De facto seizure of probate estates

[Catherine]

Posting here and not in "Politics" as this has major tax ramifications.

http://seattletimes.com/html/localnews/2022469957_medicaidrecoveryxml.html

[JRS]

Oregon had the same problem, "The Oregon Health Authority, which oversees the plan, said last week it would change its asset-recovery policy. Starting Oct. 1, anyone applying for coverage under the plan won't be subject to asset recovery rules meant for those receiving long-term care, the agency said.

The agency also plans to remove the alarming fine print in Cover Oregon's application.

"We are not going to be implementing the state recovery for people receiving just the Oregon Health Plan," said health authority spokeswoman Patty Wentz. "(Recovery) will remain in effect for long-term care services and connected medical costs."

[BulldogTom]

Good information. I had not heard of that before.

Thanks Catherine.

Tom

Hollister, CA

[kcjenkins]

The other issue not mentioned is that more doctors are deciding not to take Medicare patients at all, or no new ones, so being forced onto Medicare can turn out to be a really bad deal for a seriously ill person.

[Catherine]

OTOH -- Surgery Center of Oklahoma will enter into a pre-payment plan for most types of surgery -- cash only, in advance (obviously not for emergencies!). Full price disclosure beforehand. That price runs about 20% of hospital billings -- and EQUAL to a Medicare patient's co-pay amount. So for "standard" procedures all the Medicare premiums etc. demonstrably go to overhead, waste, and fraud.

For yet another alternative, you can go to India, have a great tourist trip, then have your elective surgery in a first-class Indian hospital with US-trained physicians -- all for less than the 20% Medicare co-pay amount.

[Guest Taxed]

>>> For yet another alternative, you can go to India, have a great tourist trip, then have your elective surgery in a first-class Indian hospital with US-trained physicians -- all for less than the 20% Medicare co-pay amount.

That works fine as long as you don't get any post op complications. My doctor is an Indian and he tells me that the malpractice laws are very lax in India so if you have any problems after the procedure Good Luck! Also you have to pre-pay the procedure in cash or wire transfer before they even touch you.

>>> Surgery Center of Oklahoma will enter into a pre-payment plan for most types of surgery -- cash only, in advance

That business model may not work for most medical service providers. Sooner or later they will have to decide accept ACA payments or go out of business!

[Catherine]

<snip>

>>> Surgery Center of Oklahoma will enter into a pre-payment plan for most types of surgery -- cash only, in advance

That business model may not work for most medical service providers. Sooner or later they will have to decide accept ACA payments or go out of business!

And that fact should be utterly abhorrent to anyone interested in the health of anyone they know and care for.

[Mr. Pencil]

Sooner or later they will have to decide accept ACA payments or go out of business!

What are ACA payments? Unlike single-payer Medicare, ACA only regulates coverage. The private companies continue to negotiate their own prices. But yes, the least competitive companies will have to get up or get out. Nothing new about that.

[Guest Taxed]

Correct.

[SaraEA]

I think some people are confusing Medicare and Medicaid. Medicare is for those who are at least 65 years old or younger if disabled. It is paid for through payroll taxes and retirees' premiums for all parts except A. MEDICAID is free medical insurance for the recipient, paid for by taxpayers in the state (supplemented by a federal contribution, paid for by all taxpayers). This is no different than when taxpayers fund the cost of an indigent elderly person's nursing home stay. If that person gets a windfall or wins the lottery, the taxpayers should rightfully be paid back, no? It is right in a just society for people to pay for the care of someone who has nothing. It is not right for the recipient of this benevolence to hide their assets or balk at the thought of paying back what was given to them when they were in need.

This is no different than people who connive to give away their homes, bank accounts, etc. so they will qualify for Medicaid ("free" nursing home care). Their kids get all their assets and we sucker taxpayers pay for their care while those kids live in luxury. In prior generations people saved for their old age and cringed at the thought of public assistance. Now it is thought of as a right. I have no problem paying extra taxes so that people who can't afford medical care can get it. I have a big problem when those people think they have no obligation to pay me back when they are able.

[easytax]

I think some people are confusing Medicare and Medicaid. Medicare is for those who are at least 65 years old or younger if disabled. It is paid for through payroll taxes and retirees' premiums for all parts except A. MEDICAID is free medical insurance for the recipient, paid for by taxpayers in the state (supplemented by a federal contribution, paid for by all taxpayers). This is no different than when taxpayers fund the cost of an indigent elderly person's nursing home stay. If that person gets a windfall or wins the lottery, the taxpayers should rightfully be paid back, no? It is right in a just society for people to pay for the care of someone who has nothing. It is not right for the recipient of this benevolence to hide their assets or balk at the thought of paying back what was given to them when they were in need.

This is no different than people who connive to give away their homes, bank accounts, etc. so they will qualify for Medicaid ("free" nursing home care). Their kids get all their assets and we sucker taxpayers pay for their care while those kids live in luxury. In prior generations people saved for their old age and cringed at the thought of public assistance. Now it is thought of as a right. I have no problem paying extra taxes so that people who can't afford medical care can get it. I have a big problem when those people think they have no obligation to pay me back when they are able.

With one exception here ---- I agree almost totally ==== the exception is where they place in one statement (paraphrasing) --- when over 55 .... but in other statements (paraphrasing) can't decide benefits or costs. care, on age...

Help those that need, make people who can pay - pay HOWEVER don't have two different structures because of age of recipient. ALSO don't hide it in the small print.

By the way --- prior generations didn't THINK it was a RIGHT --- it was an obligation to take care of yourself and family --- AND ---- take care of those who REALLY needed help but fell short ///// NOT the scammers.

Now without rule enforcement --- scammers have nothing to fear and even less worry they'll be punished if even caught.

[Guest Taxed]

>> This is no different than people who connive to give away their homes, bank accounts, etc. so they will qualify for Medicaid ("free" nursing home care). Their kids get all their assets and we sucker taxpayers pay for their care while those kids live in luxury.

There is a whole industry of lawyers behind this. Just watch the elder care ads they publish to get the "assets" out of your estate so you can qualify for this. People do it and then pray that they don't get sick until the look back period expires (5 yrs in my state)!

[GeneInAlabama]

I wonder how many cases there have been where a parent transfers their house to a child and then the child gets sued for an automobile accident or whatever and the house is lost while the parent is still living. I wonder how many of those cases the child provides a place for the parent to live when the home is taken from them.

[Guest Taxed]

I wonder how many cases there have been where a parent transfers their house to a child and then the child gets sued for an automobile accident or whatever and the house is lost while the parent is still living. I wonder how many of those cases the child provides a place for the parent to live when the home is taken from them.

I am not an attorney so my knowledge is based on what my clients tell me. Most of the cases that I see the parents if they have more than one child transfer the title in the names of more than 1 child. So if 1 child gets sued they don't lose the house. I have another client who has a huge country estate and 5 acres of land transfer her property to a charity with a right to stay in the house until her death. She pays the property taxes. Her only son pre deceased her.

[Mr. Pencil]

I have a big problem when those people think they have no obligation to pay me back when they are able.

Actually, while Medicaid's recovery policy is weak, it's still more than Medicare's which doesn't exist at all. You are incorrect to say that Medicare "is paid for through payroll taxes and retirees' premiums for all parts except A." Part A (hospital benefits) is paid from current payroll taxes regardless of how much retirees may have paid themselves. Part B (medical benefits) does charge a monthly premium, but by far the greatest share is paid from the general fund. Millionaires have full entitlement to the subsidy. So do you have a big problem when those people think they have no obligation to pay you back when they are able?

[Lee B]

The government reimbursement rates to medical providers is lower for Medicaid than it is for Medicare,

so while some providers are declining to accept Medicare patients,

there are far more who are declining to accept Medicaid patients due to the lower reimbursement rates.

I've read news stories where some doctors are limiting their medicaid patients to no more

than 10 % of their total patient base.

[kcjenkins]

I can not blame the doctors, they can't operate their offices if the payments are less than their costs for the service. The new laws have already driven many doctors to either become employees of hospitals, etc, or retire, simply because of the cost of new equipment needed to comply with the requirements for computerized records. It's going to continue to reduce the number of doctors in rural locations, for sure.

[Guest Taxed]

It is not always the case that doctor's are refusing medicaid. In the past year I have noticed two pediatric doctor's office expand and they proudly display they accept medicare (MassHealth). In addition to that one dentist is doing the same.

[GeneInAlabama]

It is not always the case that doctor's are refusing medicaid. In the past year I have noticed two pediatric doctor's office expand and they proudly display they accept medicare (MassHealth). In addition to that one dentist is doing the same.

Apparently they are trying to expand their business and willing to take less money to do it. Some tax preparers are willing to take less money to expand their business.

[Guest Taxed]

Apparently they are trying to expand their business and willing to take less money to do it. Some tax preparers are willing to take less money to expand their business.

So it would be incorrect to say that doctors are bailing out due to ACA? Perhaps the inefficient and fat cats are, but for each doctor that bails out there will be another new, energetic doctor who wants to expand their business who will jump in.

Think about it, without that they may as well get out of expensive medical school, and become an undertaker or tax preparer

[Mr. Pencil]

So it would be incorrect to say that doctors are bailing out due to ACA? Perhaps the inefficient and fat cats are, but for each doctor that bails out there will be another new, energetic doctor who wants to expand their business who will jump in.

This discussion started last summer when the Wall Street Journal noticed that the Centers for Medicare and Medicaid Services published opt-out statistics for the first time. (Yes, another example of how this is the most transparent administration ever.)

Although it will take a few years to get real perspective, it's pretty interesting stuff. 1.5% dropped out of Medicare last year while only 1% joined anew. The popular line is that Medicare doesn't pay enough (i.e, doctors want more money). It doesn't seem to me that such low stats support that explanation. Seniors on Medicare constitute too big a market share to ignore.

Besides, more than 20% of doctors aren't enrolled in Medicare anyway. So obviously there are other career paths. Maybe consultants to the drug and equipment corporations. Maybe employees in HMOs or hospitals. The total number of doctors seems to be rising slowly, but like other industries health care is replacing personal service with technology. There are lots of changes and experiments in the field, and that's going to continue with or without Obamacare.

Here's the link. See what else there is to speculate about. http://online.wsj.com/news/articles/SB10001424127887323971204578626151017241898

And here's some other numbers I used for this post. Note that 1/4 of doctors are retirement aged. http://if I can't call her back by Monday, she will have to move the file to appeals

[GeneInAlabama]

I don't know about other towns, but in my town a lot of the doctors are still staying in the medicare program but are simply not taking any new medicare patients. I know because my wife has called several doctors and every one of them stated that they are not taking any NEW medicare patients. The indication was that they are accepting new patients but not new medicare patients. I guess my choice is to stay with my present doctor who is excellent but keeps you waiting in the waiting room for 2 or 3 hours or find a new inexperienced doctor that is still trying to build a business.

[Gail in Virginia]

But this is not anything new - at least not in my town. Six or seven years ago, when my son was graduating from seeing a pediatrician to a regular GP, the first thing my doctors receptionist asked my when I asked if they were taking new patients was if he was on Medicare.

[kcjenkins]

It is not always the case that doctor's are refusing medicaid. In the past year I have noticed two pediatric doctor's office expand and they proudly display they accept medicare (MassHealth). In addition to that one dentist is doing the same.

Medicare and Medicaid are two different programs, and Medicare pays more than Medicaid, for the same treatments. So your example does not disprove my point, at all.

[Guest Taxed]

Gail you are absolutely correct. We all know that medicare and medicaid reimbursement is less than some of the private insurance company, so when a doctor has some capacity to add new patients, they want the higher reimbursement ones. That is just a fact of life.

Now if we had a single payer system, we would not have this problem!