Medicaid rule change coming, but not yet

By Leah Leach
Peninsula Daily News

The state Health Care Authority plans to file an emergency rule early this week that will limit recovery from Medicaid patients’ estates.

“It’s still in progress,” said Jim Stevenson, spokesman for the agency, on Friday.

“It will take effect immediately when it is filed, so it can be filed Tuesday and be in effect Wednesday,” when the state’s expanded Medicaid program comes into effect, he said.

The emergency amendment to the Washington Administrative Code will limit Medicaid estate recovery to long-term care and related medical expenses, officials have said.

That will change the present provision which allows the state to bill the estates of those 55 on Medicaid for ordinary health-care expenses.

Had the change been made earlier, Sofia Prins and Gary Balhorn of Port Townsend, both 62, would not have rushed to marry on Dec. 15.

“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 found the provision while looking through paperwork as the two, who have been together for about four years, prepared to sign up for Medicaid coverage, called Apple Health in Washington state, after the federal Affordable Care Act increased the number of low-income residents eligible for free Medicaid.

Prins and Balhorn 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.

Questions raised by Prins and others led to a change in the rule, Stevenson said earlier this month.

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

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

Health Care Authority Director Dorothy Teeter said nearly all current recoveries are tied to long-term care clients.


Managing Editor/News Leah Leach can be reached at 360-417-3531 or at

Last modified: December 28. 2013 5:27PM
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