Expanded Medicaid's fine print holds surprise: 'payback' from estate after death

As thousands of state residents enroll in Washington's expanded Medicaid program, many will be surprised at fine print: After you're dead, your estate can be billed for ordinary health-care expenses. State officials are scrambling to change the rule.
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Dr. Jane Orient, executive director of the politically conservative Association of American Physicians and Surgeons, writing in the The Washington Times, called the recovery provision "a cash cow for states to milk the poor and the middle class."

"People will think this is wonderful, this is free insurance," Orient said in an interview. "They don't realize it's really a loan, and is secured by any property they have."

Even states that are now limiting estate recovery, she warned, can change the rules again if budget problems become more intense.

Unclear rules

One reason this snafu has become so troublesome is that ACA rules appear to give those who qualify for Medicaid little choice but to accept the coverage.

People cannot receive a tax credit to subsidize their purchase of a private health plan if their income qualifies them for Medicaid, said Bethany Frey, spokeswoman for the Washington Health Benefit Exchange.

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