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How This State's Expanded Medicaid Program Incentivized a Washington Couple to Get Married


“Unfortunately not everyone has such an elegant solution to the problem.”

A Washington couple got married recently so they could avoid Medicaid expenses being billed to their estate.

By marrying, Sofia Prins and Gary Balhorn, both 62, now earn a combined income that's too high to qualify for Medicaid, but low enough to qualify for Obamacare tax credits, the Seattle Times reported.

The Affordable Care Act states that if an individual qualifies for Medicaid, they can’t qualify for tax credits to enroll in Obamacare.

This is where things get tricky: Washington expects roughly 223,000 adults to enroll in the state’s expanded Medicaid program over the next three years.

But Medicaid’s “estate-recovery" rules, which gives the state the power to collect on medical expenses, have some questioning the viability of the program as it evolves under Obamacare

Medicaid has long billed estates for ordinary health care expenses. But the way it worked pre-Obamacare is that recovery was regulated mostly to expenses for nursing homes and similar long-term care. However, thousands of low-income individuals are now eligible for Medicaid thanks to the Affordable Care Act, meaning there could be some serious issues involving state recovery of expenses.

Prins and Balhorn, for example, separately qualified for Medicaid based on their individual incomes -- but then the estate issue came into play.

So the couple decided to combine their incomes by getting married, qualifying them for a subsidized health plan. That way, the couple said, they can leave Prins' two sons a home that won't be on the hook for their health care bills.

“We’re happy to be getting married,” Prins told the Seattle Times. “Unfortunately not everyone has such an elegant solution to the problem.”

State lawmakers, including Gov. Jay Inslee, have begun work on an emergency rule that would “limit estate recovery to long-term care and related medical expenses,” the Seattle Times reported.

Unfortunately, according to Bob Crittenden, Gov. Inslee’s senior health policy adviser, the fix could cost the state as much as $3 million per year.

Regardless of the cost, Inslee’s office argues it’s “the right thing to do.”

“There was no intent on the part of the ACA to do estate recovery on people going into Medicaid (for health insurance),” Crittenden said. “The idea was to expand coverage.”

Click here to read more from the Seattle Times.


Follow Becket Adams (@BecketAdams) on Twitter


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