Medicaid's Inheritance Tax and the House Health Care Bill

There is a little known section of Medicaid that allows each individual state to place on lien on the insured's personal and real property and allows those states to force sale in order to collect on bills following the insured's death. Most people likely think that Medicaid provides insurance for those that can't provide for themselves. In some sense, that's true. On the other hand, there is a plethora of medical procedures that Medicaid doesn't provide and if a patient is subject to one of them, a lien will be slapped on their property. Some of the medical procedures that aren't necessarily covered are: nursing home or other long-term institutional services, home- and community-based services, and hospital and prescription drug services provided while the recipient was receiving nursing facility or home- and community-based service.

The 1993 Medicaid Estate Recovery Mandate gives states the authority to 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. As of 2003, this act produced a collection of about $330 million from estates upon which liens were placed. This act gives the states authority to send out an assessor to assess the value of a home, care, furniture, etc. of the property which the state will then mandate for sale. In fact, when an individual signs up for Medicaid, as part of their agreement, they allow the government to place a lien on their property in case the government then needs to collect.

One tragic case was described this way to me.

My mother had her medical coverage eliminated by her employer after 30 years of working in a hospital. All she owned was her house. No car. No stocks. No bonds. When she got sick and sent to the hospital, they put a lien on her house. When they put her in a nursing home, they added another one. Even though I gained custody of her, I had no decision making control in her care, even which nursing home she was sent to after release from the hospital. When she died, the state wanted the only thing she owned. A house that she bought at age 64 and paid for at age 68.

They had over $300,000 of liens on it.

The only reason she got to keep the funeral that she paid for was that the contract was irrevocable. She was already in her 60s when the hospital eliminated medical coverage for retirees. This is why she didn't retire until she was forced to at age 73.

As of the last known date, there were about 53 million people enrolled in Medicaid. That maybe all about to change. One of the arguments made by both sides is that nearly 10 million people are elgible for Medicare/Medicaid but don't sign up. That's because enrollment continues to be optional. Under the house plan enrollment in both will no longer be optional. Furthermore, those eligible for Medicaid will increase. Now, any family with an income of $80,000 and less will be eligible for medicaid. On page 102 (lines 12-18) all eligible individuals will be enrolled in Medicaid. As such, any family that makes less than $80,000, and has no private insurance, will immediately be enrolled in Medicaid. So, the enrollment will expand exponentially. As part of the enrollment, they will agree to have liens put on their properties. Page 195 of the plan will give government bureaucrats access to access to ALL Americans financial/personal records. So, it will be a short step to simply allowing the government to take from patients all uncovered expenses on the spot.

Finally, the now infamous page 425, either mandates or suggests (depending on how you interpret the very legalese language), "Advance Care Planning Consultation. Of course, nursing home care is one form of Advance Care Planning Consultation and that isn't usually covered under medicaid. So, how many millions of elderly Medicaid patients will be heading to the nursing home under the suggestion of their "consultant", only to then have the state sell their home to cover the expenses of that stay?

As such, the house health care bill is in fact a stealth inheritance tax on millions of unsuspecting poor and middle class folks. Ask your Congress person if they know this.