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Thousands of Connecticut residents will become eligible for Medicaid Jan. 1, and for some, the coverage will come with an often-overlooked trade-off: When they die, the state could dock their estates to repay the medical costs it covered.

So-called “recovery” of the assets of Medicaid recipients applies to only some people in Connecticut’s program. It’s long been one of the strings attached to the public health care coverage.

But in some places, it’s getting new attention as Medicaid grows to cover millions more Americans as part of the federal health law commonly known as Obamacare. In Washington state, officials recently announced they would scale back the scope of its recovery efforts, according to The Seattle Times, which had reported on the concerns of a woman who was newly eligible for Medicaid but wanted to avoid the program so she could leave her home to her two sons when she died.

In Connecticut, whether a person, or a person’s estate, will be on the hook to repay the state for Medicaid benefits depends on the person’s age and the type of services received, what part of the Medicaid program he or she is part of, and when the coverage began.

The state’s Medicaid program is known as HUSKY and has multiple parts. The only portion that is expanding because of Obamacare is known as HUSKY D, which covers poor adults who don’t have minor children.

For someone who enters HUSKY D, the state can recover assets under three circumstances:

  • If a person is aged 55 and older, the state can recover the cost of any medical care that was covered by HUSKY D. The state would seek repayment from the estate of the person when he or she dies, but not while the person is alive, according to the state Department of Social Services.
  • If a person is in a nursing home or receives other HUSKY D coverage for long-term care, the state can recover costs from the person’s estate after death, regardless of the person’s age when the costs were incurred, according to DSS.
  • If a person of any age receives Medicaid coverage for injuries sustained in an accident and receives a financial settlement related to the accident, the state can seek reimbursement for the accident-related bills while the person is alive.

If a Medicaid recipient dies and leaves a surviving spouse or child under 21, the state’s recovery from the estate would be delayed until after the spouse dies or the child turns 21, according to DSS.

Those rules will apply to the people who become eligible for HUSKY D as of Jan. 1, as well as to people who have joined the program since it was established April 1, 2010.

But a separate set of rules applies to people who were part of a program formerly known as SAGA medical, or state administered general assistance, which was converted to HUSKY D in April 2010.

People who received SAGA medical coverage are subject to more state recovery efforts while they’re alive, including having the state place a lien on property or make a claim against any inheritance they’re slated to receive, lottery winnings or any other windfall.

In the HUSKY A program, which covers more than 430,000 children and parents or guardians, the state recovers money for medical benefits received by people aged 55 and older, and for nursing home care received at any age. The recovery is made from people’s estates after they die.

Last fiscal year, the state Department of Administrative Services recovered approximately $15 million related to Medicaid payments, according to a spokesman.

Note: This story has been corrected to reflect the state Department of Social Services’ policy of recovering money for some benefits paid through HUSKY A. DSS previously provided incorrect information about recovery in HUSKY A.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She 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 caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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