State Medicaid offices target homes of dead to recoup health care costs

As Salvatore LoGrande battled cancer and all the pain that came with it, his daughters vowed to keep him in the white, sloping-roofed house he worked so hard to buy decades ago.

So Sandy LoGrande thought it was a mistake when, a year after her father’s death, Massachusetts billed her for $177,000 for her father’s Medicaid expenses and threatened to sue her home if she didn’t pay up quickly .

The house was everything,” LoGrande, 57, told her father.

But the bill and the accompanying threat were not a mistake.

Rather, it was part of a routine process that the federal government requires of every state: retrieving money from the assets of dead people who, in their later years, relied on Medicaid, the taxpayer-funded health insurance for North- poorer Americans.

A person’s household is usually exempt from qualifying for Medicaid. But it is subject to the asset recovery process for those who were over 55 and used Medicaid to pay for long-term care, such as nursing home stays or home health care.

This month, a Democratic lawmaker proposed gutting the cruel program entirely. Critics argue that the program collects too little of the roughly 1 percent of the more than $150 billion Medicaid spends annually on long-term care. They also say many states fail to warn people who sign up for Medicaid that large bills and claims on their property could await their families after they die.

LoGrande says that’s how she ended up in a two-year legal battle with Massachusetts after her father’s death. Several years before he died in 2016, she had turned to a local nonprofit for advice on caring for her elderly father. The group suggested enrolling him in Medicaid. She even remembers asking about the house, but was assured that the state would only look for it if she sent her father to a nursing home.

He would never have signed anything that could endanger his home, he said.

For years, her father received an annual renewal notice from the states Medicaid office. She says it wasn’t until after his death, when the state’s $177,000 lawsuit arrived, that she saw the first bill for his care, which included a brief hospital stay for cancer pain, medication and the hospice.

That’s what ripped my guts out, LoGrande said. It was dishonest.

The state settled with the LoGrandes in 2019 and released their claim on the house.

State policies around this recovery process vary widely, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission, which makes policy recommendations to Congress.

Some states will put a legal lien on a home while others will not. Meanwhile, some Medicaid offices try to recover all of patients’ medical costs, such as doctor visits or prescriptions, while others only pursue long-term care costs. Alaska and Arizona went after only dozens of properties in recent years, while other states are going after thousands of homes, totaling hundreds of millions of dollars.

New York and Ohio led the nation for such collections, recovering more than $100 million combined in a single year, a Dayton Daily News investigation found.

An investigation into the Kansas program, released last Tuesday by the inspector general of Health and Human Services, found that the program was cost-effective, bringing in $37 million while only spending $5 million to recover the money, but the state did not always collect the money from the estates. who were eligible.

Last month, a foundation for one of the industry’s largest health insurance giants asked Massachusetts to review its process, which includes charging reimbursement for most Medicaid costs beyond the minimum requirement of federal government to recover long-term care costs. The Blue Cross Blue Shield Foundation of Massachusetts recommended that the state legislature pass a law that would prohibit such additional collections.

Equity recovery has the potential to perpetuate wealth disparities and intergenerational poverty, said Katherine Howitt, the foundation’s director of Medicaid policy.

In Tennessee, which recovered more than $38.2 million from more than 8,100 estates last year, Imani Mfalme found herself in a similar situation after her mother died in 2021.

As his 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 began to look for other options. He arranged a meeting at his mother’s home with the local Medicaid office. The representative told her to deplete the money from her mother’s bank accounts that Mfalme poured into assisted living facility payments for her mother so that her mother could qualify for the program.

She remembers being a little offended during the meeting after the representative asked her three times: Is this your mother’s house? The representative, Mfalme said, did not say that she might be forced to sell the house to pay her mother’s Medicaid bill after she died.

Now, the Tennessee Medicaid office says she owes $225,000, and the state is seeking an injunction forcing Mfalme to sell the house to pay.

Mfalme, now 42, said he wants to pay what he can, but the house is a particular pain point. Her mother, a black woman, bought her dream home in Knoxville after winning a historic discrimination lawsuit against her former employer, Boeing, for paying her less than her male co-workers.

He fought hard for equal pay and equal rights. “Just to see that it’s ripped away just because she was sick and I was sick, it’s absolutely devastating,” Mfalme said of her mother.

TennCare, Tennessee’s Medicaid office, said in an email to The Associated Press that it would not comment on specific cases.

The Medicaid and CHIP Payment and Access Commission report recommended that Congress reverse the 1993 law that required states to recover money from estates, instead of making it optional.

Earlier this month, Democratic Rep. Jan Schakowsky of Illinois reintroduced legislation that would end the federal government’s mandate. Schakowsky believes the rule is a losing proposition for families, who are giving up their homes, and taxpayers, who are not seeing big returns from recovery efforts.

It’s one of the most cruel and ineffective programs we see, Schakowsky told the AP. “This is a program that doesn’t work for anyone.

In a gridlocked Congress, where some Republicans are calling for cuts to Medicaid entitlements, the bill is unlikely to garner the bipartisan support needed to become law.

There is at least one person who recognizes that the rule doesn’t work: the man who designed it.

Many people are unaware of the decades-old mandate, which was intended to encourage people to save for long-term care or risk losing their home equity, said Stephen Moses, who now works for the conservative Paragon Health Institute .

The plan here was to make sure people who need long-term care can get it, but plan ahead to be able to pay privately so you don’t end up in the public health care program, Moses said.

Copyright 2024 Health News Florida


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