Feds consider scaling back Medicaid estate recovery

For some adults, getting Medicaid coverage means that when they die, the state could claim some or all of their assets to recover the cost of the medical care they received. That’s left some people who qualify for the program under the federal health law wary of joining.

Now the federal government, concerned about the effect on enrollment, plans to consider scaling back the practice.

In a letter to state Medicaid directors, Cindy Mann, deputy administrator of the Centers for Medicare and Medicaid Services, wrote that the agency “intends to thoroughly explore options and to use any available authorities to eliminate recovery of Medicaid benefits" other than those spent on long-term care, like nursing home services or home care.

She wrote that the move was because of “the potential barrier to enrollment that future estate recovery may create for some individuals.”

The possibility that the government could claim a person's assets when they die has long been a feature of Medicaid, but it's gained new attention in recent months as millions more Americans qualify for the newly expanded program as part of the health law commonly known as Obamacare.

The federal government currently requires states to seek to recover money spent on the care Medicaid beneficiaries aged 55 and older receive in nursing homes, home care and for related hospitalizations and prescription drugs. But states have the option of also seeking repayment for other services covered for Medicaid clients 55 and older.

Connecticut’s policy is to recover the cost of any medical care covered by HUSKY -- the state’s Medicaid program -- for people aged 55 and older. It also recovers money spent on nursing home or home care for people under 55.

The “recovery” is made from people’s estates when they die, not while they’re alive. If a Medicaid client is survived by a spouse or child under 21, the claims are delayed until the spouse dies and the child turns 21.

There is one circumstance in which the state can seek repayment while a person is alive: if a person receives Medicaid coverage for injuries sustained in an accident and receives a financial settlement related to the accident. In those cases, the state can seek reimbursement for accident-related bills.

State Healthcare Advocate Victoria Veltri said she’s been making inquiries about the possibility of Connecticut's relaxing its Medicaid recovery policies, particularly for the next three years. From the start of this year through 2016, the coverage of new Medicaid clients will be funded entirely by the federal government, and any money recovered for the cost of their care will go to Washington.

But Veltri said it’s not clear what leeway the state would have to relax its recovery policies. She said she was glad the federal government is considering revisiting its recovery rules.

Veltri said her office has received calls from potential Medicaid enrollees who are worried about the possibility of the state trying to recover money from their estates when they die.

“There’s no question, we’ve had some people who were deterred by the possibility that there might be someone trying to recover the cost of that care,” she said.

Related: When getting Medicaid now means repaying the state later

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About Arielle Levin Becker

Arielle Levin Becker was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on home caretakers from the National Association of Health Journalists. Arielle previously worked for The Hartford Courant, most recently as its health reporter. She also has covered education and municipal beats for The Courant and for the Home News Tribune of East Brunswick, N.J. She is a 2004 graduate of Yale University.

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