waldman, Deane; ContributorDirector; Center, Texas Health Care Policy (2016-05-31). "Beware of the Medicaid 'Big Con'". HuffPost. Retrieved 2019-08-27. {{cite web}}: |last2= has generic name (help)
  23. ^ Service, John Lundy | Forum News (2016-02-16). "Some shocked by estate claims after joining Medicaid via MNsure". Twin Cities. Retrieved 2019-08-27.
  24. ^ "The Medicaid bill that doesn't go away when you die". PBS NewsHour. 2015-03-24. Retrieved 2019-08-27.
  25. ^ "MACPAC Issue Brief: Medicaid's New Adult Group and Estate Recovery" (PDF). 2019-08-27. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  26. ^ "Iowa State Recovery: Will Medicaid take my house? - Consumer Reports". www.consumerreports.org. Retrieved 2019-08-27.
  27. ^ "EDITORIAL | Minnesota should back off on Medicaid estate recovery". Star Tribune. Retrieved 2019-08-27.
  28. ^ "On Medi-Cal Now, Lose Your House Later?". KQED. 2015-03-24. Retrieved 2019-08-27.
  29. ^ "Ask Emily: Medi-Cal will charge your heirs for your care after you die". Orange County Register. 2015-05-19. Retrieved 2019-08-27.
  30. ^ "What Is Happening With Medicaid Estate Recovery – And Why It Matters". OPEN MINDS. Retrieved 2019-08-27.
  31. ^ "Washington Post: Little-known aspect of Medicaid now causing people to avoid coverage (2/2014)". 2019-08-27. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  32. ^ "Key Proposals to Strengthen the Affordable Care Act". The Century Foundation. 2015-11-23. Retrieved 2019-08-27.
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