Medicaid Estate Recovery: Barrier to Medicaid Enrollment

With more people becoming eligible for Medicaid, one question repeatedly comes up: "will receiving Medicaid coverage jeopardize my family home?" Depending on the circumstances, the answer can be complicated. But states can do much to make it less complex.

The fact is that states can recover against the estates of some Medicaid beneficiaries, but only after the beneficiary passes away, and only in certain circumstances. Federal law actually requires that states try to recover from the estates of Medicaid beneficiaries who received nursing facility services and/or home and community-based services when they were age 55 or older. In other words, federal law sets the floor for Medicaid estate recovery by states.

Complicating matters is that states have the option to recover for more than what is federally required. States may recover from individuals age 55 and older for any items or services covered under the state's Medicaid plan. California is one of just a few states that has taken the option to recover for all covered services provided to individuals age 55 and older. Currently, a bill is moving through the state legislature to limit recovery to only what is federally required. Last year, a similar bill received unanimous support from the California legislature, but was vetoed by the governor due to budgetary concerns.

It is important to keep in mind that there are exceptions to when a state can recover and from whom it can do so. For example, Medicaid estate recovery cannot occur during the lifetime of a surviving spouse or when there is a surviving child under age 21 or a blind or disabled child of any age. Also, states must establish procedures for waiving estate recovery when it would cause an undue hardship. Yet many states do not have clear undue hardship policies, leading to increased denials and making it difficult for family members to figure out who qualifies for a hardship waiver and in which circumstances.

State policy makers should also realize that, for the next couple of years, states will not keep recovered claims for the Medicaid expansion population and after 2016 will still keep only a small amount. When states recover from the estates of former Medicaid beneficiaries, they return to the federal government the portion that represents the federal share of expenditures on an individual's Medicaid covered services. Since services provided to the Medicaid adult expansion population are 100 percent federally funded for the first three years (2014-16), and almost fully federally funded thereafter, states will have to return to the federal government the full amount collected (and in future years close to the full amount). States are essentially serving as a collection agency for the federal government.

Many have identified estate recovery rules as a potential barrier to enrollment in Medicaid. Individuals may be hesitant to enroll in Medicaid because they own a home that they want to leave to their adult children when they pass away. Advocates must urge states to limit estate recovery to what is federally required, and advocate for clear exceptions policies to ensure that individuals and families feel comfortable enrolling in Medicaid and getting the care that they need.