Issue:  Vol. 48 / No. 8 / 22 February 2018

Seniors, disabled face
Medi-Cal asset caps


AIDS Housing Alliance director Brian Basinger
(Photo: Jane Philomen Cleland)
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Under the Affordable Care Act, seniors and people with disabilities who receive Medi-Cal will continue to have to meet asset limits that can force them to deplete their savings.

Through the national health care reform law, much of which goes into effect January 1, some non-disabled people between the ages of 19 and 64 whose income isn't more than 138 percent of the federal poverty guideline are exempt from the caps.

However, others, including many people who are living with AIDS, will continue being subjected to caps of $2,000 in assets for individuals and $3,000 for married couples. The federal poverty guideline for individuals is $11,490.

Brian Basinger, director of the AIDS Housing Alliance-San Francisco, said the caps create "a structural barrier to these vulnerable populations being able to have a nest egg to fall back on when they experience hard times."

But Basinger was optimistic that lawmakers could be persuaded to change the policy.

"This is just a law that was conceived and crafted by our elected officials in Washington," he said. "It is ink on a piece of paper, and so whatever has been done can be undone. This does not have to be our reality, and we have to push back and get them to change it, say, 'We're sorry, this is a mistake,' and do it over."

Andy Chu, managing legal director for Positive Resource Center, a San Francisco nonprofit that provides benefits counseling and employment services for people with or at risk for HIV/AIDS, expressed some hope that change was possible, as well.

"What we don't know is whether people can transition" into the section of Medi-Cal that doesn't take into account peoples' assets, he said.

If the caps do stay in place, "The impact will be that people who are disabled and seniors will still have to live in poverty in order to have health insurance," said Chu.

Basinger reached out to the staff of House Minority Leader Nancy Pelosi (D-San Francisco), a longtime advocate for people with HIV and AIDS, and warned that keeping the limits could help lead to more people becoming homeless, since they're "not allowed to have any cushion."

Pelosi spokesman Drew Hammill gave no indication that there would be change any time soon.

"While we are always looking for ways to strengthen" the Affordable Care Act, "Medicaid has always had strict assets tests," said Hammill in an email exchange with the Bay Area Reporter. "The Congress took steps in the law to try to diminish gaps in coverage, but we were not able to end asset tests for the elderly and disabled, including those living with AIDS." (Medi-Cal is the California version of the federal Medicaid program for poor people.)

Hammill blamed the GOP for the limits remaining.

"House Republicans have stated repeatedly that their number one legislative priority is to repeal the Affordable Care Act – not strengthen it," he said. "As you know, they are in the majority in the House."

One group the limits are troubling for is people with disabilities who are considering returning to work and have to look at whether their paycheck plus their disability check will put them over the $2,000 asset cap.

"When you look at them from a logical point of view," these factors "are things that can be managed," said Basinger. "But what people don't necessarily understand is how the fear of making a mistake that can cause you to lose your Medi-Cal that you need to stay alive ... reverberates and affects people emotionally. That fear paralyzes people and keeps them stuck in ways that maintain their vulnerability."

Basinger's had at least one client spend money on a TV and shoes in order to be able to hold onto his benefits.

Chu has reached out to the city for an interpretation of whether people will be able to transition into the non-asset cap part of Medi-Cal, but he said he hasn't received an official answer.

A call to San Francisco's Human Services Agency, which is responsible for enrolling people in Medi-Cal in the city, wasn't returned.

Hammill sought to remind people of some positive developments related to national health care reform.

Among other benefits, the act "will provide significant protections for those living with HIV/AIDS by dramatically increasing access to Medicaid," which "will no longer demand that you meet the strict tests to prove disability status or that you have children. Single and childless couples will be eligible for Medicaid," he said, adding, "We will continue to work to strengthen the Affordable Care Act."


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