Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death. Obamacare penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs.

◼ As thousands of state residents enroll in Washington’s expanded Medicaid program, many will be surprised at fine print: After you’re dead, your estate can be billed for ordinary health-care expenses. - Seattle Times

...As fine print is wont to do, it had buried itself in a long form — (Gary) Balhorn’s application for free health insurance through the expanded state Medicaid program. As the paperwork lay on the dining-room table in Port Townsend, (Sophia) Prins began reading.

She was shocked: If you’re 55 or over, Medicaid can come back after you’re dead and bill your estate for ordinary health-care expenses.

The way Prins saw it, that meant health insurance via Medicaid is hardly “free” for Washington residents 55 or older. It’s a loan, one whose payback requirements aren’t well advertised. And it penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs, Prins said....

Medicaid, in keeping with federal policy, has long tapped into estates. But because most low-income adults without disabilities could not qualify for typical medical coverage through Medicaid, recovery primarily involved expenses for nursing homes and other long-term care.

The federal Affordable Care Act (ACA) changed that. Now many more low-income residents will qualify for Medicaid, called Apple Health in Washington state.

But if they qualify for Medicaid, they’re not eligible for tax credits to subsidize a private health plan under the ACA, which requires all adults to have health insurance by March 31.