Medicaid Estate Recovery

[Disir]

Does anyone know where I can find how much money has been recovered per year in any one state?

 

[MeBelle]

Good question! I searched the usual sources can't find anything.

I think you'd have to pull up a state budget and drill down to find the answer.

 

[Disir]

Thanks. I was afraid of that. I am willing to bet that they don't have this listed. I am already working through one state's Medicaid website.

 

[MeBelle]

Thanks. I was afraid of that. I am willing to bet that they don't have this listed. I am already working through one state's Medicaid website.

Good luck! If you find an answer post!

 

[boedicca]

I found this - but the data is from 2004:

Medicaid Estate Recovery Collections

This table has collections by state for that year:

Medicaid Estate Recovery Collections

 

[Disir]

Thank you, Boedicca. It gives me a much better starting point.

 

[Disir]

All states have had the option since Medicaid began in 1965 to recover some Medicaid costs from recipients after they die, as the Department of Health and Human Services explains in a 2005 policy brief. In 1965, it was optional and states could only recoup Medicaid costs spent on those 65 years or older. That changed in 1993, when Congress passed an omnibus budget bill that required states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older. The 1993 federal law also gave states the option to recover all other Medicaid expenses.

The Affordable Care Act did nothing to change existing federal law. It did, however, expand the number of people who are eligible for Medicaid, so there will be more people on Medicaid between the ages of 55 and 65, and, therefore, potentially more estates on the hook for Medicaid expenses after the beneficiary dies.

The gist of the Times story went viral in the blogosphere, where some blamed the ACA and/or questioned the motives of the Obama administration for expanding Medicaid. One blog post on the conservative Western Center for Journalism website — which carried the headline, “Obamacare Shocker: Strip Assets From Dead Seniors” — accused the administration of “deliberately turning the dead into cash cows.”

Medicaid Estate Recovery Program

Let’s first look at the origin of the recovery program. The HHS policy brief on state recovery programs said: “Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child.” Medicaid is a joint federal-state program that provides health care for the low-income and long-term care for the low-income elderly and disabled. The cost of long-term care, such as nursing home or community-based home health care, is substantial, and it is largely paid for by Medicaid. The HHS brief said Medicaid in 2002 paid “nearly half of the total amount spent on nursing homes.”

A March 1989 report by the General Accounting Office (now the Government Accountability Office) said that 21 states at the time established optional recovery programs, which the GAO found successful in offsetting the costs of long-term health care for Medicaid recipients. GAO recommended making the program mandatory and expanding it to include the estates of surviving spouses, not just deceased beneficiaries.

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.

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. That law also reduced the age of deceased recipients whose estates are subject to the recovery from 65 or over to 55 or over. Congress kept the prohibition on estate recovery in cases when there is a surviving spouse, a child under the age of 21 or a child of any age who is blind or disabled. In the cases of property, the law also carved out other exceptions for adult children who have served as caretakers in the homes of the deceased, property owned jointly by siblings, and income-producing property, such as farms.

All states now have Medicaid Estate Recovery Programs, although some were slow to create them. Michigan was one of the last to create one in 2007 after the federal government threatened to withhold federal Medicaid funds. 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 $5 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. States recovered $347.4 million in fiscal year 2003, ranging from a low of $86,000 in Louisiana to a high of $54 million in California, according to a 2005 AARP report. The total recovered was 0.13 percent of total Medicaid spending for the year. Moorhead told us that although federal law allows states to recoup all of their Medicaid costs, not just costs for long-term care, only 25 states do so.

AARP, June 2005: OBRA ’93 allows recovery for “any items or services under the state plan,” going beyond what is required by federal law (nursing facility services, home- and community-based services, and related hospital and prescription drug services). Twenty-five states reported recovery of “all other items under the state plan”; 10 states recover “some other items”; 10 states do not recover for any other services beyond what is required; and 1 state was DK/NR. A few states reported specific additional items for recovery as follows: ambulance, funeral, and burial costs (Illinois); costs of technological assistance such as motorized wheelchairs and readers for eye gestures (Kansas); transportation, dental services, and other services (Minnesota, New Jersey); physical therapy (Nevada); durable medical equipment, dental and vision services (Ohio); and PACE (Program of All-Inclusive Care for the Elderly) (Tennessee).

The Seattle Times said that the state of Washington expanded its program in 2004 to cover “all medical services for Medicaid clients.” That was the case when the Times wrote its story. But the state has since changed the rules to limit the program to what is required under federal law: the recovery of state Medicaid expenses for long-term care and related costs
.Medicaid Estate Recovery Program

^^^ That is the short, short version of how it works.

I think we need to change the law.