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Congress rejected the idea of taking from estates of surviving spouses, but it did make it mandatory for states to recover the cost of long-term care (such as nursing home care or home health care) in the Omnibus Budget Reconciliation Act of 1993.

GAO, March 7, 1989: GAO believes the Congress should consider making mandatory the establishment of programs to recover the cost of Medicaid assistance provided to nursing home residents of all ages either from their estates or from the estates of their surviving spouses.The law requires Americans, with some exceptions, to purchase a qualified health insurance plan or pay a penalty. Eliminates assets test from eligibility requirements. As the American Public Health Association explains, Medicaid eligibility “is complicated, and varies from state to state. The penalty this year will start at per person or 1 percent of household income, whichever is higher, and increases until it reaches 2.5 percent or 5 per person in 2016. Medicaid has been largely limited to low-income children, parents, pregnant women, the disabled and elderly. It involves calculations of income and assets, as well as ‘disregards’ of income and assets that vary for different populations.” But, as AARP explains, the ACA created an “additional set of rules” based on income, specifically Modified Adjusted Gross Income. A blog post on the website of a Michigan law firm that carried the headline “Now They Can Take Your Home: Estate Recovery Law Arrives in Michigan” said the state could have lost billion in Medicaid funds.The amount of money collected by states varies greatly, depending on how the state structures its program and how vigorously it pursues collections, according to Kristina Moorhead, state legislative representative for AARP.

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