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, Gov. Rick Perry said he would not let Texas join the expansion unless the federal government tailored the program for this state.
Perry gave a list of requirements for Texas to join the 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 said at CPAC.
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 health care 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.
“One of our recommendations on the long term care side is to eliminate ‘Miller trusts’ or qualified income trusts,” said John Davidson from the policy group. “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 Morehead is the executive director of Texas Impact, a statewide religious grassroots network. She says 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.
“That vehicle, it may be pretty expensive, especially if it’s a work truck,” Morehead said. “If you disqualify a family from benefits like for Medicaid because they have a vehicle like that, you’re overlooking that you’re sort of disqualifying them because they have a job.”
Morehead 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 says the vast majority of Medicaid recipients truly have little money.
State Rep. Garnet Coleman, D-Houston, disagrees with another aspect of the asset tests: Perry wants them not just for new recipients under expansion but current Medicaid recipients as well. Coleman says any new restrictions on the current Medicaid system probably wouldn’t be approved by Washington.
“I think it’s appropriate to have cost sharing on the adult population,” Coleman said. “But the minute we start rearranging and reordering and weakening the existing Medicaid program, there just has to be a line in the sand there.”
The Affordable Care Act actually gets rid of Medicaid asset tests on Jan. 1. That has raised questions as to whether Perry made his demands knowing Washington would say no, just so he could use the rejection for political gain back in Texas.