New Medicaid Recipients Through Obamacare May Be in for a Surprise


Under the Affordable Care Act (ACA, often called “Obamacare”), more Americans may be eligible for Medicaid due to an expansion of coverage.  These new covered individuals would receive direct Medicare coverage, rather than the government subsidized private health insurance discounts found in the state or federal healthcare exchanges.  Low-income individuals ($16,105 annual income or less for an individual person in 2014) would qualify for this direct Medicaid coverage, regardless of their assets.  Many states have opted to implement this new qualification method for coverage, using the expanded income qualification, including California.

The California Department of Health Care Services (DHCS) estimates that by adopting this higher income threshold, there may be as many as two million new people eligible for Medi-Cal (California’s version of Medicaid) in the state.  Furthermore, these individuals do not have the option to choose between Medicaid/Medi-Cal and the premium assistance options, Medicaid/Medi-Cal is the only option for those who fall into the new income categories.

What these new covered individuals might not know is that states do have the option to try and get paid back for the coverage provided, sometimes years in the future.  Although states say that they will not recover (try to get funds back from the covered individual’s estate) against those who receive care when younger than age 55 (California itself is prohibited from doing so), people who receive Medicaid/Medi-Cal at age 55 or older can expect the state to try and recover against their estate when they pass away.  This can be a surprise for families of those who have low income but own their home, or have other assets or savings, especially for the surviving spouse of a deceased covered individual.

Lawmakers have introduced a senate bill in California (SB 1124 Hernandez) that is aiming to stop recovery against these covered groups, but it is still unclear what stance state governments will take.  In the meantime, new coverage recipients may find that their health insurance may cost them or their families more than they expected, even years in the future.

This entry was posted on Monday, May 5th, 2014 at 8:21 pm and is filed under General Legal, Medi-Cal.