NAELA Comments on CMS Letter; Affordable Care Act Gives Access to Health Care to Many Low-Income Individuals Through Medicaid

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Centers for Medicare and Medicaid Services (CMS) Letter Sheds Light on Estate Recovery; Elder Law Attorneys Can Help Consumers Understand the "Fine Print"

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For example, a person who has their insurance through Medicaid may have a home or a small amount of savings despite their relatively low income. These assets could be subject to the Medicaid estate recovery provision.

The Affordable Care Act (ACA) includes provisions expanding Medicaid coverage for certain low-income individuals. States may allow persons with modified adjusted gross incomes (MAGI) as high as 138 percent of the poverty level ($16,105 per year for an individual in 2014) to qualify for Medicaid. Medicaid would then serve as their health care provider. About one-half of the states and the District of Columbia have elected to expand Medicaid coverage in this manner.

Consumers must understand that some states have the ability to recover from their estates, upon his or her death, any health care expenses received by those 55 or over. It is generally known that states are required to recover for services associated with long-term services and supports (LTSS). In addition, states have the option of recovering from the estate of a Medicaid beneficiary any payments paid to a beneficiary if the beneficiary received Medicaid at age 55 or older.

The Centers for Medicare and Medicaid Services recently issued a letter on estate recovery to State Medicaid Directors confirming that people eligible for Medicaid under the ACA who were 55 or over when they received Medicaid are “not exempt from the estate recovery provision in Section 1917(b)(1)(B).” In the letter, CMS clarified that in general, most of the estate recovery rules will apply to MAGI Medicaid individuals who receive coverage for LTSS.

Since policies vary by state, consumers who are receiving their health insurance through Medicaid need to understand how the Medicaid estate recovery policy works in his or her state. NAELA member attorneys are an excellent source for reliable information.

“Elder Law attorneys in states participating in the Medicaid expansion understand their state's estate recovery policy as it applies to services beyond long-term care,” said NAELA President Howard S. Krooks, CELA, CAP. “They have the skills and knowledge to help clients understand the repercussions of health insurance through Medicaid for people over age 55. For example, a person who has their insurance through Medicaid may have a home or a small amount of savings despite their relatively low income. These assets could be subject to the Medicaid estate recovery provision.”

To receive a free NAELA brochure: “Questions and Answers When Looking for an Elder and Special Needs Law Attorney,” contact Communications Associate Abby Matienzo by email at amatienzo(at)naela(dot)org or phone at 703-942-5711 #230.

Find an Elder and Special Needs Law attorney in your area using NAELA’s Member Directory.

About NAELA
Members of the National Academy of Elder Law Attorneys (NAELA) are attorneys who are experienced and trained in working with the legal problems of aging Americans and individuals of all ages with disabilities. Established in 1987, NAELA is a non-profit association that assists lawyers, bar organizations, and others. The mission of NAELA is to establish NAELA members as the premier providers of legal advocacy, guidance, and services to enhance the lives of people with special needs and people as they age. NAELA currently has members across the United States, Canada, Australia, and the United Kingdom. For more information, visit NAELA.org.

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Abby Matienzo, Communications Associate
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