Opponents have nicknamed one provision of Medicaid the “Obamacare death debt.”

They are referring to the Medicaid Estate Recovery Program. And while it does exist, it predates Obamacare by two decades.

The Medicaid Estate Recover Program is how the federal government is repaid for money it spent on a lengthy stay in the nursing home. If someone was on Medicaid, the government can, in some instances, put a lien on his estate after his death.

That’s been the rule since 1993, when Washington told the states they had to try to recoup what Medicaid spent on nursing home care and related expenses for Medicaid recipients 55 and older.

Here’s where Obamacare comes in: The Affordable Care Act encourages states to expand their Medicaid rolls so single people and childless couples can now qualify if poor enough.

That means thousands of newcomers to Medicaid may not realize that ultimately they may have to repay the piper.

“For the uninformed, it could be a problem,” said John Callinan, a Middletown certified elder law attorney. “It can be a trap for the unwary.”

The prospect of seeing her estate docked for her medical bills makes one 60-year-old Ocean County woman reluctant to enroll in Medicaid, even though she and her husband both qualify. The retired couple lives on modest retirement 401(K) savings.
She’s debating whether she should go without insurance entirely — and face a fine — or enroll in Medicaid and leave her small estate vulnerable years down the road.

“It’s a concern, because it does leave the door open that they can come after you,” said Linda E., who didn’t want her full name used because she said she didn’t want to attract the attention of the government. “It could open up a big can of worms.”

The asset that usually prompts the most attention is a Medicaid recipient’s house, he noted. It isn’t counted as an asset when a person applies for Medicaid. In other words, if a homeowner has little income, he can qualify for Medicaid. After the homeowner dies, the government will typically file a lien on his house.

However, there are exceptions. The government will not seek money from the sale of the house if the homeowner’s spouse still lives there, or if there are children under the age of 21.

But if there is no surviving spouse or minor children, the heirs may discover the lien when they sell the house. Sometimes, said Callinan, that can be years later. “If the kids go to sell it 20 years from now, that lien will pop up,” he said.

People can sign up for NJ FamilyCare, New Jersey’s Medicaid program, throughout the year. However, the state saw a surge of new applicants as people seeking health insurance through the Obamacare website learned their income was so low they qualified for Medicaid.

There is no asset test for Medicaid; only income and available cash resources determine eligibility, according to Nicole Brossoie, spokeswoman for the state Department of Human Services.

By the end of March, NJ FamilyCare had nearly 1.4 million residents enrolled. Roughly half of them are children. Just over 84,000 are categorized as “aged.”

In New Jersey, liens were filed against 325 estates in 2012, and 343 estates last year, according to Brossoie. Medicaid doesn’t seek repayment while the recipient is still alive, she said.

The state doesn’t get first dibs on estate funds, though, said Callinan. Ahead of it in line for payment are funeral expenses, medical bills from the final illness and the executor’s administrative fee, he said.

The prospect of repaying Medicaid after one’s death wasn’t a big deal for most of the people who enrolled in Obamacare over the last few months, said Leah D. Dade, executive director of the Paterson Alliance, a collection of community groups.

The reason? Most were too poor to have any assets to worry about.

“They have so little,” she said. “They’re not owning houses.”

The backlog that applicants to the state’s expanded Medicaid program have complained about showed up in the latest enrollment numbers released by Obamacare officials.

Expansion of the program to singles and childless couples has been a popular component of the Affordable Care Act in New Jersey. Data released Friday show new applications during January and February alone totaled just over 30,000.

However, only 4,878 of those – or just one out of every six — made it all the way through the process.

Nationally, Medicaid enrollment is up 8 percent. In New Jersey, it is up by 6 percent. At the end of February, total enrollment was 1,361,513 people.

Some of the people who applied for Medicaid have complained they haven’t received their proof-of-insurance cards and sometimes learn neither the state nor the federal government has a record of their enrollment.

New Jersey’s Medicaid program is called NJ FamilyCare. Officials there said the initial backlog was caused by the unusable data sent to them by the federal government. U.S. Health and Human Services Secretary Kathleen Sebelius confirmed that in early February, and indicated at the time that the technical problem would be solved in a matter of days.

New Jersey is one of only three states – joining Arizona and North Dakota – that chose to expand Medicaid within their states, yet rely on the federal website to do the enrolling. (The more common approaches were for states to expand Medicaid and set up their own websites, or decide they wanted neither to expand Medicaid nor set up a website.)

Transferring enrollment data from healthcare.gov to New Jersey has been balky at best. NJ FamilyCare’s website assures applicants their enrollment will be retroactive to Jan. 1, but that has been little solace to applicants, who say they can’t risk going to a doctor if it’s not going to be covered.

As a nuclear medicine technician who has seen his work hours cut to just eight a week, Dhiru Dhebaria, of Edison, was thrilled to discover he, his wife and his son now qualified for expanded Medicaid.

After answering some extra questions about his wife’s immigration status, all three were approved last fall for NJ FamilyCare, as Medicaid is called in New Jersey.
He and his son got their proof-of-insurance cards. But his wife, Bharatiben, is still waiting for hers.

“I’ve been calling every week for five months,” he said. “I don’t have a clue what to do.”

By all accounts, enrollment in the expanded Medicaid program has gone well in New Jersey. The numbers are robust as the program’s expansion under the Affordable Care Act allows single residents and childless couples to get coverage provided their income is low enough. But getting an actual ID card that allows someone to see a doctor? The flood of applicants appears to have resulted in a systemwide backlog, according to applicants and field workers.

“I’ve heard getting an actual Medicaid card is nearly impossible. It’s like getting Willy Wonka’s Golden Ticket,” said Rena Jordan, director of external affairs for Planned Parenthood of Metropolitan Jersey, which has been helping patients enroll.

“A lot of strange things have been happening, that’s the easiest way to say it,” said Virginia Nelson, administrative supervisor of the Medicaid Department for Middlesex County.

The flood of phone calls to her office about older cases has taken time away from processing the newest cases, Nelson said.

Federal officials conceded some of the blame for the delay can be put squarely at the feet of the federal website, healthcare.gov. That website transferred data about applicants whose income looked like they might qualify for Medicaid to the state system, but in a format the state system couldn’t use.

Since the state received the information about enrollees from the federal website, it has processed about 60,000 of those applications, said Nicole Brossoie, spokeswoman for NJ FamilyCare.

Compounding the problem is some people have submitted duplicate applications, which the agency then has to sort through, according to Brossoie.

The ACA enrollment counselor at Planned Parenthood of Metropolitan New Jersey has helped 230 patients sign up for either private insurance or Medicaid via the federal website, healthcare.gov.

So far not a single one of the Medicaid enrollees has received a card, said Kalimah Johnson. Worse yet, she said she can’t get any answers on their behalf.

“Medicaid is not responding to anyone,” she said. The state’s toll-free number sometimes works and sometimes cuts off callers. Essex County’s phone number for local Medicaid inquiries reaches a recording that its message box is full.

“It disconnects you,” Johnson said. “It doesn’t even work to let you leave a number.” (In response to an inquiry, a spokesman for Essex County said all comments had to come from Brossoie.)

Without a card, patients — even women who are pregnant — can’t see a doctor unless they’re willing to pay out of pocket.

Kim Peterson, 51, of East Orange, has her Medicaid confirmation number, but no card. Inquiries get her nowhere. “I haven’t heard anything from anyone,” she said.
She’s a substitute teacher and part-time college student who wants to keep up on her preventive doctor and dentist visits, but for now, that means finding room in her budget for the $50 office fee. “It’s adding up,” she said.

People in her situation should be able to get care at hospitals or any federally qualified health center, Brossoie said. They will have what’s called “presumptive eligibility,” but will need to fill out an interim application once there.

New Jersey is one of three states that chose to both expand Medicaid and rely on the federal website instead of operating its own. It took months to resolve the technical problem of transferring information between the two programs, said Rachel Klein, enrollment program director of Families America, a non-profit that supports the new law.

Since December, NJ FamilyCare enrollment has grown by about 83,000, for a total of about 1,387,000 residents. Just under half are children.

Unlike Obamacare, there is no enrollment deadline to seek coverage through NJ FamilyCare. People may sign up throughout the year.

Jennifer Barrett Sryfi, director of community programs at the New Jersey Hospital Association, coordinates enrollment for the health exchange and Medicaid. As the March 31 deadline nears to enroll in a private health plan, the association is spreading the word there is no deadline for Medicaid and NJ FamilyCare.

Q: How is the Affordable Care Act different from NJ FamilyCare and Medicaid?

A: The plans available on the ACA’s online marketplace at healthcare.gov are open to anyone lawfully present in the United States. In addition, some adults within certain income requirements — between 138 and 400 percent of the federal poverty level — and who do not have access to affordable, essential coverage may qualify for tax credits and other subsidies. Medicaid and NJ FamilyCare, on the other hand, are specifically state-run programs that serve those who earn even less.

Q: How do I know if I am eligible?

A: I mentioned the income guideline — below 138 percent of the federal poverty level. To give people a rough idea of what that means, it equals $15,857 for an individual and $32,499 for a family of four. Some websites, like Get Covered America and NJ Helps, provide online calculators to help people check for eligibility. Consumers also can talk with an ACA navigator or certified application counselor — NJHA employs certified application counselors across the state., and they are providing individual enrollment assistance beyond March 31.

Q: Are there enough doctors who take NJ FamilyCare and Medicaid?

A: This remains a concern. In general under the ACA, and particularly for Medicaid, there have been reports that show a shortage of available physicians, especially in primary care.

It can vary further by region, by health plan selected and by type of specialty needed. For any enrollee that has trouble finding a physician, I would encourage them to find a primary care medical home with their local federally qualified health center. Find one here.

Q: Do I need a computer to sign up?

A: Technically no, but in reality signing up for NJ FamilyCare or Medicaid is really geared toward online applications at their web site.

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TRENTON — Gov. Chris Christie said today he was “proud” of his decision to expand Medicaid through the Affordable Care Act, but plans to introduce better oversight to the $12 billion program so it can serve the 1.4 million people who rely on it for health care, housing and other services.

In his state budget address today, Christie took aim at what the medical professionals call “super-utilizers:” the people with chronic health conditions that frequently end up in emergency rooms and get admitted to the hospital. He said he has enlisted the nine schools that make up Rutgers Biomedical and Health Sciences, as well as University Hospital in Newark, and Rutgers Camden, to find a more cost-effective way to reduce their reliance on costly hospital care.

“Last year, 5 percent of Medicaid recipients accounted for 50 percent of the costs,” Christie said. “More than 16,000 Medicaid recipients visited emergency rooms six or more times last year.”

He added, “I am proud to have made the decision to expand Medicaid and provide greater access to healthcare for New Jerseyans in need. But greater access necessitates larger reforms as well.”

The key is managing patient care more closely, Christie said, and the state is working with insurance carriers that provide Medicaid coverage to develop an “accountable care organization” to track these patients more carefully.

Rutgers Center for State Health Policy and the Robert Wood Johnson Foundation released a study Monday based on hospital admission data from 2007 to 2010, that found 55 percent of patients with 15 or more admissions visited more than one hospital. One in five had used three or more hospitals.

The state’s Medicaid program would get $200 million more in Christie’s $34.4 billion budget. He agreed to expand New Jersey’s Medicaid program under President Obama’s Affordable Care Act last year. In his next budget, the state will get about $100 million from the federal government and $100 million from the state.

Larry Downs, chief executive of the Medical Society of New Jersey, a lobbying group for doctors, said they “have a unique frontline perspective of the barriers and problems inherent in the current Medicaid program.”

“It remains a stubborn fact that access to physician services, particularly specialty care, is a challenge in the New Jersey Medicaid program,” Downs said. “Our citizens deserve access to a wide range of both primary care and specialist physicians when they need them.”

The budget also dedicates $125 million in state Medicaid funds to providing home-based support services to prevent senior citizens and adults with disabilities from needing institutional care.

Christie’s budget commits a total of $985.1 million toward hospital aid – the same amount as the current budget. But he deducted $25 million from the charity care pool, reducing it to $650 million, and moved $25 million to University Hospital “to continue to support its role as a health care cornerstone of the Newark Community, including maintaining its status as a Level 1 Trauma Center.”

Star-Ledger staff writer Salvador Rizzo contributed to this report.

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TRENTON — Gov. Chris Christie said today he was “proud” of his decision to expand Medicaid through the Affordable Care Act, but plans to introduce better oversight to the $12 billion program so it can serve the 1.4 million people who rely on it for health care, housing and other services.

In his state budget address today, Christie took aim at what the medical professionals call “super-utilizers:” the people with chronic health conditions that frequently end up in emergency rooms and get admitted to the hospital. He said he has enlisted the nine schools that make up Rutgers Biomedical and Health Sciences, as well as University Hospital in Newark, and Rutgers Camden, to find a more cost-effective way to reduce their reliance on costly hospital care.

“Last year, 5 percent of Medicaid recipients accounted for 50 percent of the costs,” Christie said. “More than 16,000 Medicaid recipients visited emergency rooms six or more times last year.”

He added, “I am proud to have made the decision to expand Medicaid and provide greater access to healthcare for New Jerseyans in need. But greater access necessitates larger reforms as well.”

The key is managing patient care more closely, Christie said, and the state is working with insurance carriers that provide Medicaid coverage to develop an “accountable care organization” to track these patients more carefully.

Rutgers Center for State Health Policy and the Robert Wood Johnson Foundation released a study Monday based on hospital admission data from 2007 to 2010, that found 55 percent of patients with 15 or more admissions visited more than one hospital. One in five had used three or more hospitals.

The state’s Medicaid program would get $200 million more in Christie’s $34.4 billion budget. He agreed to expand New Jersey’s Medicaid program under President Obama’s Affordable Care Act last year. In his next budget, the state will get about $100 million from the federal government and $100 million from the state.

Larry Downs, chief executive of the Medical Society of New Jersey, a lobbying group for doctors, said they “have a unique frontline perspective of the barriers and problems inherent in the current Medicaid program.”

“It remains a stubborn fact that access to physician services, particularly specialty care, is a challenge in the New Jersey Medicaid program,” Downs said. “Our citizens deserve access to a wide range of both primary care and specialist physicians when they need them.”

The budget also dedicates $125 million in state Medicaid funds to providing home-based support services to prevent senior citizens and adults with disabilities from needing institutional care.

Christie’s budget commits a total of $985.1 million toward hospital aid – the same amount as the current budget. But he deducted $25 million from the charity care pool, reducing it to $650 million, and moved $25 million to University Hospital “to continue to support its role as a health care cornerstone of the Newark Community, including maintaining its status as a Level 1 Trauma Center.”

Star-Ledger staff writer Salvador Rizzo contributed to this report.

RELATED COVERAGE

• Chris Christie pitches pension fix in $34.4B NJ budget

• N.J. doctors least likely to accept new Medicaid patients, survey says

• More Politics

TRENTON — Gov. Chris Christie said today he was “proud” of his decision to expand Medicaid through the Affordable Care Act, but plans to introduce better oversight to the $12 billion program so it can serve the 1.4 million people who rely on it for health care, housing and other services.

In his state budget address today, Christie took aim at what the medical professionals call “super-utilizers:” the people with chronic health conditions that frequently end up in emergency rooms and get admitted to the hospital. He said he has enlisted the nine schools that make up Rutgers Biomedical and Health Sciences, as well as University Hospital in Newark, and Rutgers Camden, to find a more cost-effective way to reduce their reliance on costly hospital care.

“Last year, 5 percent of Medicaid recipients accounted for 50 percent of the costs,” Christie said. “More than 16,000 Medicaid recipients visited emergency rooms six or more times last year.”

He added, “I am proud to have made the decision to expand Medicaid and provide greater access to healthcare for New Jerseyans in need. But greater access necessitates larger reforms as well.”

The key is managing patient care more closely, Christie said, and the state is working with insurance carriers that provide Medicaid coverage to develop an “accountable care organization” to track these patients more carefully.

Rutgers Center for State Health Policy and the Robert Wood Johnson Foundation released a study Monday based on hospital admission data from 2007 to 2010, that found 55 percent of patients with 15 or more admissions visited more than one hospital. One in five had used three or more hospitals.

The state’s Medicaid program would get $200 million more in Christie’s $34.4 billion budget. He agreed to expand New Jersey’s Medicaid program under President Obama’s Affordable Care Act last year. In his next budget, the state will get about $100 million from the federal government and $100 million from the state.

Larry Downs, chief executive of the Medical Society of New Jersey, a lobbying group for doctors, said they “have a unique frontline perspective of the barriers and problems inherent in the current Medicaid program.”

“It remains a stubborn fact that access to physician services, particularly specialty care, is a challenge in the New Jersey Medicaid program,” Downs said. “Our citizens deserve access to a wide range of both primary care and specialist physicians when they need them.”

The budget also dedicates $125 million in state Medicaid funds to providing home-based support services to prevent senior citizens and adults with disabilities from needing institutional care.

Christie’s budget commits a total of $985.1 million toward hospital aid – the same amount as the current budget. But he deducted $25 million from the charity care pool, reducing it to $650 million, and moved $25 million to University Hospital “to continue to support its role as a health care cornerstone of the Newark Community, including maintaining its status as a Level 1 Trauma Center.”

Star-Ledger staff writer Salvador Rizzo contributed to this report.

RELATED COVERAGE

• Chris Christie pitches pension fix in $34.4B NJ budget

• N.J. doctors least likely to accept new Medicaid patients, survey says

• More Politics

TRENTON — Gov. Chris Christie said today he was “proud” of his decision to expand Medicaid through the Affordable Care Act, but plans to introduce better oversight to the $12 billion program so it can serve the 1.4 million people who rely on it for health care, housing and other services.

In his state budget address today, Christie took aim at what the medical professionals call “super-utilizers:” the people with chronic health conditions that frequently end up in emergency rooms and get admitted to the hospital. He said he has enlisted the nine schools that make up Rutgers Biomedical and Health Sciences, as well as University Hospital in Newark, and Rutgers Camden, to find a more cost-effective way to reduce their reliance on costly hospital care.

“Last year, 5 percent of Medicaid recipients accounted for 50 percent of the costs,” Christie said. “More than 16,000 Medicaid recipients visited emergency rooms six or more times last year.”

He added, “I am proud to have made the decision to expand Medicaid and provide greater access to healthcare for New Jerseyans in need. But greater access necessitates larger reforms as well.”

The key is managing patient care more closely, Christie said, and the state is working with insurance carriers that provide Medicaid coverage to develop an “accountable care organization” to track these patients more carefully.

Rutgers Center for State Health Policy and the Robert Wood Johnson Foundation released a study Monday based on hospital admission data from 2007 to 2010, that found 55 percent of patients with 15 or more admissions visited more than one hospital. One in five had used three or more hospitals.

The state’s Medicaid program would get $200 million more in Christie’s $34.4 billion budget. He agreed to expand New Jersey’s Medicaid program under President Obama’s Affordable Care Act last year. In his next budget, the state will get about $100 million from the federal government and $100 million from the state.

Larry Downs, chief executive of the Medical Society of New Jersey, a lobbying group for doctors, said they “have a unique frontline perspective of the barriers and problems inherent in the current Medicaid program.”

“It remains a stubborn fact that access to physician services, particularly specialty care, is a challenge in the New Jersey Medicaid program,” Downs said. “Our citizens deserve access to a wide range of both primary care and specialist physicians when they need them.”

The budget also dedicates $125 million in state Medicaid funds to providing home-based support services to prevent senior citizens and adults with disabilities from needing institutional care.

Christie’s budget commits a total of $985.1 million toward hospital aid – the same amount as the current budget. But he deducted $25 million from the charity care pool, reducing it to $650 million, and moved $25 million to University Hospital “to continue to support its role as a health care cornerstone of the Newark Community, including maintaining its status as a Level 1 Trauma Center.”

Star-Ledger staff writer Salvador Rizzo contributed to this report.

RELATED COVERAGE

• Chris Christie pitches pension fix in $34.4B NJ budget

• N.J. doctors least likely to accept new Medicaid patients, survey says

• More Politics

TRENTON — Gov. Chris Christie said today he was “proud” of his decision to expand Medicaid through the Affordable Care Act, but plans to introduce better oversight to the $12 billion program so it can serve the 1.4 million people who rely on it for health care, housing and other services.

In his state budget address today, Christie took aim at what the medical professionals call “super-utilizers:” the people with chronic health conditions that frequently end up in emergency rooms and get admitted to the hospital. He said he has enlisted the nine schools that make up Rutgers Biomedical and Health Sciences, as well as University Hospital in Newark, and Rutgers Camden, to find a more cost-effective way to reduce their reliance on costly hospital care.

“Last year, 5 percent of Medicaid recipients accounted for 50 percent of the costs,” Christie said. “More than 16,000 Medicaid recipients visited emergency rooms six or more times last year.”

He added, “I am proud to have made the decision to expand Medicaid and provide greater access to healthcare for New Jerseyans in need. But greater access necessitates larger reforms as well.”

The key is managing patient care more closely, Christie said, and the state is working with insurance carriers that provide Medicaid coverage to develop an “accountable care organization” to track these patients more carefully.

Rutgers Center for State Health Policy and the Robert Wood Johnson Foundation released a study Monday based on hospital admission data from 2007 to 2010, that found 55 percent of patients with 15 or more admissions visited more than one hospital. One in five had used three or more hospitals.

The state’s Medicaid program would get $200 million more in Christie’s $34.4 billion budget. He agreed to expand New Jersey’s Medicaid program under President Obama’s Affordable Care Act last year. In his next budget, the state will get about $100 million from the federal government and $100 million from the state.

Larry Downs, chief executive of the Medical Society of New Jersey, a lobbying group for doctors, said they “have a unique frontline perspective of the barriers and problems inherent in the current Medicaid program.”

“It remains a stubborn fact that access to physician services, particularly specialty care, is a challenge in the New Jersey Medicaid program,” Downs said. “Our citizens deserve access to a wide range of both primary care and specialist physicians when they need them.”

The budget also dedicates $125 million in state Medicaid funds to providing home-based support services to prevent senior citizens and adults with disabilities from needing institutional care.

Christie’s budget commits a total of $985.1 million toward hospital aid – the same amount as the current budget. But he deducted $25 million from the charity care pool, reducing it to $650 million, and moved $25 million to University Hospital “to continue to support its role as a health care cornerstone of the Newark Community, including maintaining its status as a Level 1 Trauma Center.”

Star-Ledger staff writer Salvador Rizzo contributed to this report.

RELATED COVERAGE

• Chris Christie pitches pension fix in $34.4B NJ budget

• N.J. doctors least likely to accept new Medicaid patients, survey says

• More Politics