State Medicaid offices target dead people's homes to recoup their health care costs

[dalton99a]

https://apnews.com/article/medicaid-estate-recovery-nursing-homes-65d5e637e19dc27bd1bd3b097d239b53

State Medicaid offices target dead people’s homes to recoup their health care costs
By AMANDA SEITZ
Updated 3:18 PM CDT, March 16, 2024

WASHINGTON (AP) — As Salvatore LoGrande fought cancer and all the pain that came with it, his daughters promised to keep him in the white, pitched roof house he worked so hard to buy all those decades ago.

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

“The home was everything,” to her father said LoGrande, 57.

But the bill and accompanying threat weren’t a mistake.

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

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

...

[ck4829]

1. World's greatest healthcare system at it again

[jimfields33]

6. They promise the homeowner he could stay in the house until he died.

[ck4829]

9. OK

[jimfields33]

10. That is a blessing for him and the family.

Now the family can sell the house and pay the Medicaid bill without financial burden. It’s a win.

[Demsrule86]

17. No it isn't a win. Seriously?

[AllyCat]

18. Not a win. We pay taxes to provide services.

We don’t turn around after the person dies to take away assets from a grieving family.

[jimfields33]

20. Yes we do. In states that allow Medicaid it's a requirement to pay back from the estate.

It’s not new.

[AllyCat]

37. It's not right. It's not a win.

[niyad]

25. Did you forget the sarcasm thingie?

[Prairie_Seagull]

57. It's completely F'd up.

You know how hard it is for the mass of younger folds to get started in life? The asset of parents home even if the parent/parents got sick. Wow that is mostly how people die, go figure This inheritance can give the youth a leg up. Is that so bad? Is home ownership a sign of the 'haves'. No F'n way.

Health care system operating just as Republicans envisioned.

[Pisces]

61. The children inheriting could have opted to move in and

Take care of their elderly parent as most ethnic families do. Then they would not be faced with losing the family home. Nothing is free!

[Goodheart]

2. This is nothing new.

It's a fair system, actually.

I take that back. It's not fair that people have to pay so much money for cancer treatment.

What IS fair is the government recouping living expenses that extend beyond purely medical ones.

[ColinC]

5. I disagree wholeheartedly

But that’s only because I think that the government can and should be responsible for expenses beyond medical ones. With the assumption they should not, I would say you are completely right.

[Goodheart]

11. I'm speaking from experience.

My father used Medicaid to stay in a nursing home for almost eight years. There he received much more than medical treatment. He had meals, lodging, recreation, and attention he couldn't have gotten on his own at home.

He signed up with the full knowledge that his house would be taken to pay for those things. And as one of his children I didn't mind that I would lose an inheritance... I cared that he got the nursing home he needed.

Should all of it have been free? I don't think so. The medical part, sure... the rest, no.... I'm not yet at the stage where I think the government should pay for EVERYTHING in life.

[dembotoz]

46. yep been thru probate with my moms estate...this is real

[North Shore Chicago]

3. In many ways..

WE are a shit-hole country.

[Goodheart]

4. The political alternative would be no Medicaid at all.

At least the man was able to get treatment without being kicked out of his home.

[Wonder Why]

7. They're repossessing coffins now?

[Ms. Toad]

8. Is there a reason the heirs shoudl benefit, at the expense of the rest of us?

People on Medicaid aren't forced to sell certain assets in order to receive Medicaid. But if those assets are not used to pay for expenses paid by Medicaid it creates a windfall for the heirs - at the expense of the rest of us who are footing the bill.

A different system would be a whole lot better - one which assured everyone access to medical care (including long-term care at the end of life). But that's not the system we have. The system we have does at least let the person receiving care retain certain assets including a home) as long as they are alive. Once they have died, the assets they were allowed to retain while receiving "free" care are used to repay the expenses we all shared in (in the form of taxes) while they were alive.

[leftstreet]

14. Most "heirs" aren't compensated for their free caregiving labor

The state is happy to watch family members lose their jobs, leave their careers, and get burned out - trying to help their loved ones avoid institutional care for as long as possible

Let them keep the damned assets

[AllyCat]

19. this

[Ms. Toad]

21. That is sometimes, but not universally, true.

And in most families the caregiving falls unevenly on one or two kids, rather than all of them sharing the work.

It would be a good idea to modify the rules so it is easier for family members who are caregivers to be compensated by Medicaid - preferably before their loved one dies so that life is easier for everyone. Or, in the alternative, for the assets to go to those family members who are providing care rather than to repay Medicaid. But that isn't how the system currently works - the assets (if there is no will) goes primarily to the spouse or, if none, is split evenly among the siblings. If there is a will - how they are divided is based on the desires of the deceased (which may or may not be related to the person who provided the care).

But I'm not in favor of just randomly favoring family members (caregivers or not) over the rest of us who pay for Medicaid.

[Silent Type]

26. Good point about compensation for family caregivers. Not sure what requirements should be, but it's doable.

I know I have read about some programs that pay some family caregivers. Need to look that up.

[TexasBushwhacker]

31. Worth noting that family caregivers are disproportionately female

If course, caregivers if children are also disproportionately female. So we take a few years away from our careers to raise our pre-school children, then we take a few more to care for elderly parents. Before you know it, we don't have the 35 years that Social Security is based on. Let me tell you, those zero years really hurt.

[Silent Type]

33. Another good point that ought to be an easy tweak. But . . . . . .

[Ms. Toad]

50. True,

Which is both why I suggested payment for caregivers AND, if the estate does stay with the family making sure it goes to the caregivers, not just distributed evenly among the heirs (which would take money out of taxpayers pockets to give a windfall to the non-caregiver brothers, increasing the inequity).

[TxGuitar]

45. Family caregivers can be paid.

If someone is on Medicaid.

[Ms. Toad]

51. True. At least in some circumstances.

I didn't have time to look up the details. They probably can't be paid for all of the time the family believes it is useful.

[TxGuitar]

43. Not true

If someone is on Medicaid and receiving caregiver assistance, the state will usually allow the recipient to "hire" a family member for the care giving role and will be paid for a set amount of hours per week. My RN wife worked ad a Medicaid case manager for 15 years and performed these assessments daily.

[pinkstarburst]

48. Agree with this

We need a complete health care overhaul in this country. But until we're all willing to pay much higher taxes, to the tune of what they pay over in Europe, I don't see that happening.

Medicaid is for people living in poverty with no ability to pay for their own care. You are allowed to keep your home if you own one, but Medicaid will absolutely come after your estate because it is not fair for the taxpayer to pay for someone's care after they claim they could not pay for it themselves, only to have them leave a valuable asset like a home to their heirs in their estate. It is only fair that a person's own assets should be used to pay for their care, before the taxpayer is asked to pay for their care.

[JustAnotherGen]

12. My mom receives Medicare

And she still "sold" her house to my brother and me last year for $500.

She doesn't trust the government to "hold" as it is. At 77 - with the things she's experienced in life - I don't blame her.

[Ms. Toad]

22. Medicare or Medicaid?

If she "sold" it within 5 years of applying for Medicaid for long-term care your mother may be kicked off of Medicaid (and the payments reclaimed). In most states the look-back period is 5 years; in one or two it is 2.5 years. I hope your mother consulted an attorney before she "sold" it to you at less than fair-market value.

[JustAnotherGen]

72. Medicare and all of the Alphabet of Parts

We have evil in America - and if it triumphs - they are going after race traitors. She's old enough to remember being driven off the road in Kentucky (Fort Knox) when near term with my brother.

And people wonder why even living in Western NY - my dad never got in a car with my mom without being armed.

Only time he didn't was when we were stationed in Wiesbaden West Germany.

Those MAGATS will be looking for anyway possible to rob her black children of intergenerational wealth.

[Ms. Toad]

73. Availability of Medicare has nothing to do with wealth.

It is available to everyone who has paid in enough quarters. There is no point in dumping assets to get Medicare.

[JustAnotherGen]

75. Understood and agree

But we aren't good Tutsis assuming that America is great, honest, or equal.

Everyone has to take care of themselves and never trust your neighbors. I feel like only other black folks, indigenous and Japanese Americans get this.

All.of the doomsday scenarios being passed around as something *new* in a MAGAT world have ALL happened in America before.

The fear in some quarters is that it has never happened to them - the dominant culture.

Hope for the best, prepare for the worst.

I just don't trust America - not with black wealth. They always fuck us over.

[Ms. Toad]

76. Still don't see why divesting yourself of assets helps.

What if you predecease her? Then she is in worse shape than she would be if she owned her home. If she still owned it, at least she would have the ability to sell it to raise money to pay for her care. Or, in the alternative, had she sold it to you at fair market value, she would have had the proceeds of the sale. Now, unless you have a will that returns it to her on your death, the possibility that you will predecease her outs her at greater risk than when she owned her own home.

[MichMan]

77. I don't understand it either

Is the poster bragging that they swindled their elderly mother by buying her home (worth $120k) from her for only $500?

[Ms. Toad]

79. I don't think so.

I thought it was because of a pretty common confusion between Medicaid and Medicare. But it seems to be about Medicare.

So it seems to be driven by some sort of fear that Medicare will suddenly be treated like Medicaid, and that not owning her own home will be detrimental (maybe because of some sort of retroactive claim against her assets. I think the point of the $500 sale was designed to make it be treated like a sale, rather than a gift. But it makes no difference for Medicare - and as to Medicaid, below market sales are subject to being treated as gifts, or worse, as an attempt to defraud Medicaid.

[marybourg]

34. And you will not get the step up in the cost basis of the house

that occurs when one inherits a house, so that when the house is sold you and bro will owe capitol gains tax on the difference between what Mom paid for the house and what you sell it for, nor, unless you both go live in the house for a few years will you get the $250,000 Capitol gain exemption that a person who owned and lived in a house for several years gets when selling the house. So by neither validly selling nor bequeathing the house to your brother and you, your Mom left a lot on the table by this maneuver. Not to mention the gift tax return that should have been filed for this gift of the actual value of the house minus $500.

[JustAnotherGen]

74. My dad died in 2011

At that time the cash wealth was $1.9 M.

She receives over 5K per month between my dad's military disability, social security and a retirement fund.

The house was last valued at 120K. We intend to give it to my niece when my mom passes.

Neither my brother nor I are concerned about it -and I'm not looking for an inheritance. I want her to have the best care - she's earned it.

But I could definitely see the Trumpers in the town I grew up in hanging her on election night. Or - trying to take her home.

I do not trust these evil MAGATS.

We can't assume that the American we live in on this March 17, 2024 will be the same next year.

I wish we could get her to start moving the money offshore as we have. My brother has too.

We are out of her next November if Trump steals it. Still have the 1st floor suite of my in laws house (ours now) in Acri ready for her.

[TxGuitar]

42. Doesn't apply to Medicare

[MichMan]

53. Makes zero sense; Medicare eligibility doesn't have anything to do with assets.

Not understanding why any of you thought this was necessary

[marybourg]

58. Confusion between Medicare and Medicaid.

Ignorance. I’ve heard people who think if they can hide their assets, the wealthy nursing home absorbs the cost. They don’t realize that it’s their neighbors who absorb the cost. And this kind of ignorance just feeds greed and a sense of entitlement.

[Demsrule86]

65. If she goes into care in less than five years I think (nursing home), she will still lose the House.

[Fiendish Thingy]

13. So in essence the govt. operates as a reverse mortgage lender. Nt

[Celerity]

24. he approves

[Silent Type]

27. OK, that got the best laugh of week for me. I'm still laughing.

[PlutosHeart]

30. maybe the newly TV advertising "Christian Insurance" companies

could have helped on medical costs.

[drmeow]

15. Medicaid is aid

you are supposed to exhaust all other resources to pay. Same with "welfare" for the poor. You can't earn too much money, you can't own too many things, you can't own nice things. It is yet another way the system keeps the poor poor. I think it is also true of most long term care insurance policies (although there is usually a provision if the family caregiver lives in the house for the last two years - although that may be a state law that varies from state to state).

Remember, unless you are part of the inherited wealth pseudo aristocracy that isn't supposed to exist in this country, inheriting any wealth is against the American way so it shouldn't be allowed

[babylonsister]

16. I thought standard practice was to repossess

homes before people died so their Medicaid bills will be paid. I know it happens.

[Silent Type]

28. I think some states might take one's home if there is no reasonable chance they will

return from a facility. But, practically, people usually die within a few years, so they just wait. Don’t really know that for sure, though.

[TxGuitar]

41. It never happens

Until the recipient and their dependents die or the dependent becomes of age.

[TxGuitar]

44. After the person dies

And it isn't automatic. In fact, it is pretty rare.

[Hamlette]

23. I don't think heirs are "entitled" to anything

It seems that some here do. I know many people care for their parents at great expense to themselves and if so, they may limit the amount due at death. I don't get people who fight over assets.

When my parents died it was easy to split the small estate they left because neither my sister nor I thought we had done anything to lay claim to it. Yes, we cared for both of them in their latter years but we did it out of love, not duty or with an eye to monetary gain.

Of course in my family you can't spend the corpus of the estate. My mom would roll over in her grave if you did.

[IcyPeas]

29. What if the person doesn't own a house?

[marybourg]

32. Then there's no home to take. Reimbursement only occurs when the

taxpayers have supported someone in a nursing home and there are assets that can be used to reimburse the taxpayer.

[TxGuitar]

40. Then nothing happens

The program, (MERP) was set up to help prevent Medicaid fraud. If you don't own or have an estate, nothing hapoens

[Xolodno]

35. There are ways to get around it.

Wealthy people do it all the time, just need a good lawyer and accountant. We moved a lot of assets into "safe havens". First time my parents had any kind of wealth (starved when I was a kid) and were unable to enjoy it. So we all worked together for my siblings and self to make sure it didn't all go poof.

[marybourg]

36. It doesn't go poof. It goes to reimburse the

taxpayer supported system that paid $70,000+/year to keep your family member in a nursing home. Teachers, fast food workers, social security recipients. Their taxes, rather than your parents’ own assets, kept your family member in a nursing home.

[Xolodno]

64. They didn't make it to a nursing home.

But the hospital with inflated prices was all too willing to try and grab the assets.

[marybourg]

66. The nerve of them! Billing people

for hospital care!

[Xolodno]

69. Fifty bucks for a band aid?

I wouldn't call that billing. I call that robbery.

Wife has a rare genetic issue and has to take blood thinners on any flight over four hours. Four pills of Xarelto here in the states, $100. While in Italy she lost the last two, I went to a pharmacy there, told me they can't sell me just two pills, only a months supply. It was also $100....for a months worth.

Later, due to a heart condition, I have to take a blood thinner. Eliquis to be exact. I had to fill the prescription in Mexico.

[marybourg]

71. So that, which most of us have had to put up with, justifies your family

in having previously hidden their money so that your neighbors have to pay not only their own hospital bills, but yours also? Give me a break!

[Xolodno]

78. Hide money? Didn't have to.

It was all moved into legal and known financial instruments, the IRS approved. If you didn't, as I stated in another post, not my problem. But I am informing others that there is a way to hold on to assets. You seem to want everyone to suffer.

[TxGuitar]

39. Then you are part of the problem

Medicaid is for disabled and impoverished. (In TX you have to be both unless you are a pregnant person impoverished or a child impoverished). And this only applies to recipients of waiver programs, not "regular" Medicaid programs.

[Xolodno]

67. Nope. It's all legal and part of our system.

You may not like it, but, it is the law of the land, it is what it is. Don't call me part of the problem just because I took advantage of what was there already.

I grew up impoverished for my entire childhood, my parents probably qualified for several government programs, but were too proud and pressured by other family members who would look down on us. When they finally came into some inheritance, unlike the other relatives who made it go poof via spending (generational wealth often doesn't last), I helped them invest it so they could retire with some comfort. Father didn't make it to social security before cancer took him. And my mom, still here, but not very aware. But she is not in a nursing home because I made some very good decisions.

Don't like it? Not my problem. I just played the cards I was dealt. Irony, the relatives who got inheritance also tried "subvert" my mom's and take it, including my father's who was set to get (my grandfather out lived him sadly). Do I and my siblings live a bit better? Hell yes and I wouldn't change a single decision. I know what it is to go hungry.

In the state of Washington they are trying to find a way where you pay taxes for long term care. Both Oregon and California have indicated they want to go that route as well, but are watching as its the first in the nation to try and accomplish this. They don't want to take your parents house.

[MichMan]

54. Unfortunately, there are always some who gain pleasure from defrauding taxpayers by cheating the system

Their greed often makes them believe the rest of us are suckers.

[moonscape]

63. This. I used Mom's assets

for her care rather than hide them via spending down in advance,, getting Medicaid, and pocketing the spoils. Why should taxpayers pay for her care instead of her? I might hate the system we have, but that’s what needs to change. A bad system does not justify greed.

[Xolodno]

68. The thing is...the laws are there.

With a bit of due diligence you can go through the hoops. Might cost you some money, but its all there, plain as day. But too many are unaware and get hit. Unfortunately, its all too often the lower class as they don't have a lawyer on speed dial. So just as the family starts to get ahead, it gets ripped from them. If your parents worked hard all their lives and want to leave the house they paid with blood, sweat and tears, I want you to keep it. Many on this thread just want to say "tough shit".

[TxGuitar]

38. Mrs TxGuitar here

I spent the last 15 years as an RN case manager for Medicaid in Texas. This only applies to people who were covered under the waiver programs and is called Medicaid Estate Recovery Program. Everyone who applies for the waIver program is assessed by an RN in their home and the program is explained to them. They sign forms, including the MERP (Medicaid Estate Recovery Program) and copies are left in the home. These are not quick assessments, typically involving 1-2 hours and involves about 10 signature pages that are signed and witnessed. It is always explained that any forfeiture of any part of the estate happens after the death of the recipient and their dependents or when the dependent comes of age

[pinkstarburst]

47. Medicaid is for people with no assets--it is absolutely fair

The people crying foul here are his children, who hoped to inherit the house, and have the American taxpayer pick up the bill for their father's care, but that is not how Medicaid works. In cases like this, or in the case of the elderly who have moved to nursing home care, Medicaid goes after their estate, including any major assets remaining such as a home, in order to pay for care received.

This man is deceased, Medicaid paid for his care because he claimed that he was down to no assets remaining while he was alive (except for his house) that could pay for his care, and now that he is dead, they are going after the estate to recoup those costs, so that his estate bears the costs of his treatment, rather than the American taxpayer bearing the cost of his treatment.

[Rebl2]

49. My mother

died in January and I just got one of those letters from the state. They asked if she had a house, life insurance-no to both. We sold the house before they (parents) were on Medicaid. It was the only way we could pay for nursing home which was not exactly my choice, but I am disabled and was unable to care for them. They ask if her spouse is still alive, no again. Then they asked if there was a disabled child even if the child is an adult. I thought that was an odd question. I had to show proof of my disability and the only thing I had (I had been on SSDI since my early twenties) was a letter I received from SS last year telling me I was no longer on SSDI because I was full retirement age. There was no way I have the original forms I filled out in 1979.

[Grins]

52. Yes! "This is routine..."

This is not something that should be a surprise. It’s in the admitting documents!

The way around it - GET A MEDICARE ATTORNEY!! NOW!

Yes, there is such a legal specialty, and you have to have your plan in place WELL in advance of when you will actually need it, and that may be 10 YEARS! (When I went through it it it was 5-years.)

If you are 70 years of age - see an attorney. Pay him for his warnings and advice. It’s well worth it.

[dalton99a]

60. 49 states look back 60 months (5 years). California uses 30 months

The California exception will end in July 2026

[Grins]

81. With my elderly mother in NJ it was 10 years.

A few years later, before she passed, it was fewer (7?). Why you have to start earlier. And on top of it

[MOMFUDSKI]

55. Regular people don't have the luxury of having

an attorney at their elbow. Home should have been transferred to daughter on the day he was diagnosed. This is how we get screwed daily.

[jimfields33]

59. You need to have it five years before diagnosis

They ensure that fraud doesn’t happen. I don’t understand why you don’t think the house shouldn’t be sold, He was given 24/7 care. The children should be grateful they don’t have to pay anything.

[Marthe48]

56. Years ago, I read about a Medicaid recovery case in WV

It was probably 20+ years ago, and the article said it was part of Medicaid conditions, but hadn't been used often up until then. The WV case was one of the first, iirc.

I felt bad for the people who it affected, and who like me, had no idea what was in the fine print. My relatives who needed Medicaid either had no assets, or used their asset to pay for their care, and then were declared indigent and applied for Medicaid. I found out after I read the article that if the person had divested themselves of assets 5 years or more before they started using Medicaid, they'd be exempt from recovery. Later, that time period was changed to 10 years. My Mom had no assets in her name. She lived in Colorado and inherited my brother's cabin simply because she'd lived with him long enough to get it because he died intestate. She in turn, gifted it to her grandkids, but she was allowed to live there until she died. My husband and I managed her finances and the kids got the cabin. My husband's uncle used all of his savings, and then went on Medicaid, so he didn't have any debts to Medicaid after he died. My mother-in-law had the same situation, used up her assets, then went on Medicaid, with no debts to pay back after she died.

My husband had good insurance, and Medicare. He was treated for cancer for 10 months-big fail. At the last, the hospital recommended hospice care, which we used for less than 10 days. When he died, I gave all of the medical equipment and supplies to the agency that supplied hospice care, and donated the feeding supplies to the hospital. We didn't get bills from the hospital or hospice because of the insurance and Medicare. But my husband was involved in a class action asbestos lawsuit, and the CMS has sent me regular letters for the last 6 years that if there is any payout from the lawsuit, I will have to pay $2500.00+/- for that last 10 days. I don't have to pay out of pocket, just if any money comes from a settlement. I thought settlements related to health issues were exempt, but who knows, maybe that's changed, too. Besides that, I've always thought it was bs, because his insurance was supposed to cover it. Our lawyer worked with the lawsuit lawyers and established a fund overseen by the local court. None of the individual lawsuits were settled in the years after my husband's death. The estate fund expired last year, and I stopped getting letters from CMS for awhile. Right after it expired, I got a settlement check, which I put in its own account at the bank, and if I hear any more from the lawyers about paying CMS, it'll come out of that. I looked for information about CMS claims having a statute of limitations, but not sure if I found anything that eases my mind.

I know way more than I want to about the fine print :/

[WiVoter]

62. So Is Medicaid A Loan?

Or Medicare (sometime in the future)?

[pinkstarburst]

70. Medicaid is only for people with no assets

who have zero ability to pay for their care (medical or in a nursing home.) If you happen to own a house at that point, they might allow you or your spouse to continue living in the home, but if the taxpayer pays for your medical care, you will have to give up that asset (your home) as soon as you no longer need it (you die and your spouse dies.)

It's not the same as Medicare, which everyone eventually qualifies for based on age. If you are applying for Medicaid, you are saying you have no assets and no ability to pay, therefore you should not have an estate to hand down to your heirs. Any estate should be handed over to the taxpayers to reimburse what was spent on you.

[Zeitghost]

80. That's because medicaid is to provide assistance

For those without assets, not to provide an inheritance to their heirs.