Ohio lawmakers propose expanding controversial Medicaid Estate Recovery Program

By The Guardian / October 24, 2024

COLUMBUS, Ohio — In a move that has alarmed consumer advocates and critics of the current healthcare system, Ohio lawmakers have introduced House Bill 681, which would significantly expand the Medicaid Estate Recovery Program. The bill proposes changes that would allow the state to recover Medicaid costs from a broader range of recipients’ estates after their death, including those who received long-term care at home or in other non-institutional settings.

The bill seeks to amend existing legislation to permit the state to claim real and personal property from Medicaid recipients aged 55 and older, even if they were not permanently institutionalized. This includes those who received care at home or in residential facilities. The state’s Department of Medicaid would be authorized to recover costs related to services provided through Medicaid, targeting property and assets that the individual held legal interest in at the time of their death.

Criticism from Advocates and Families

Critics of the proposal argue that the expanded estate recovery program disproportionately harms low-income families, many of whom rely on Medicaid for essential healthcare services. They contend that the state’s practice of recovering costs from the estates of the deceased essentially penalizes families who have little to no financial safety net.

“Medicaid is a lifeline for millions of Ohioans, and expanding estate recovery like this essentially punishes people for growing old or disabled,” said a representative from a local consumer rights group. “Families who have worked their entire lives are at risk of losing their homes and modest inheritances, all to pay back medical costs that a more equitable healthcare system would cover.”

The program, critics say, places a burden on families already grieving the loss of a loved one, forcing them to navigate complex legal and financial hurdles just to hold on to family homes and assets. The bill also targets individuals who received long-term care services at home or in non-traditional settings, raising concerns that people who choose in-home care to avoid the high costs of institutional care will still see their assets stripped by the state after death.

Exemptions and Loopholes

Though the bill contains exemptions—such as protecting the spouse of the deceased or minor and disabled children from estate recovery—advocates argue these protections are not enough. The proposed legislation still allows the state to place liens on homes and other properties, assets that many families depend on as part of their generational wealth.

The bill shows that Medicaid estate recovery will also target cases where individuals receive in-home health services, hospital care, or care in facilities like nursing homes and residential facilities. While the legislation promises a waiver process for those facing “undue hardship,” critics warn that many low-income families lack the resources or legal representation to effectively navigate such a process.

Lack of Transparency and Notice

Another significant concern is the lack of transparency and clear communication with Medicaid recipients. The bill requires that the Department of Medicaid notify applicants about the estate recovery program when they apply and are approved for Medicaid, but critics argue that these notifications are often written in legal jargon that is difficult for the average person to understand.

A Broader Problem of Systemic Inequality

The push to expand estate recovery comes amid broader concerns about inequality in the U.S. healthcare system. Critics argue that the estate recovery program is emblematic of a system that punishes people for getting sick, aging, or needing assistance, particularly in a country that still lacks universal healthcare. Many argue that estate recovery disproportionately affects low-income and working-class families who are already disadvantaged by rising healthcare costs and systemic inequities.

While proponents of the bill argue that estate recovery is necessary to recoup taxpayer dollars spent on Medicaid, opponents counter that a fairer and more compassionate approach to healthcare—such as expanding Medicaid access without punitive measures—would better serve Ohio’s most vulnerable populations.