Get the facts about Medicaid Estate Recovery when considering a Medicaid long-term-care program

Wednesday, July 18, 2018

Miriam Sheline
   Miriam Sheline, Pro Seniors

There’s no doubt about it:  the rules and regulations that govern Ohio’s Medicaid programs that provide alternatives to nursing home care can sometimes feel onerous and difficult to understand. This can be especially so when you or a loved need help, and are trying to understand the effect the rules may have on your finances and your future.

Programs such as PASSPORT, Assisted Living Waiver, Ohio Home Care Waiver and MyCare Ohio (all of which are statewide Medicaid programs administered by Council on Aging in its operating area) offer long-term care services and supports to Medicaid-eligible individuals. They have helped thousands of Ohioans to remain safe and independent at home, rather than enter a nursing home prematurely.

However, these programs are also subject to the Medicaid Estate Recovery (MER) program, a federally mandated program that requires the state to attempt – upon the death of an individual enrolled in a Medicaid program – to recover some or all of what Medicaid paid for services provided to the individual.

Many people applying for these programs have questions and concerns about the MER program. “The number-one fear of those applying for PASSPORT is ‘Will my spouse be left destitute,’” said Miriam Sheline, managing attorney for Pro Seniors, Inc. Pro Seniors operates a free legal advice hotline for seniors.

The short answer to this question is “no.” “In general, in regards to Medicaid Estate Recovery, there is no recovery during your lifetime, period,” Sheline said. In other words, by law, the state can only attempt to recover costs after a Medicaid recipient’s death. Even then, recovery will not happen if there is a surviving spouse, surviving children under the age of 21 or surviving children of any age who receive Social Security disability benefits.

Often, people learn about MER when provided with their program application paperwork. Or they might hear a rumor that in order to qualify for help through a Medicaid program administered by Council on Aging (COA) they will have to give up all their money and assets first – even sign their home over to COA. The latter is certainly not true, but either way, this can needlessly scare people away from getting help that might be available to them.

Understanding MER and its implications can be extremely confusing, and each case can be different, so Sheline encourages anyone with questions about MER to call the Pro Seniors hotline for advice at (513) 345-4160. Ohioans age 60 and older are eligible for a free 30-minute phone consultation with an attorney.

Additionally, COA has produced Medicaid Estate Recovery: Connecting you to information, answers and resources, which contains a thorough Q&A about MER and a list of places you can turn to get the facts and advice about MER in order to make an educated decision about enrolling in a Medicaid, in-home, long-term-care program.