IT’S PAST TIME TO REFORM DEEPLY UNFAIR OHIO MEDICAID ESTATE RECOVERY PROGRAM
Clinton County resident Rebecca Miller called Investigations Editor Josh Sweigart last summer crying.
She feared being evicted from the home she lived in while caring for her father. Her father was on Medicaid, and after he died, the Ohio Attorney General sent her a letter saying the father owed $56,000 for services he received. If she didn’t pay it, the state would put a lien on the home, the letter said.
“I’m going to be homeless because of all of this,” Miller said.
Sweigart had reporter Nick Blizzard investigate the program, analyzing state data and national reports. He told Miller’s story, and found Ohio is one of the most aggressive states in the U.S. at estate recovery. For example, Ohio is one of only 15 states that puts liens on residents’ homes.
Reporter Samantha Wildow revealed how estate recovery collects less than 1% of what the program pays out and can sometimes charge more than services rendered. In speaking with representatives of the Medicaid and CHIP Payment and Access Commission (MACPAC), she found that even if a Medicaid beneficiary over age 55 receives no care from their managed care plan, under current law, the state still retains the right to pursue the beneficiary’s estate for the entire cost of all capitation payments paid to the plan by the state. This differs from other federal programs for which no funds are recovered from the enrollees’ estates after they die.
After our first reports, dozens more people came forward to share their stories of struggles with the estate recovery program.
As we were reporting, we also learned that Ohio Medicaid was in the middle of a mandated review of the program. They were accepting public comment, but the comment period was only one week and wasn’t publicized — until we reported on it.
That led a flood of people to send nearly 100 public comments calling for comprehensive changes. Nearly all of the comments that were submitted to the state came in the last days of the comment period. Several of them cited our reporting.
Many comments focused on changes to the hardship waiver process, which allows people to appeal the recovery process based on personal circumstances. Personal testimony included in comments suggests the waiver process doesn’t work for everyone.
According to comments we received as well as the public comment responses submitted to the agency obtained by the Dayton Daily News, it’s clear that Ohioans want changes made to the Ohio Department of Medicaid’s estate recovery program.
Because of Ohio’s policies, the state collects more from its residents in Medicaid recovery than even much larger states. In its 2021 report on estate recovery, MACPAC found Ohio’s Medicaid estate recovery program ranked among the top five states in collections four years ago, bringing in more than $55 million.
The program also “falls on those with modest means, and may disproportionally affect people of color and perpetuate intergenerational poverty,” according to the report, which also found the average household net worth of deceased Medicaid beneficiaries ages 65 and older was $46,692 and the average home equity was $27,419.
Some states, such Georgia or Massachusetts, don’t collect unpaid Medicaid expenses from estates valued under $25,000. Texas sets the minimum for collections at $10,000, records show.
“To think about it kind of long term, when a policy is actually perpetuating poverty from generation to generation, that costs the state a lot more money in the long term or even in the mid term in terms of what services and supports people will need because they’ve decided to pursue the one form of gaining resources that has any value for folks from generation to generation,” said Amber Christ, managing director of health at Justice in Aging.
While state officials may be motivated by a desire to act as responsible stewards of taxpayer money, the program’s recovery efforts go too far at the expense of some of the most vulnerable Ohioans.
The aggressive pursuit of Medicaid payments creates an administrative burden on the state and still only amounts to less than 1% of what the program pays out. Further, these collections often fall on those least equipped to deal with the staggering financial costs associated with our broken health care system.
Ohio lawmakers in 2013 repealed the so-called “death tax” so estates values at more than $338,333 are no longer taxed when someone dies. But Medicaid Estate Recovery continues to bill estates of Ohioans who relied upon a program designed for low-income households.
To more equitably serve Ohioans, we call on the Ohio Department of Medicaid to listen to public comments they’ve received and enact the following reforms:
■ Per the MACPAC recommendation, when the estates of applicable Medicaid enrollees get charged for capitation rates, they should be charged for what services were actually utilized.
■ Have the “look back” period reduced, which is how far back Ohio Medicaid can look back into a beneficiary’s finances when establishing what assets they had. Change the five year look-back period for asset transfers to the previous 36-month look-back period.
■ Remove or extend the deadline for undue hardship waivers for surviving family members who may be impacted by the estate recovery process. Applications are currently due within 30 calendar days after notice of the estate recovery claim was mailed by the attorney general’s office, according to the Ohio administrative code.
■ Establish a fair process to determine an individual’s home equity and what their home’s current fair market value is.
In March, U.S. Representative Jan Schakowsky (IL09) reintroduced the Stop Unfair Medicaid Recoveries Act of 2024, which would repeal the federal mandate that requires state Medicaid programs to pursue families and estates for repayment. The nearly 30-year-old mandate, intended to encourage people to save for long-term care, has been deemed a failure, even by its architect, Stephen Moses.
We agree. Congress should move to end the federal mandate. Absent that action, as Gov. DeWine’s office sets priorities for administrative law, we ask him and Ohio lawmakers to consider what can be done to address the issues outlined here.
Our state made the choice to have one of the most aggressive and unfair Medicaid recovery programs in the country. We can also make the choice to reform that program as other states have done. We can and should decide to not pursue some of our most vulnerable citizens at a time of personal loss.