qotd: Ohio redefines “family” to deprive Medicaid beneficiaries

The Blade
September 2, 2015
Court rules Ohio spouses are eligible for Medicaid
By Jim Provance

In a decision that could have far-reaching effects, a federal appeals
court ruled Tuesday that Ohio must count an applicant's spouse as a
member of his family when determining eligibility for financial
assistance to pay Medicare bills.

A three-judge panel of the Cincinnati-based U.S. 6th Circuit Court of
Appeals told the state it can't exclude a beneficiary's spouse when it
comes to income calculations simply because the federal law doesn't
define the word "family."

At issue is a program under Medicaid, the federal-state insurance
program for the poor, that helps low-income Ohioans pay their premiums,
co-payments, and deductibles under Medicare, the federal health
insurance for senior citizens.

The larger the family, the more a beneficiary may earn and be eligible
for that financial help.

"Ask 100 Americans whether a 74-year-old man's 'family' includes his
wife who lives with him, and every one of those Americans will likely
say yes," 6th Circuit Judge Raymond M. Kethledge wrote. "But the Ohio
Department of Medicaid answered no, with the result that it denied Joe
Turner's application for benefits under the Medicaid Act."

"It should have been clear to Ohio that the word 'family,' as used in
the provisions here, does not mean whatever the state's officials want
it to mean, but instead includes at least a beneficiary's resident
spouse," Judge Kethledge wrote.

https://www.toledoblade.com/Medical/2015/09/02/Court-rules-Ohio-spouses-are-eligible-for-Medicaid.html

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Comment by Don McCanne

What kind of bureaucrat would make a decision that Medicaid benefits can
be denied to an applicant by arbitrarily declaring that the applicant's
spouse is not part of the family and thus the family is too small to
qualify? Perhaps Ohio's family-values Governor John Kasich could
explain, if he weren't so busy running for President.

The real lesson here is that we really need to question the wisdom
behind the multitude of health reform proposals that would provide
federal grants to states and allow them to craft their own health care
financing policies. It's bad enough that states can refuse to
participate in the Medicaid expansion, depriving millions of the health
care that they should have. Just imagine the liberties they could take
if allowed to make decisions such as redefining a family as having only
one spouse when there are actually two.

Although a single payer system would be administered on a state or
regional basis, the basic requirements would be established at the
federal level. An example is the Canada Health Act which simply requires
public administration, comprehensiveness, universality, portability and
accessibility. Although their single payer systems are administered on
the provincial level, there are no provinces that exclude a spouse from
the definition of a family.

In the United States, it would not work to have federal legislation
defining a national health program that is as simply stated as in the
Canada Health Act. We have a track record of shameless gaming of the
system to the detriment of patient care. That's why we need greater
specifications of the requirements - such as those in HR 676, the
Expanded and Improved Medicare for All Act, by Rep. John Conyers with 51
cosponsors. We really can't turn the decisions over the bureaucrats in
supposed family-values states who actually don't believe in family values.