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

By C.M. Swanson
Moose Lake Star-Gazette 

Minnesota MA estate liens put to final rest


C.M. Swanson

While Rick Rayburn feels a sense of accomplishment at passage of the Minnesota law, he and members of the grass roots coalition are now focused on changes at the federal level.

On Friday, May 12, for the second time, Gov. Mark Dayton (DFL) signed a bill into law ending Minnesota's ability to place estate claims on people receiving Medical Assistance (MA) for general health care costs paid on their behalf.

Friday's bill (SF216), and a similar bill passed in 2016, came about through the efforts of a grass roots coalition formed to bring about change in the way the Minnesota Department of Human Service's (DHS) routed people to MA when signing up for general health care services through the MNSure website. With recipients of MA, the state retained the right of recovery for all health care costs paid on behalf of the client by placing estate claims, which activated to liens, upon the death of the recipient.

The coalition first consisted of Minnesota residents Scott and Ellen Killerud, Rick and Rose Rayburn, Robert and Julie Gelle, and Claudia Foussard. All had been routed to MA, unbeknownst to them. All were shocked to discover state claims on their estates for $11,000, $30,000, and $16,000, and $20,000 (respectively).

"It took a lot of sleepless nights, phone calls, and emails to right a wrong," said coalition member Julie Gelle. "I learned your voice can and will make a difference if you stand up for what you believe in."

How did that happen?

In 1965, Medicaid, an MA program, was established with Medicare as a joint federal and state program created to assist with coverage of medical costs for people with limited income. Traditionally, its primary recipients were people with disabilities or those in need of long-term care. At that time, to qualify for MA, Minnesotan's had to liquidate assets, such as a house, car, motorcycle, boat, savings account, or retirement plan.

Enter ACA

A significant change occurred for Americans with passage of the Affordable Care Act (ACA) in 2010, a federal level program making health care insurance mandatory. However, it was the expansion of the ACA in January 2014 that was the real game changer for people in Minnesota whose legislators took the option of expanding eligibility qualifications for Medicaid by no longer disqualifying applicants because they held assets.

Typically, the combined income of a couple living on Social Security put applicants within 138 to 400 percent of federal poverty guidelines. That, combined with the state dropping the requirement to liquidate assets, qualified over 80,000 people, primarily between the ages of 55-65, for MA.

The coalition goes into action

When the coalition discovered state claims on their estates, they began a yearlong campaign to get the law changed at the state level. The first action for each of them was to close their account with DHS. Members then contacted county officials, DHS representatives, state representatives and legislators, media sources, family, friends, neighbors and associates to disseminate information. Claudia Foussard even created a Facebook campaign. They wrote and encouraged others to write letters to the editors of local newspapers. They called and encouraged others to call officials to register their discontent and request a change in the law.

Members of the coalition testified before the House of Representatives, Senate and a variety of committees resulting in a bill placed in an Omnibus supplemental budget bill (HF2749) presented to and signed by Gov. Dayton on June 1, 2016. However, even before the champagne dried on the cork during their celebration, the coalition learned the Centers for Medicare and Medicaid Services (CMS), a federal level agency, was requesting a change in the wording of the law passed in Minnesota, effectively rendering HF2749 powerless.

The coalition goes

into action ... again

Though Minnesota DHS began applying the law signed by Gov. Dayton in 2016, the option remained open at the federal level to revert to the estate claim policy. CMS wanted verbiage in the law signed by Gov. Dayton to include recipients of MA prior to January 1, 2014, the date stated in the law. While the date change was intended to benefit more Minnesotans, it resulted in the necessity of writing a new law.

The coalition went back into action, this time, having gathered a year's worth of experience, a larger following of Minnesota residents and increased support from non-profit organizations with similar missions.

The coalition closely followed the action as new language was incorporated into a bill presented to the House and Senate in May 2017, which passed unanimously. However, when the coalition learned the bill was then put into an Omnibus Health Care Bill for signing by the governor, their objection was immediate and vehement.

"I was so excited a year ago when we passed this and the governor signed the bill," said Claudia Foussard. "Then we had the glitch from the feds. I just feel the rug has been pulled out so many times. I don't trust any of it."

Members of the coalition threw themselves into a telephone and email campaign contacting state legislators. Just 10 days before summer break, the law was pulled from the Omnibus Health Care Bill and left to stand on its own.

In a victory for the grass root coalition's 15-month battle, Friday, May 12, Gov. Dayton signed bill SF216 into law, finally preventing claims to be placed on estates of Minnesotans on MA to recover costs paid by the state for general medical assistance on behalf of recipients.

"Through many twists and turns, we were able, as a group, to muster the energy and time required to shepard these legislators to our ultimate goal," said Scott and Ellen Killerud. "We learned that a loosely organized, tenacious core of citizens, once wronged, can make needed changes if they are, indeed, sincere."

Keeping watch

Though the coalition met their goal to change the law at a state level, experience, passion and drive keeps them focused. Many in the expanded group have now pivoted to the federal level where states still have the option to engage in estate claims to recover health care costs.

"We are in the estate lien debacle for the long haul," said Julie Gelle. "It is a very long journey with a lot of bumps and bruises that you feel every step of the way, but we can't quit now."

"Ultimately, safety from MA estate liens can only be guaranteed by withdrawal of the lien option at the federal level," said coalition member Rick Rayburn. "What we should all take away from this unpleasant experience is that, as citizens, we cannot and must not expect that others will always look out for our wellbeing. We must, each and every one, shoulder some of that responsibility."


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