Ohio is one of 15 states that puts liens on Medicaid recipients’ properties. The Dayton Daily News recently revealed how this policy can force people from homes after their loved ones die.
Ohio is also among about 18 states that pursue recovery for non-Long-Term Service and Support benefits, according to a federal study. Those benefits include debts from doctor visits, hospital stays, scans and other medical tests, among others, according to the agency.
Some states, meanwhile, don’t collect unpaid Medicaid expenses from smaller estates. Estates valued under $25,000 are not subject to recovery in Georgia or Massachusetts while Texas sets the minimum for collections at $10,000, records show.
Ohio is one of the few states that “does not perform a cost-effectiveness test or place any predetermined dollar thresholds or real property value,” according to the 2021 study by the Medicaid and CHIP Payment and Access Commission, a group that advises Congress.
Federal rules require states to have a program in place to collect unpaid Medicaid debt from recipients. But other than requiring states to provide notice to Medicaid applicants explaining the estate recovery policy, rules are largely left up to each state.
Ohio collections rising
Because of Ohio’s policies, the state collects more from its residents in Medicaid recovery than even much larger states. The national MACPAC study 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 total for the eighth most populous state has risen steadily since, topping $87.5 million last year with what one southwest Ohio senior advocacy group called aggressive collection efforts that include property of dead recipients.
A state Medicaid official said Ohio law governing Medicaid recovery was updated five years ago and is sufficient.
The MACPAC study 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. People with means and know-how are able to use legal tools to protect their estates from recovery and pass it along to their family.
This means the program “falls on those with modest means, and may disproportionally affect people of color and perpetuate intergenerational poverty,” MACPAC said in its study.
MACPAC has recommended making estate recovery “optional for the populations and services for which it is required under current law.”
Ohio’s AG’s Office has recovered more than $270 million since 2019, a year that netted more than $730 million nationwide, records show.
Miriam Sheline, managing attorney for Pro Seniors Inc., a southwest Ohio organization educating older adults and their caregivers about a variety of legal and long-term care issues, said Ohio pursues estate recovery more aggressively than other states.
Sheline said current AG Dave Yost “is pretty good,” but gives the state an “eight or nine” with 10 being most aggressive.
“The way it is set up now, it depends on who’s in charge at the attorney general’s level as to how aggressive they’re going to be,” she said. “And it shouldn’t be based on that. It should be based on rules, regulations and a known process so that correct collections can be made.”
Sometimes, Sheline said, the state takes measures to bypass exemptions and recover the property of adult disabled children of Medicaid recipients.
That person then “has to contact the attorney general and prove that they’re disabled … and ask them to remove the lien if they have the legal support to do that. And it should be the other way around,” she said.
AG’s office spokesman Steve Irwin said that’s not the case.
“In these circumstances, we file an affidavit of fact relating to title,” which is “not a lien, encumbrance, or cloud on title” he said. “The affidavit of fact expressly states that Medicaid has a claim but that the claim is not enforceable until a future event occurs, such as a death of the spouse or disabled child.”
Ohio also collects personal needs accounts for nursing home residents, Sheline said.
“If there’s something left in a nursing home resident’s personal needs account, it will be automatically sent to the state,” she said. “Those are small amounts, but they add up when you have several thousand Medicaid recipients in nursing homes.”
State officials say they have made several changes to help Ohioans understand estate recovery when they apply for Medicaid.
This has included inserting the estate recovery form in all approval and change notices generated by Ohio Benefits, which helps residents check eligibility and apply for a variety of benefits available through the state.
It has also updated the Ohio Benefits self-service portal with more information on estate recovery and has added language to make it more prominent to applicants, state officials said.
“Our operational changes … we believe are sufficient,” said Lisa Lawless, deputy director for Ohio Medicaid.