Medicaid is a program that many Americans use to combat illness.
Salvatore LoGrande’s children vowed to keep him in the white, pitched-roof home he had worked so hard to acquire all those decades before, even while he battled cancer and all the suffering it brought.
Thus, Sandy LoGrande believed it was an error when, a year following her father’s passing, Massachusetts sent her a $177,000 bill for her father’s Medicaid costs and threatened to file a lawsuit for his house if she didn’t promptly pay.
State Medicaid Offices
The 57-year-old LoGrande told her father, “The home was everything.”
However, the bill and the threat it accompanied weren’t an error.
Instead, it was a standard procedure that the federal government mandates all states follow in order to obtain funds from the estates of deceased individuals who, in their last years, depended on Medicaid, the government-funded health insurance program for the nation’s poorest citizens.
Generally, a person’s house is not eligible for Medicaid. However, for persons over 55 who utilized Medicaid to pay for long-term care, including stays in nursing homes or in-home medical care, it is subject to the estate recovery procedure.
A Democratic senator suggested eliminating the “cruel” scheme completely this month. Opponents claim the program only receives 1% of the more than $150 billion Medicaid spends annually on long-term care, which is an excessive amount. Additionally, they contend that many states do not alert Medicaid recipients to the possibility of large funeral costs and property claims awaiting their heirs when they pass away.
That’s how, according to LoGrande, she found herself in a two-year legal struggle with Massachusetts following her father’s passing. She had consulted a nearby nonprofit several years before his death in 2016 for guidance on taking care of her aging father. The group advised her to apply for Medicaid for him. She even recalls enquiring about the residence, but was told the authorities would only look for the house if it sent her father to a nursing home
She said, “He would never have agreed to do anything that would jeopardize his home.”
Her father received an annual notice of renewal from the state’s Medicaid office for many years. She claims she never saw the first bill for his care—which included a brief hospital stay for cancer pain, medicine, and hospice—until the state demanded $177,000 after his death.
LoGrande exclaimed, “That’s what ripped my guts out.” “It wasn’t honest.”
In 2019, the state waived its claim to the residence after reaching a settlement with the LoGrandes.
According to a 2021 report from the Medicaid and CHIP Payment and Access Commission, which provides policy recommendations to Congress, state rules regarding this recovery process differ greatly.
Liens are legal rights that can be placed on a residence in some states but not in others. While some Medicaid offices only pursue the costs associated with long-term care, others attempt to recover all medical expenses from individuals, including doctor visits and prescription drugs. While other states have sought thousands of homes totaling hundreds of millions of dollars, Alaska and Arizona have only pursued a handful of properties in recent years.
With a combined recovery of nearly $100 million in a single year, New York and Ohio led the nation in these kinds of collections, according to a Dayton Daily News investigation.
The Health and Human Services inspector general’s review of the Kansas program, which was made public on Tuesday, revealed that the program was efficient in terms of cost, producing $37 million while only needing to spend $5 million to collect the money. However, not all qualified estates had their money collected by the state.
A foundation supporting one of the largest health insurance companies in the business demanded last month that Massachusetts restructure its procedure, which includes recovering the majority of Medicaid spending above and beyond the federal government’s minimal threshold for long-term care costs. The Massachusetts Blue Cross Blue Shield Foundation suggested that the state legislature enact legislation outlawing the extra collections.
Estate recovery “has the potential to perpetuate wealth disparities and intergenerational poverty,” said Katherine Howitt, a Medicaid policy director with the foundation.
In Tennessee, which recovered more than $38.2 million from more than 8,100 estates last year, Imani Mfalme found herself in a similar predicament after her mother’s death in 2021.
As her mother’s early-onset Alzheimer’s worsened, Mfalme continued to care for her. But in 2015, when Mfalme was diagnosed with breast cancer and needed a double mastectomy, she started looking at other options. She hosted a meeting in her mother’s home with the local Medicaid office. The representative told her to drain her mother’s bank accounts—money Mfalme poured into assisted living facility payments for her mom—so her mother would qualify for the program.
She recalls being somewhat offended during the meeting after the representative asked her three times, “This is your mother’s home?” The representative, Mfalme said, made no mention that she could be forced to sell the house to settle her mother’s bill with Medicaid once she died.
Now, Tennessee’s Medicaid office says she owes $225,000 and the state is seeking a court order that would require Mfalme to sell the house to pay up.
In a gridlocked Congress where some Republicans are clamoring to trim Medicaid entitlements, the bill is unlikely to garner the bipartisan support needed to become law.
There’s at least one person who acknowledges the rule isn’t working: the man who engineered it.
Many people don’t know about the decades-old mandate, which was intended to encourage people to save for long-term care or risk losing equity in their homes, explained Stephen Moses, who now works for the conservative Paragon Health Institute.
“The plan here was to ensure that people who need long-term care can get it but that you plan ahead to be able to pay privately so you don’t end up on the public health care program,” Moses said.
Also read-State Medicaid Offices Go After The Homes Of The Dead To Recoup Their Medical Expenses
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