Medicaid: Difference between revisions

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Revision as of 16:21, 7 August 2019 edit NormSpier (talk \| contribs) Extended confirmed users 971 edits Corrected Omnibus Budget Reconciliation features on estate recovery. (States have the option, not the mandate, to recover all medical expenses.) Tag: Visual edit ← Previous edit		Revision as of 16:50, 7 August 2019 edit undo NormSpier (talk \| contribs) Extended confirmed users 971 edits →‎Medicaid differences by state: Added state differences in estate recovery Tag: Visual edit: Switched Next edit →
Line 25: The [[Medicaid Drug Rebate Program]] and the [[Health Insurance Premium Payment Program]] (HIPP) were created by the [[Omnibus Budget Reconciliation Act of 1990]] (OBRA-90). This act helped to add Section 1927 to the Social Security Act of 1935 which became effective on January 1, 1991. This program was formed due to the costs that Medicaid programs were paying for outpatient drugs at their discounted prices.<ref name="autogenerated3">{{cite web\|url=http://www.cms.hhs.gov/MedicaidDrugRebateProgram/\|publisher=HHS\|title=Medicaid Drug Rebate Program Overview\|deadurl=yes\|archive-url=https://web.archive.org/web/20071214143730/http://www.cms.hhs.gov/MedicaidDrugRebateProgram/\|archive-date=December 14, 2007\|df=mdy-all}}</ref> The [[Omnibus Budget Reconciliation Act of 1993]] (OBRA-93) amended Section 1927 of the Act as it brought changes to the Medicaid Drug Rebate Program,<ref name="autogenerated3" /> as well as requiring states to implement a [[Medicaid estate recovery]] program to sue the estate of decedents for long-term-care-related costs paid by Medicaid, and giving states the option of recovering all non-long-term-care costs, including full medical costs.<ref name=":9">{{cite web\|url=http://aspe.hhs.gov/daltcp/reports/estaterec.htm \|title=Medicaid Estate Recovery\|publisher=U.S. Department of Health and Human Services\|date=April 2005}}</ref> <ref name=":7" /><ref name=":8" /> (It should be noted that estate recovery, when the state recovers all medical costs for people 55 and older, extends to the expanded Medicaid coverage that is part of the ACA.) Medicaid also offers a Fee for Service (Direct Service) Program to schools throughout the United States for the reimbursement of costs associated with the services delivered to special education students.<ref>{{cite web\|url=http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Fee-for-Service.html\|title=Fee for Service (Direct Service) Program\|publisher=Medicaid.gov}}</ref> Federal law mandates that every disabled child in America receive a "free appropriate public education." Decisions by the United States Supreme Court and subsequent changes in federal law make it clear that Medicaid must pay for services provided for all Medicaid-eligible disabled children. Line 68: === Medicaid differences by state === Medicaid is managed by the states, and each one has varying criteria on how to qualify for the program, what services are covered, and how physicians and care providers are reimbursed through the program. Differences between states are often influenced by the political ideologies of the state and cultural beliefs of the general population. Differing criteria can also make it very difficult for people to understand how to navigate the system, leave people who need coverage uninsured because they don't meet certain criteria, and deepen inequality in certain populations. [[Medicaid estate recovery]] regulations also vary by state. (Federal law gives options as to whether non-long-term-care-related expenses, such as normal health-insurance-type medical expenses are to be recovered, as well as on whether the recovery is limited to probate estates or extends beyond.)<ref name=":9" /><ref name=":10" /><ref name=":10" /> ===== Political influences ===== Line 165 ⟶ 167: == Medicaid Estate Recovery == States are required to recover long-term-care-related (LTCR) Medicaid expenses from the estates of people 55 or older when they received Medicaid, to the extent of at least probate estates. States also have the option to recover costs of all medical care for people who were 55 or older, and have a separate option to extend the recovery beyond a probate estate<ref name=":10">{{Cite web\|url=https://www.elderlawanswers.com/medicaids-power-to-recoup-benefits-paid-estate-recovery-and-liens-12018\|title=Medicaid's Power to Recoup Benefits Paid: Estate Recovery and Liens\|website=ElderLawAnswers\|language=en\|access-date=2019-08-07}}</ref>.<ref>{{Cite web\|url=https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html\|title=Estate Recovery and Liens\|website=www.medicaid.gov\|language=en-us\|access-date=2019-08-07}}</ref> This latter option is generally called "expanded estate recovery". When the estate recovery is applied to medical expenses, since it be a recovery of all medical expenses paid out, and not just some sort of actuarial premium equivalent<ref name=":8">{{Cite web\|url=http://nasmusicsoft.com/BlogACAConsumerProblems.html\|title=Affordable Care Act Problems\|website=nasmusicsoft.com\|access-date=2019-08-07}}</ref><ref>{{Cite web\|url=https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6696-ENG\|title=MN ACA application. See p. adobe p. 21, third option up before the signature. (MN seems to not do non-long-term-care estate recovery currently, but the form apparently leaves the option open for the future. It is included because it explicitly states cost of medical care, and not just premiums, may be recovered.)\|last=\|first=\|date=2019-08-07\|website=\|archive-url=\|archive-date=\|dead-url=\|access-date=}}</ref><ref name=":7">{{Citation\|title=Medicaid estate recovery\|date=2019-08-07\|url=https:https://www.how.com.vn/wiki/index.php?lang=en&q=Medicaid_estate_recovery&oldid=909777320\|work=Wikipedia\|language=en\|access-date=2019-08-07}}</ref>, it can be argued that people with the Medicaid really have no health insurance at all, in our ordinary conception of insurance. The Medicaid coverage could most accurately be viewed as a "loan until death for uninsured medical expenses".