Ohio Medicaid raises $87.5 million from families after the death of their loved one

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July 29 — Rebecca Miller said her father was on Medicaid for about two years and served as his chief caretaker at his home after he was diagnosed in 2018 with Parkinson’s disease, from which he died last August.

About 30 days later while still mourning David Miller’s death, the 36-year-old said she received a letter from the Ohio Attorney General’s office saying her father owed $56,000 for Medicaid Estate Recovery.

The Medicaid collection program was foreign to the Clinton County woman, the attorneys said, as it is to the vast majority of people.

The state’s notice came as a shock, as she informed Miller that her father’s house—which she said the mortgage had been paid in full for and was “the only real home she had ever known”—was in jeopardy, potentially leaving her homeless.

“They’re taking the spot because of a $56,000 lien from Medicaid,” the AG’s letter said. “I called Medicaid myself to find out why — what kind of services do you say (he owes) the $56,000?”

Stories like Miller’s, the Dayton Daily News attorney said, are a “classic Medicaid recapture” experience in the federally mandated program.

Records showed the AG’s Ohio office — which raises money for the Ohio Department of Medicaid — has recovered more than $270 million since 2019, the year in which more than $730 million was raised nationally.

Washington Twp. Solicitor Ted Goodorff said he has a client who has been at the nursing home in Kettering since last October.

“She got a $75,000 bill. Her home is in Kettering. Her son lives in the house,” Godorff said. “The facility hasn’t applied for Medicaid yet… It will go to Medicaid and when you die, the State of Ohio will come back and take this house and sell it… It happens on a regular basis.”

“No homes were taken,” Ohio State Press Secretary Steve Irwin told this news organization. “The money is recovered from the sale of the houses, but we don’t take possession of the property.”

About the recovery of the estate

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, seniors, and people with disabilities.

Estate restitution, which began in 1995, seeks reimbursement for the cost of benefits once a Medicaid recipient dies, according to the Ohio Division of Medicaid. Records show that action is taken on those who have been institutionalized permanently or are 55 or older.

The documents show among cases where recovery occurs after the death of a Medicaid recipient’s surviving spouse and when the deceased recipient had no surviving children under the age of 21.

“The AGO will send a Notice of Claim to the executor of the estate requesting payment for the cost of Medicaid benefits,” according to state guidelines.

David Miller had retired and was receiving a modest monthly pension when Medicaid benefits were approved, his daughter said.

Rebecca Miller said she took care of her dad at his home, he didn’t have a nurse and he’d never been in a nursing home, so she was surprised by the attorney general’s letter asking for $56,000.

“A lot of people think they’ll only replace you if you’re in a nursing home or if you have full-time care,” Miller said. Medicaid. a period. “

According to its deputy director, Lisa Lawless, Ohio’s Department of Medicaid “has made several changes to ensure that Ohioans covered by Medicaid are notified of property refunds.”

She added that the department included the Medicaid Estate Recovery form in “all approval and change notices and updated the Ohio Benefits Self-Service Portal with additional information about the program.”

But Godorff said there is “very little” public knowledge of the collection program. Similar comments were made by the managing attorney for Pro Seniors Inc. A Cincinnati-based organization that educates seniors in Southwest Ohio and their caregivers on a wide range of legal and long-term care issues.

“You won’t receive any kind of notification until after you’ve applied for Medicaid,” said Miriam Chelin of Pro Seniors. “And they’re usually included in a bunch of other notices. Even though they’re there, this is the first time anyone’s actually looked at them.”

Pro Seniors are calling for judicial changes in the program, she said.

“We were challenging the way the restitution of the estate was written. It effectively interpreted that upon death—even if the property is transferred to a third party—somehow a (state) claim could be converted into an automatic lien,” Shlain said.

She added, “This is not what the law says. There are no legal procedures or third-party judgments to challenge it.” “There are certain exceptions to the privilege of estate recovery—or even estate recovery in general—(but) there is no mechanism for a third party to raise these issues even after there is already a foreclosure on their home.”

This news organization requested records on the number of properties affected by the statewide Medicaid repossession program with a breakdown of southwest Ohio counties from 2017 to 2022. The Ohio AG office, however, was unable to provide them “due to ongoing system upgrades,” Irwin said. “.

National and state numbers

In 2019, states nationwide reported collecting about $733.4 million in beneficiary estates. States return a portion of the money to the federal government based on a percentage of federal Medicaid, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission (MACPAC), an agency that advises Congress.

The amount each state collects annually varies widely. According to the federal report, Hawaii’s Medicaid repossession program raised $31,000 in 2019 while Iowa recovered more than $26 million.

“The five states with the largest real estate pools — Massachusetts, New York, Pennsylvania, Ohio and Wisconsin — accounted for 38.5% of all redemptions in fiscal 2019,” the report stated.

State records show that last year Ohio raised more than $87.5 million. Irwin said that total was the “peak” annual amount.

Irwin said the Ohio AG office primarily uses an outside consultant for collections in different regions for several reasons. He added that local attorneys have first-hand knowledge of the courts in their area, and are familiar with estate filings and property records.

Medicaid Ohio and other creditors are paid before any assets are distributed to heirs or other beneficiaries, according to the Ohio Association of Area Aging Agencies. If there is undue hardship for the survivor, the right to immediate recovery may be delayed or waived. Unjustified hardship is determined on a case-by-case basis.

Miller said she learned of the hardship waiver after the deadline to apply passed after her father’s death. In the year since her father died, she’s done everything she knows to avoid losing the house, but she’s not hoping it will work out.

She added, “Now I feel like I’m going to be homeless because of all this. My dad didn’t know it.”

avoid the “nightmare”

The 2021 MACPAC report urged Congress to prevent states from collecting money from families with meager assets, and to allow states to opt out of the effort altogether.

“The program primarily recovers properties of modest size, suggesting that individuals with greater resources are finding ways to circumvent property recoveries and raise fairness concerns,” the report reads.

States can limit their collection practices. Massachusetts implemented changes in 2021 to exempt properties of $25,000 or less, according to a report from NPR.

Pro Seniors didn’t seek that kind of change, Shailene said. Some countries have sought other reforms.

Godorff said he specializes in long-term Medicare Medicare, which has an assets test and an income test to determine eligibility.

Attorneys who specialize in aged care and Medicaid planning can point clients in directions in which they can protect about half — if not all — of their assets from the recovery program. Another option, Godorff said, is to purchase long-term care insurance to avoid dependence on Medicaid.

Miller said she was not aware of these options.

“I don’t know if I’ll be able to keep the place,” she said, referring to her father, “he’s worked his whole life and bought this place.”

Miller said she wants to help others not experience what she went through.

“I just feel like if I can help avoid this from happening to anyone else, I would really appreciate it because this is just a nightmare,” she said. “It’s not something you want to happen right when you lose your dad and all of a sudden you’re fighting to keep your house. It’s awful, right after you lose a loved one.”

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