Ann Marie Marciarille has a pair of posts about Medicaid and expansion that I think bring up a very good point. The Medicaid expansion in slightly more than half the states has expanded eligibility from what is effectively a politically powerless and disenfranchised primary user base of children and poor women as well as elderly individuals in nursing homes, to a less disenfranchised and potentially politically powerful group of working poor. The working poor will never have as much power as the non-working rich, but they have some ability, especially at the local and state level, to organize and press for their interests.
A friend from Minnesota asks if I have heard of the “old” Medicaid rules on child support assignment being applied to “new” Medicaid ACA-expanded beneficiaties…..
Does this mean Medicaid’s more draconian aspects will finally see the light of day in public debate? Will the inclusion of working poor people create a constituency for a Medicaid program that does not dovetail with child support/medical support frameworks — like that found in Minnesota — apparently premised on the idea that Medicaid beneficiaries are getting something for nothing and payback is our mission?
As I have discussed elsewhere, we are conflicted about Medicaid so it is no surprise that the ACA is conflicted about Medicaid. Most particularly, the ACA does nothing to alter state discretion to seek state recoupment of Medicaid costs from Medicaid beneficiaries who received basic medical services through Medicaid at or after the age of 55.
No, I’m not talking about Medicaid recoupment of nursing home costs but, rather, recoupment of basic Medicaid medical costs. This, in some states, is old hat. California, New York, Massachusetts and others have been recovering funds from the estates of 55+ Medicaid beneficiaries who received basic health services under the program for decades. But now that the reach of Medicaid in these Medicaid expansion states is broadening Medicaid eligibility to greater numbers of citizens with assets (read: the family home) the tension between Medicaid’s historical status as a program where, to some extent, the benefit is returned to the government and its re-invented status as the health insurance provider of last resort for those too poor to shop throught the exchanges is made manifest.
These types of rules have been put in place as part of the favorite American game of determing who is and is not part of the deserving poor. Those rules applied to Medicaid when it was truly the poor person’s program and not a broad based payer of last resort. To some, anyone who qualifies for Medicaid, even with the income eligiblity expansion is a “loser” who deserves random harrassment, but beyond those assholes and sociopaths, it is harder for the American voting public (which is quite different and generally more privileged than the general public on a variety of measures) to see the value of harrassing people who they either know or could have seen themselves to be.