Dilemma: Health Care or Marriage?
hippiemom
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Couples face divorce for Medicaid benefits
Monday, April 16, 2007
Zachary Lewis
Plain Dealer Reporter
Many low-income couples are sacrificing their marriages to pay their medical bills.
Although they are poor by most standards, they are discovering that they are not quite poor enough to qualify for Medicaid.
The elderly, the disabled or people with life-threatening diseases are particularly likely to split up in order to get the government-provided health coverage.
"Sadly, I don't think it's unusual," said Mieko Smith, professor of social work and director of the Biomedical and Health Institute at Cleveland State University.
"In order to get the maximum amount, they have to be independent, and if they want to fight it through the court system, they might not live to see the end."
William Browning, of the Columbus law firm Browning & Meyer, said he encounters three such cases every week. Of those, one usually proceeds to divorce, he said.
"It's more common now because of the change in law," he said, referring to the Deficit Reduction Act of 2005, which aims to cut federal Medicaid spending by $26.1 billion over 10 years.
Determining exactly how many people divorce for Medicaid is difficult. Most are reluctant to talk about it.
Sandra Buzney, a lawyer with the Cleveland law firm Hickman & Lowder, said most don't want their neighbors to know they're on public assistance or "living in sin."
"There is this misconception that people are living the life of Riley on benefits," she said.
More important, perhaps, Medicaid frowns on strategic divorces. Kathy Hoeffer, an assistant bureau chief with the Ohio Department of Job & Family Services, said they're considered a form of fraud.
"If we were widely aware of it, we would have to take action," she said.
More seniors in general are choosing to live single. According to the Administration on Aging in the U.S. Department of Health and Human Services, the number of divorced and separated seniors nationwide doubled between 1980 and 2005.
Jacquelyn Peterson, 63, of Berea might have been one of them.
She hasn't had health insurance since 1996, when the company she worked for moved to Atlanta. Her husband, a retired gas station employee, has been on disability since 2000. She herself has drawn on Social Security since 2004.
Between those two sources, the couple make $1,300 a month. That's just enough to keep Peterson from getting Medicaid to pay for treatment of her chronic obstructive pulmonary disease, a lung disease that makes breathing difficult.
Here's the rub. If the Petersons made $120 less - 90 percent of the federal standard for poverty - she would be eligible. But at that income level, $120 is the difference between scraping by and not.
"It's an impossible level to live on," Buzney said.
A social worker suggested the Petersons end their 17-year marriage. They opted to take their chances with illness instead.
"We thought about it," Peterson said. "But when they tell you to do that . . . I don't think it's right. . . . If you're going to get Medicaid and then you get divorced, who does that help?"
She's not the only one wondering.
Janet Lowder, of Hickman & Lowder, told the story of a client who quit her job to care for her husband when he developed cerebral palsy.
If the couple had divorced, the woman would have been paid by Medicaid for serving as the man's primary care-giver. But since they remained married, they received nothing.
Now, with three children at home, they're rapidly running through their savings.
"She just couldn't bring herself to do it," Lowder said.
The cruel calculus that prompts divorce isn't restricted to the poor. It affects former middle-class couples, too.
Many states allow couples applying for Medicaid to retain most of their assets, minus a certain contribution, such as $20,000, Browning said.
Ohio, however, is a "spend-down" state. Couples here seeking Medicaid for the long-term must reduce, or "spend down," their "countable" assets by 50 percent. Included in the sweep: private retirement accounts such as 401(k)s and IRAs.
Public retirement plans, such as those provided to government employees, are not counted, Browning said.
Legal maneuvering may protect some additional assets. But for the most part, healthy adults often are left to choose between divorcing their sick mate at their darkest hour and watching their life savings diminish along with their partner's health.
"It creates a burden on the well spouse," Browning said. "They're going to end up bankrupt."
How did it get like this?
The broadest explanation is that people today live longer and require more expensive care than they used to, and Medicaid hasn't kept pace. Meanwhile, politicians, facing budget overruns, continue to cut Medicaid spending.
It's not that Medicaid is anti-marriage, per se, Lowder said. It just seems that way to some.
"I don't think they laid these things out when they were looking at eligibility requirements," she said. "I think it's short-sightedness."
http://www.cleveland.com/medicaid/plaindealer/index.ssf?/base/other/117671261730590.xml&coll=2
Monday, April 16, 2007
Zachary Lewis
Plain Dealer Reporter
Many low-income couples are sacrificing their marriages to pay their medical bills.
Although they are poor by most standards, they are discovering that they are not quite poor enough to qualify for Medicaid.
The elderly, the disabled or people with life-threatening diseases are particularly likely to split up in order to get the government-provided health coverage.
"Sadly, I don't think it's unusual," said Mieko Smith, professor of social work and director of the Biomedical and Health Institute at Cleveland State University.
"In order to get the maximum amount, they have to be independent, and if they want to fight it through the court system, they might not live to see the end."
William Browning, of the Columbus law firm Browning & Meyer, said he encounters three such cases every week. Of those, one usually proceeds to divorce, he said.
"It's more common now because of the change in law," he said, referring to the Deficit Reduction Act of 2005, which aims to cut federal Medicaid spending by $26.1 billion over 10 years.
Determining exactly how many people divorce for Medicaid is difficult. Most are reluctant to talk about it.
Sandra Buzney, a lawyer with the Cleveland law firm Hickman & Lowder, said most don't want their neighbors to know they're on public assistance or "living in sin."
"There is this misconception that people are living the life of Riley on benefits," she said.
More important, perhaps, Medicaid frowns on strategic divorces. Kathy Hoeffer, an assistant bureau chief with the Ohio Department of Job & Family Services, said they're considered a form of fraud.
"If we were widely aware of it, we would have to take action," she said.
More seniors in general are choosing to live single. According to the Administration on Aging in the U.S. Department of Health and Human Services, the number of divorced and separated seniors nationwide doubled between 1980 and 2005.
Jacquelyn Peterson, 63, of Berea might have been one of them.
She hasn't had health insurance since 1996, when the company she worked for moved to Atlanta. Her husband, a retired gas station employee, has been on disability since 2000. She herself has drawn on Social Security since 2004.
Between those two sources, the couple make $1,300 a month. That's just enough to keep Peterson from getting Medicaid to pay for treatment of her chronic obstructive pulmonary disease, a lung disease that makes breathing difficult.
Here's the rub. If the Petersons made $120 less - 90 percent of the federal standard for poverty - she would be eligible. But at that income level, $120 is the difference between scraping by and not.
"It's an impossible level to live on," Buzney said.
A social worker suggested the Petersons end their 17-year marriage. They opted to take their chances with illness instead.
"We thought about it," Peterson said. "But when they tell you to do that . . . I don't think it's right. . . . If you're going to get Medicaid and then you get divorced, who does that help?"
She's not the only one wondering.
Janet Lowder, of Hickman & Lowder, told the story of a client who quit her job to care for her husband when he developed cerebral palsy.
If the couple had divorced, the woman would have been paid by Medicaid for serving as the man's primary care-giver. But since they remained married, they received nothing.
Now, with three children at home, they're rapidly running through their savings.
"She just couldn't bring herself to do it," Lowder said.
The cruel calculus that prompts divorce isn't restricted to the poor. It affects former middle-class couples, too.
Many states allow couples applying for Medicaid to retain most of their assets, minus a certain contribution, such as $20,000, Browning said.
Ohio, however, is a "spend-down" state. Couples here seeking Medicaid for the long-term must reduce, or "spend down," their "countable" assets by 50 percent. Included in the sweep: private retirement accounts such as 401(k)s and IRAs.
Public retirement plans, such as those provided to government employees, are not counted, Browning said.
Legal maneuvering may protect some additional assets. But for the most part, healthy adults often are left to choose between divorcing their sick mate at their darkest hour and watching their life savings diminish along with their partner's health.
"It creates a burden on the well spouse," Browning said. "They're going to end up bankrupt."
How did it get like this?
The broadest explanation is that people today live longer and require more expensive care than they used to, and Medicaid hasn't kept pace. Meanwhile, politicians, facing budget overruns, continue to cut Medicaid spending.
It's not that Medicaid is anti-marriage, per se, Lowder said. It just seems that way to some.
"I don't think they laid these things out when they were looking at eligibility requirements," she said. "I think it's short-sightedness."
http://www.cleveland.com/medicaid/plaindealer/index.ssf?/base/other/117671261730590.xml&coll=2
"Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity." ~ MLK, 1963
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The lady told us a story about an elderly couple who came in to talk to her and the lady had cancer and was on expensive drugs...the couple made $1 too much to get help, but their incomes separately would qualify them for help.
For many years now I have heard of elderly people divorcing just so they can afford health care.
So much for the government's "famiuly values" campaign.
Its something like you can make $15,000 if single and get help, but if a couple, $19,000 is too much for any help. Those aren't the exact numbers but close.
~Ron Burgundy
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