Names and personal information are redacted from the comments, nearly all of which were submitted after the Dayton Daily News on Aug. 29 made Ohioans aware that a public comment period on the program was closing. Many comments object to the state placing liens on Medicaid recipients’ homes after their death.
>>>RELATED: Public comment asks Ohio to revise estate recovery hardship rules
“I believe this perpetuates poverty by taking away even more for people already in poverty,” another person wrote. “It places a financial burden on those survivors who many times inhabit these homes as well. Those people are then funneled back into the system for financial help. Then the cycle repeats.”
Some comments relay personal stress and hardship caused by the program.
“I wanted the property to stay in the family, but it is actually making it difficult for my wishes,” a commenter wrote.
“Please give families a break,” wrote another.
As the state reviews the public comments, advocates for aging Americans say estate recovery should be done away with altogether.
“There’s not another program of any kind that has been paid out properly and which we’re then seeking recoupments at the death of the individual,” said Amber Christ, managing director of health at Justice in Aging. “Those are all tax funded programs, yet for those with the lowest amount of resources, we’re asking them to pay back for covered services.”
State reviewing program
For months, the Dayton Daily News has reported how Ohio Medicaid is more aggressive than other states in recouping Medicaid costs from deceased residents and is in the minority of states that puts liens on Medicaid recipients’ properties.
In August, Ohio Medicaid sought public comment for changes being made to the estate recovery program while the agency was going through a mandated review of program rules.
The federal government requires states to have Medicaid estate recovery programs to recoup costs of providing medical care for poor residents, but leaves the particulars up to states. Ohio law in turn gives Ohio Medicaid leeway in developing program rules, which have to be reviewed every five years. A one-week public comment period on changing program rules ended Aug. 30.
The Dayton Daily News requested the public comments after that period ended and has received 83 records so far.
The only changes the agency was seeking to make included minor revisions from references of “son” or “daughter” to “child,” as well as removing phrases of “he or she.” The changes also add “American” in front of references to American Indians, as well as adding references to Alaska Natives.
Respondents from the public asked for more changes to be made to the state’s estate recovery program, including raising the threshold for when the state can seek recoupment of costs, providing longer response times when families are seeking hardship considerations, and allowing more time before the state seeks estate recovery payments.
‘Perpetuating poverty’
If the Medicaid beneficiary is low income, their children probably are as well, one public commenter said.
“If I can’t leave my house for them, they would become homeless, needing more state (and) federal aid. If they have a good job (and) a roof over their heads, maybe they can get ahead and get out from under the rock that is government assistance,” the commenter said.
The estate recovery process can continue the cycle of poverty by stripping families of their only source of wealth that they can pass on to their family members, Christ said.
“We really are, with this policy, stripping families from intergenerational wealth,” said Christ, who said a family’s home may be their only resource. “To put it another way I think it’s a policy that actually perpetuates poverty and it’s somewhat unconscionable that we have accepted a status quo that we’re going to have the people who rely on Medicaid pay back for needed health care services just because they are impoverished.”
This can lead survivors of the Medicaid beneficiary to rely on Medicaid services for themselves in the future, continuing the use of that safety net.
“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,” Christ said.
Several commenters noted that even if they have means, one illness could change that.
“It is very difficult to face the fact that if you get sick, it is very possible you will eventually lose everything,” one person wrote.
Other proposed reforms
Some who submitted public comment said homes should be exempt from recovery.
“Please stop picking on the middle class. All we have to leave our children is our house,” one wrote.
Others want to see 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.
“We’d like to see Congress repeal the five year look-back period for asset transfers,” said Michelle Shirer, communications director of AARP Ohio. Previously, the standard was a 36-month look back period.
There also needs to be a fair process to determine an individual’s home equity and what their home’s current fair market value is, Shirer said.
The advisory group MACPAC recommended to Congress that it should amend the Social Security Act to make Medicaid estate recovery optional for states. Reverting estate recovery back to a state option would give states increased flexibility, allowing them to cease recovery if they determine the return on their investment is low, while still permitting states that find estate recovery useful to continue the practice, MACPAC says in its 2021 report.
Other public comments referenced being a caregiver for their family members who had been Medicaid beneficiaries and fearing the financial loss of their homes.
“Medicaid eligibility restricts assets to $2,000, forces individuals to live below poverty, and then when they die, state Medicaid comes in and takes what little an individual has left. The poor get poorer, and the rich get richer,” another commenter said.
State: Rules aim for financial stewardship
At least one commenter wrote that they felt nothing with the program should be changed and it was fair for the Medicaid beneficiary to pay their fair share through their assets.
“(If) people on (Medicaid) have received large amounts of money to assist in their end of life expenses, then obviously if they have assets then that should offset those expenses,” that commenter said.
State officials have said they try to focus on making the Medicaid program as cost-effective as possible with taxpayer money.
“The public policy that’s been directed is that these have been taxpayer funds expended, and in order to try and keep the program as lean and cost-effective and make sure these services are available for other families who need them and would need those resources to fund that care, certainly that’s the other side of this,” Dan Tierney, press secretary for Gov. Mike DeWine, said to this newspaper in October. “That has to balance.”
“We always try to give greatest deference to individuals and consumers as opposed to other interests, other types of stakeholders who may have a financial interest or something else depending on what it is,” said Maureen Corcoran, director of the Ohio Department of Medicaid, previously said while explaining about what goes into the rulemaking process for Ohio Medicaid.
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