Tag Archives: Medicaid

The Horrors of Estate Recovery

New Orleans    The horrors visited on low-and-moderate income families are numerous and their damage inestimable and often devastating now and onward to future generations.  Even knowing this, it is still shocking to find additional examples hidden right before our eyes.

A case in point is estate recovery.  The Medicaid Estate Recovery Program in its present form is a legacy of the Clinton Administration.  Prior to 1993, estate recovery for repayment of Medicaid debts was voluntary, but President Bill Clinton signed the bill that year making it mandatory as a part and parcel of his deficit-reduction act and the false rhetoric of changing “welfare as we know it” and the mythical hype of personal responsibility as an antidote for poverty.  Much of the recovery was linked to the aging boomer population and the soaring costs of long-term care in nursing homes.

Medicaid, remember is not Medicare.  Medicare is available for those individuals over the age of sixty-five.  Medicaid is for the very poor.  Since the expansion of Medicaid through Obamacare, the Affordable Care Act, many understand how critical the program is for both the poor and lower waged workers.   In short, let there be no doubts on this score, this was a program deliberately designed and made obligatory in order to punish the poor by trying to raid whatever small estates that they might have when they die in order to impoverish their relatives as well as the deceased.

According to an article in the October issue of The Atlantic, the full level of the mean-spiritedness of this program is revealed, contrary to former Speaker Newt Gingrich and the Clintonista myth of the poor’s irresponsibility, in the almost infinitesimal level of recovery involved relative to the total cost of the Medicaid program or the long=term care program and its cost recovery, and the disproportionate horror it brings to the families trying to pay the bills.  As the story is reported in The Atlantic,

“…the overwhelming majority of estates are not worth hundreds of thousands of dollars.  In 2005, the Public Policy Institute of the AARP published a study of the first decade of mandatory estate recovery, Massachusetts, it found, recovered of $16,442 per estate in 2003,…offsetting a little more than 1 percent of long-term-care costs that year….In Kentucky…the average amount collected from an state was $93; the state recovered just 0.25 percent of its long-term-care costs.  The total amount states recouped jumped from $72 million in 1996 to $347 million seven years later – but even so, estate recoveries accounted for less than 1 percent of Medicaid’s total nursing-home costs in 2003.”

If it’s not just to hurt the poor and their hapless heirs, what’s the real point of this program?   It probably cost more cumulatively for states to administer the recovery program, than they are able to recover!

The Atlantic detailed one story after another of lower income families losing their homes or farms or their folks’ couple of acres and heirlooms passed on through the generations because of this predatory recovery.  The irony of the same program paying hundreds of thousands of dollars for operations and expecting no recovery compared to nursing home care is obvious.  The outrage that allows wealthy families to shield millions from taxation to bequeath to their heirs, while the poor are forced to become poorer and leave their own poverty as their inheritance to their children is equally obvious.

What excuse can there be for such a horror?

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Arkansas Playing Gotcha with the Poor to Cut Them Off of Medicaid

New Orleans  In a sordid and shameful episode a few weeks ago Arkansas Governor Asa Hutchinson pridefully announced that the state had managed to bar 4300 people from health care support through Medicaid because of its new work requirement policies.  Seema Verma the head of the federal Center for Medical Services (CMS) who had approved this draconian attack on the poor played clueless cheerleader.

As more information come forward the real evil that underlies this shame emerges.  Let’s look at the facts.

Arkansas began the experiment by exempting two-thirds of the eligible recipients from having to report work hours, knowing this was going to be a problem.  30,000 people were then required to report.  16,000 didn’t report any qualifying activities to the state, either work, training or volunteer time.  In fact, according to the New York Times, “only 1200 about 2% of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.”  That’s pickle-poor!  It screams to a state failure not a people failure, and it foretells thousands more that will be denied coverage.

State officials tried to cover their rear ends, claiming they had done everything possible:  mailings, calls, and even putting out fliers some places where Medicaid patients congregate.  Even more ridiculously they touted the fact that they send emails and posted on social media sites.  Who are they trying to fool?  Arkansas ranks 48th among all of the states in the US in terms of connectivity and 30% of the population is underserved.  230,000 people in Arkansas don’t have any wired internet providers available where they live.  Who wants to guess whether embedded in these sorry statistics lie most of these lower income Medicaid recipients?

Shockingly, the Times then quoted Amy Webb, the chief communications and engagement officer for the Arkansas Department of Human Services saying, “If there’s something we are not doing to reach people, if someone will tell us how to do that, we will do it.”  Yeah, really?  She doesn’t mention that the state legislature forbade any use of media to increase enrollment under the Affordable Care Act.  Nowhere do they claim they were on the television or radio airwaves.  As the manager of KABF, a 100,000-watt noncommercial smack dab in the middle of the state with more than 50,000 listeners per week, more than half of them lower income, I can absolutely tell you we never received a public service announcement from them, much less any support for a real information promotion of the program.

Every other indication is one of abysmal failure.  The state conceded even when they had email address, only 20 to 30% opened the email.  Call centers said many didn’t answer their phones.  A professor from New York visited three counties in August and interviewed 18 people and 12 were unaware that work requirements even existed.  Other experts noted that an incentive system, even a punitive one trying to get more people into the workforce, won’t work if people don’t know about it.  Duh!

Adding injury to injury, all of the work hours are required to be submitted through the internet.  That’s the same internet thing that hundreds of thousands of Arkansans are not able to access, and even with access are not necessarily all-pro at using the state’s clunky website.

State officials in Arkansas need to start some truth telling.  These so-called work requirements are nothing of the kind.  This a pure and simple way to push eligible people off of Medicaid.  Hopefully a coming court hearing will stop this hypocrisy.

In the meantime, this is a scandal that none of us should be able to stomach.

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Please enjoy Johnny Guitar from Twisted Wheel.

Thanks to KABF.

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