State limits recovery of Medicaid patients’ estates

Peninsula Daily News

The state has instituted an emergency rule that limits recovery from Medicaid patients’ estates, easing concerns of those 55 or older who have signed up or are considering applying for the expanded Medicaid option for health care.

The change came into effect Wednesday, when the state program, called Apple Health, began.

The emergency amendment to the Washington Administrative Code means a Medicaid client’s estate will no longer be liable for the all costs of Medicaid services other than long-term care and related prescription drug and hospital costs.

State regulations originally permitted the state to bill the estate of Medicaid recipients who were 55 or older for all medical costs.

The state Health Care Authority filed the emergency amendment after officials heard from those reluctant to sign up for free Medicaid after the federal Affordable Care Act increased the number of low-income residents eligible for it.

Port Townsend couple

Among those who raised concerns were Sofia Prins and Gary Balhorn of Port Townsend, both 62, who were wed Dec. 15 to avoid risking his house and land and her possible future earnings as an artist.

The marriage raised their combined income enough to enable them to receive tax credits for private insurance and avoid Medicaid coverage.

Had the state provision been changed earlier, the two, who had been together for four years, would not have married so quickly, Prins said.

“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.”

The provision had been in place since 2004, when the state Legislature authorized it, but had been used very little, the agency said.

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

Federal law requires state recovery for long-term-care services.

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, the agency said.

Apply anytime

Applications for Washington Apple Health — Medicaid — can be made at anytime throughout the year.

It’s different for those signing up for private plans. The enrollment period ended Dec. 23, but those who had not finished their applications for health coverage through before then have until Jan. 15 to enroll in retroactive coverage that began Wednesday.

Medicaid clients also must renew their applications once a year.

To apply or renew, visit

For more information about Apple Health, phone toll-free 800-562-3022 or email

Last modified: January 01. 2014 5:52PM
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