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Medicaid Expansion Debate Could Focus on Asset Tests

Texas Lawmakers Have Ideas to Keep the Healthcare Law Out of Texas
Texas Tribune
Texas Lawmakers Have Ideas to Keep the Healthcare Law Out of Texas

The state of Texas has not joined in the expansion of Medicaid under the Affordable Care Act. At the Conservative Political Action Conference late last week, Governor Rick Perry said he would not let Texas join the expansion unless the Federal government tailored the program for this state.

When Governor Perry spoke at CPAC last week, he gave a list of requirements for Texas to join in Medicaid expansion. Many were items he’s demanded in the past, but one in particular caught the ear of those who support expansion.

“We need to asset test to make sure care is there for those who really need it most," Perry told the crowd in D.C.

People from both sides of the aisle agree Medicaid should be reserved for those who need it. With limited money and resources, you don’t want people who can afford healthcare keeping it from those who really can’t.

That’s why asset tests are part of a new Medicaid overhaul plan being proposed by the Texas Public Policy Foundation, a conservative state policy think-tank. The foundation’s John Davidson.

“One of our recommendations on the long term care side is to eliminate “Miller Trusts” or qualified income trusts," the TPPF's John Davidson said. "And that’s a mechanism where by people with considerable means can hide income and assets in a trust in order to qualify for Medicaid. It’s one of the things that drives the cost of Medicaid up.”

But just what would be considered an asset is where parties begin to disagree. Bee Moorhead is the Executive Director of Texas Impact, a statewide religious grassroots network. She said a family that happens to live in a modest home whose value is up because of changes to the neighborhood, like gentrification, for example, could be kept from getting Medicaid.

And that it doesn’t make sense for a person’s car to be classified as an asset, especially if the person is in construction or cleans homes for a living.

“And that vehicle, it may be pretty expensive especially if it’s a work truck. And if you disqualify a family from benefits like for Medicaid because they have a vehicle like that, you’re over looking that you’re sort of disqualifying them because they have a job," Moorhead said.

Moorhead thinks putting everyone through the kind of asset test you might get when buying a home would mean a lot of extra work, for little reason, since she said the vast majority of Medicaid recipients truly have little money.

State representative Garnet Coleman disagrees with another aspect of the asset tests: Governor Perry wants them not just for new recipients under expansion, but on current Medicaid recipients. Coleman said any new restrictions on the current Medicaid system probably wouldn’t be approved by Washington.

“Now I am for and I think it’s appropriate to have cost sharing on the adult population. But the minute we start rearranging and reordering and weakening the existing Medicaid program, that’s just got to be, there just has to be a line in the sand there," Coleman said.

The Affordable Care Act actually gets rid of asset tests as of January 1st 2014. That has raised questions as to whether Governor Perry made his demands knowing Washington would say “No” just so he could use the rejection for political gain back in Texas.

Ben Philpott is the Managing Editor for KUT. Got a tip? Email him at Follow him on Twitter @BenPhilpottKUT.
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