Obamacare-Medicaid: State officials to change policy that prompted Port Townsend wedding
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Bettina Hansen/The Seattle Times
Sofia Prins and Gary Balhorn, both 62, decided to marry so they wouldn't have to get health insurance individually through Medicaid, which could bill their estates after death. The Port Townsend couple's joint income is too high for Medicaid but low enough for tax credits.

By Leah Leach
Peninsula Daily News

PORT TOWNSEND — The wedding of Sofia Prins and Gary Balhorn may have contributed to saving your inheritance.

The couple, both 62, were married Dec. 15 in a small, private ceremony at their Port Townsend home after they discovered that, since they were over 55, if they enrolled in the state's expanded Medicaid program, their estates could be billed after their deaths for ordinary health-care expenses.

They married to raise their income enough to enable them to receive tax credits for private insurance and avoid Medicaid coverage to protect her possible future earnings and his house and land for their heirs.

Now, state officials have announced plans to draft an emergency amendment to the Washington Administrative Code to limit Medicaid estate recovery to long-term care and related medical expenses.

The measure is expected to be in effect by Jan. 1, said Jim Stevenson, spokesman for the state Health Care Authority.

If the change had been made earlier, the couple — who had been together for four years — wouldn't have needed to get married this month, Prins said Friday.

“I'm glad we got married, but I wouldn't have done it with this timing,” Prins said.

“We would have done it differently if that rule had been in place.”

Prins said she was surprised to find the provision in paperwork for Balhorn, a retired fisherman and former tango instructor who is building a boat to return to fishing.

She hadn't found the policy before, despite examining printed information and webinars about expanded Medicaid coverage, called Apple Health in Washington state, after Obamacare — the federal Affordable Care Act — increased the number of low-income residents eligible for Medicaid.

“I happened to see it,” said Prins, an artist. “I totally didn't expect to see that.”

It meant, she said, that the Apple Health plan, touted as free, wasn't at all for those 55 or older.

Instead, it was a loan that would be paid by a person's children.

The rules do not allow people who qualify for Medicaid to receive tax credits to subsidize private health plan purchases, although they could buy health plans without tax credits.

That could be expensive. Prins said she was looking at going from a policy that cost $326 a month to one that was $577 a month.

“You had a choice between going on Medicaid with the risk of having your estate taken when you die or getting private insurance at a high rate or being given a penalty for breaking the law by not getting insurance,” Prins said.

“It was discriminatory for this group” of those 55 or older, and “there was no limit for what they could get for medical costs,” Prins said she discovered.

“Usually one of points of insurance is that if you have an emergency, you can get the care you need without having to lose your assets,” she said.

Prins said she talked with “about a dozen people” at several state offices, including the Health Care Authority and the Office of Financial Recovery with the Department of Social and Health Services, and found that they “had to research it.”

She also went to the media. Both the weekly Port Townsend Leader and The Seattle Times published stories about the upcoming wedding, and what prompted it.

Carol M. Ostrom's Seattle Times story was picked up by a variety of blogs on the Internet.

“I decided to publicize our getting married because that was a way to let people know what was going on,” Prins said.

“I think it made a big difference.

“It kind of snow-balled, with people asking.”

The change will align state policy with federal requirements and limit recoveries to enrollees 55 and over who are in long-term care and have related prescription drug and hospital costs, the Health Care Authority said in a Dec. 16 announcement.

Director Dorothy Teeter referred to the present policy as “outdated,” and said that it was “producing significant concern from families newly eligible for Medicaid.”

Since Oct. 1, more than 150,000 people have entered their information in the exchange and found out they were eligible for free health insurance through Medicaid.

“We've had people refusing medical coverage under Medicaid because of this concern about recovery,” Stevenson said.

“My understanding is that [Prins and Balhorn] are among the prospective Medicaid applicants who contacted us and talked about their concern.”

The provision had been in place since 2004, when the state Legislature authorized it, said Stevenson, but had not been used much.

“Think of it in terms of an authorization document,” Stevenson said. “It authorized the state to broaden its recovery polices. It didn't direct it to do that.”

Teeter said nearly all current recoveries are tied to long-term care clients.

The emergency amendment is only temporary, beginning a process of public notice and hearings — but it will be in place until the permanent rule comes into effect, Stevenson said.

Changing the provision will cost the state about $3 million a year, Dr. Bob Crittenden, Inslee's senior health-policy adviser, told The Seattle Times.

Because of their wedding, Prins and Balhorn now will pay $76 a month for a mid-level plan with a tax credit.

And Prins is glad they took the action they did.

An artist who specializes in creating copies of Byzantine-style icons on copper, she's not generally politically active.

“I'm holed up the woods here not being political,” she said.

“In general, I wanted to do my artwork and let the world go by. But this really struck me. The choices were not right. There was something very wrong about it.

“I'm glad we were able to use [our wedding] to be a benefit to other people.

“I feel very good about that.”

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Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leach@peninsuladailynews.com.

Last modified: December 22. 2013 9:31PM
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