Moose Lake Star Gazette - Serving Carlton and Pine Counties Since 1895

By C.M. Swanson
Moose Lake Star Gazette 

Unaware MA recipients appeal DHS estate claims

Couples go beyond filing appeals and go public with MNsure frustrations

 

C.M. Swanson

The estate of Rick and Rose Rayburn carries a $30,000 claim payable to the state upon their demise. The claim against them, which accrued following their enrollment in Medical Assistance, came as a surprise to the Rayburns. They canceled their coverage and are now appealing the claim. Pictured is the Rayburn's two-story combination barn and workshop, built by hand from logs hewn off their land.

C.M. Swanson

This is Part Three in a three article series regarding claims set by the state on personal assets of Medical Assistance (MA) recipients in the 55-65 age group who enrolled in the health care program through the Department of Human Services (DHS) via the MNsure exchange. (Search http://www.mlstargazette.com for previous articles.)

Scott and Ellen Killerud, Rick and Rose Rayburn, and Robert and Julie Gelle have been receiving a lot of telephone calls lately.

"It's just non-stop," said Julie Gelle. "Yesterday I got a call from a man in Alexandria who was just heartbroken. He said he never knew."

The experience the Killeruds, Rayburns, Gelles and the caller from Alexandria have in common is enrolling in MA through DHS via MNsure, then subsequently finding their names on the state Recovery Unit's list for claims on their estates due to having premiums paid on their behalf.

All have cancelled their MA programs. All made unsuccessful attempts to pay the amount of the claim, as there is no provision for paying the accrued amounts (respectively $11,000, $30,000 and $16,000) until death.

"I would like to pay what is actually due right now and get it behind me," said Scott Killerud.

The Killerud's situation is further complicated in that MA premiums were accumulating for several months while the couple was also paying MinnesotaCare premiums out of pocket.

"Essentially, we were being double billed," said Killerud.

The Killeruds are in the process of filing an appeal with DHS to correct the amount listed on the state Recovery Unit's records, and to potentially have the total amount dropped, as the couple was not made aware of state paid premiums when they enrolled in the program.

Affects of the

Affordable Care Act

Carrying insurance became mandatory with passage of the Affordable Care Act (ACA) in 2010. The ACA also expanded eligibility qualifications for Medicaid, called Medical Assistance in Minnesota, by dropping the asset test.

Historically, Minnesotans applying for MA had to liquidate their assets to receive health care benefits. When the asset test was dropped, the floodgates opened, particularly for the 55- to 65-year-old age group.

Typically, combined income of a couple living on Social Security puts them within 138 to 400 percent of federal poverty guidelines. That, combined with the state not taking personal assets into account, qualifies them for MA.

Employment and MA

One needn't be retired to qualify for MA. The Killeruds work a 480-acre cattle farm. He also works part-time grading/plowing roads for the county. The Rayburns work a farm as well. Rick Rayburn also drives truck on a part-time basis. However, due to the state's not taking assets into account, Ellen Killerud being in the 55- to 65-year-old age category, each couple's income levels qualify them for MA.

Like the Killeruds, the Rayburns and Gelles are in the process of filing an appeal with DHS regarding their listing with the state Recovery Unit due to premiums paid on their behalf without their knowledge.

"Nobody's going to tell you about this," said Rick Rayburn. "This is all under the carpet. They don't want you to find out because if you find out, you're going to cancel if you have anything to lose."

Affecting change

All three couples are going beyond filing appeals with DHS. Amongst them they've contacted MNsure, DHS, Lakes & Pines Community Action Council, Minnesota State Recovery Unit, Carlton County Public Health and Human Services, U.S. Rep. Rick Nolan and state Sen. Tony Lourey.

They've written letters to the editors of several newspapers, contacted reporters in print and broadcast media, spoken with family, friends and neighbors, and even put up notices in public places. People are reaching out to the Killeruds, Rayburns and Gelles for guidance, or even just to talk.

The couples are also affecting change for greater Minnesota through registering their concerns with legislators regarding not being informed of the DHS estate claim policy when enrolling for health care via MNsure.

"I found that I do agree with these constituents," said Lourey, "that the notice was insufficient and that we have an option to not pursue recoveries for basic health care."

Lourey said he has "bill-language" at DHS for evaluation regarding not pursuing state recoveries for basic health care services, particularly for those recoveries currently being anticipated under the Medicaid Expansion through ACA for the 55- to 65-year-old age group. Lourey said if the law can't be changed, at least the manner of notification could undergo renovation.

"If we're going to have this type of recovery, we absolutely have to make individuals aware that it is going to happen and give them an option," said Lourey.

Be warned,

computer systems decide

Carlton County Supervisor of Elderly and Disabled Financial and Healthcare Assistance Patti Hart noted in a written statement, "When people apply online or complete a paper MNsure application, their income will be evaluated for MA eligibility first.

"If the income is too high for MA, the income is compared to MinnesotaCare income limits, then APTC (Advance Premium Tax Credit), then unassisted health plans. The computer system will make them eligible for the first program in which their income meets the guidelines starting with MA."

Recourses to be taken

Hart further noted, "An enrollee should contact the county to request the MA be closed as soon as possible if they do not want MA coverage. A person can file an appeal with the Minnesota DHS if they feel their eligibility was incorrectly determined."

Asset reduction is not failsafe

Reducing or ridding oneself of assets so there is nothing left for the state to claim may have unintended consequences.

According to Hart, the MA recipient can dispose of assets in any way they wish as long as they do not need and request Long Term Care (LTC) services such as nursing home or home care benefits within five years of giving away assets without adequate compensation.

However, if someone gives away or sells assets for less than their fair value, there could be a penalty whereby MA will not pay for LTC services for a period of time based on the value of the asset that was given away or sold for less than its fair market value.

Is your name on

the state recovery list?

C.M. Swanson

Along with Rick and Rose Rayburn and Ellen and Scott Killerud, Julie and Robert Gelle have become the face of the "MNsure trap" - Medical Assistance enrollees unknowingly accruing claims on their estates.

According to a press release from Minnesota State Director of Communications and Marketing Shane Delaney, as of December 2015, over 10,000 consumers have been assisted through the MNsure system via MNsure.org, and through assistance of brokers, navigators and assisters.

If you are between 55 and 65 and have enrolled in an insurance plan through MNsure, if you are not paying premiums, you may have been routed to the DHS MA program.

If you have questions, contact the person who assisted you with your enrollment or contact the Minnesota Department of Human Services.

The Killeruds, Rayburns and Gelles continue to press through the appeal process and to get the word out to people in their situation about potential claims against their estates.

Rick Rayburn said his motivation lies in a quote from the 1800s journalist Ida B. Wells-Barnett, which he often repeats, "The way to right a wrong is to turn the light of truth on it."

 

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