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Hidden Medicaid Restrictions in Failed “Repeal & Replace”
… But It’s Not Over


Although most of the focus on the recently failed Trump/Ryan repeal bill has been on the insurance coverage aspects, the Medicaid expansion and the Medicaid caps, there are a number of other Medicaid changes that would severely limit the ability of potential beneficiaries to become eligible for Medi-Cal, particularly the aged and disabled. Many of these proposals were incorporated into the failed repeal bill, but all of them survive as independent bills.

  • Home Equity Limits: This proposal would delete the option of the states to increase the home equity limit as provided under the DRA of 2005, which permits states to exclude up to $750,000 of home equity, with annual increases based on the CPI. California adopted the higher amount of $750,000 and, with the annual increases, California’s home equity limit would be $840,000 for 2017. The proposed Trump/Ryan bill prohibited states from exceeding $500,000 of home equity, starting 6 months after the bill is enacted into law, limiting the availability of nursing home and other long term care services to individuals who may live in high-cost areas and have substantial home equity but limited income and other assets. It’s still alive as (H.R. 1361 Guthrie (R-KY) –The Medicaid “Home Improvement” Act and, yes, that’s really what it is called)
  • Eliminate Retroactive Eligibility: Medicaid currently provides coverage up to three months before the month an individual applies for coverage. This “retroactive coverage” protects individuals from medical expenses they incurred before they apply for Medi-Cal and ensures that providers can get reimbursed. This proposal would limit the effective date of retroactive coverage to the month in which the applicant applied. It’s still alive as (H.R. 180-Mullin (R-OK)
  • Spousal Annuities and Retirement Accounts: The bill would make one-half of the community spouse’s income from a qualifying annuity available to the institutionalized spouse for eligibility purposes. This changes current federal law, which does not count the community spouse’s income when determining Medicaid eligibility for the sick spouse. (H.R. 181 – Mullin R-KY)
  • Counting lump sum income: In the guise of prohibiting big ticket lottery winners from qualifying for Medicaid, this provision would count any lump sum payments as if they were obtained in multiple months, even if they were received in one month – regardless of the source of the lump sum. It’s still alive as (H.R. 829 – Upton R-MI)


All of these bills are currently pending in Congress, and several have already passed the House Committee on Energy and Commerce. There is still time to register your concern and/or opposition by contacting your Congressional representative. www.house.gov/representatives/find/

Page Last Modified: April 3, 2017