When Salvatore Logrande was battling cancer and all the pain that came with it, his daughters promised to let him live in the white, pitched-roof house he had bought so hard for decades earlier.
So when, a year after her father’s death, the state of Massachusetts charged her father $177,000 in Medicaid costs and threatened to sue her family if she didn’t pay immediately, Sandy Rogrande thought it was a mistake. Ta.
“Home was everything,” Logrande, 57, told her father.
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But the bill and the threats that accompanied it were not a mistake.
Rather, it is part of a routine process that the federal government requires states to use to protect the assets of deceased people who were dependent in their final years on Medicaid, the taxpayer-funded health insurance for the poorest Americans. The idea was to recover funds from.
Private homes are typically exempt from Medicaid eligibility. However, people over age 55 who used Medicaid to pay for long-term care, such as nursing home stays or home health care, are subject to the estate recovery process.
Imani Mfarme poses for a portrait outside her late mother’s home on March 7, 2024 in Knoxville, Tennessee. Mfarme’s mother had Alzheimer’s disease and she was in long-term care. After her death, the state is now seeking to claim her estate to pay for her care. (AP Photo/Katie McMekin)
This month, Democratic lawmakers proposed halting the “cruel” program altogether. Critics say the program accounts for too little, about 1%, of the more than $150 billion a year that Medicaid spends on long-term care. Many states also say they don’t warn people who enroll in Medicaid that their families could face large bills and claims on their estates after they die.
Logrande says this is the end of a two-year legal battle with the state of Massachusetts following her father’s death. A few years before his death in 2016, she sought advice from a local nonprofit about caring for her elderly father. The group suggested she enroll in Medicaid. She even remembers asking about her home, but she was assured that the state would only look for her home if she sent her father to a nursing home.
“He would never have signed a contract that would have put his home at risk,” she said.
For years, her father received annual renewal notices from the state Medicaid office. She said that after his death, the state requested $177,000, and it was the first time she had seen a bill for his medical expenses. That included a short stay in the hospital, medication and hospice for pain caused by the cancer.
“That’s what tore my insides out,” Logrande said. “That was dishonest.”
The state reached a settlement with the Lograndes in 2019 and relinquished ownership of the home.
State policies regarding this recovery process vary widely, according to a 2021 report from the Medicaid and CHIP Payment Access Commission, which makes policy recommendations to Congress.
Some states place a lien (legal title) on your home, while others do not. On the other hand, some Medicaid agencies seek to recover all medical costs from patients, such as doctor visits and prescriptions, while others pursue only the costs of long-term care. While Alaska and Arizona have gone after just a few dozen properties in recent years, other states are going after thousands of homes totaling hundreds of millions of dollars.
New York and Ohio led the nation in such collections, collecting more than $100 million combined in one year, according to a Dayton Daily News investigation.
An investigation into Kansas’ program released Tuesday by the Department of Health and Human Services’ inspector general found the program was cost-effective, generating $37 million in revenue and spending just $5 million on recouping funds. As it turns out, the state did not necessarily withdraw funds from the estates. It was the target audience.
Last month, the industry’s largest health insurance giant’s foundation ordered the state of Massachusetts to complete a process that includes collecting reimbursement for a large portion of Medicaid costs above the federal minimum requirements for recovering long-term care costs. We asked for a complete review. The Blue Cross Blue Shield of Massachusetts Foundation recommended that the state Legislature pass legislation to prohibit these additional levies.
Katherine Howitt, the foundation’s director of Medicaid policy, said estate recaptures “have the potential to perpetuate wealth disparities and intergenerational poverty.”
Imani Mfarme found herself in a similar predicament after her mother passed away in 2021 in Tennessee, where she recovered more than $38.2 million from more than 8,100 properties last year.
As her mother’s early-onset Alzheimer’s disease worsened, Mfarme continued to care for her. But when Mufalme was diagnosed with breast cancer in 2015, requiring her to have a double mastectomy, she started considering other options. She hosted a meeting with her local Medicaid office at her mother’s home. Her representative asked her to withdraw her mother’s bank account (money that Mr. Mfarme had put into paying for her mother’s care home) so that her mother could qualify for the program. I told him.
She remembers feeling a little offended after a representative asked her three times during a meeting, “Is this your mom’s house?” Mufalme’s representatives said she did not mention the possibility that she might be forced to sell her home to settle Medicaid payments after her mother died.
Now, Tennessee’s Medicaid office says Mufalme is $225,000 in debt, and the state is seeking a court order requiring Mufalme to sell his home and pay the debt.
Mfarme, now 42, said he wants to pay what he can, but housing is a particular problem. A black mother bought her dream home in Knoxville after winning a landmark discrimination lawsuit against her former employer, Boeing, for paying less than her male colleagues.
“She fought so hard for equal pay and equal rights. Just to see that taken away just because she was sick and I was sick is just shocking,” Mfarme said. spoke about her mother.
Tennessee’s Medicaid office, TennCare, said in an email to The Associated Press that it does not comment on specific cases.
The Medicaid and CHIP Payment and Utilization Committee’s report recommended that Congress repeal the 1993 law that required states to withdraw funds from estates and instead make it voluntary.
Earlier this month, Illinois Democratic Rep. Jan Schakowsky reintroduced a bill that would end the federal mandate. Schakowsky believes the rules are a disadvantage to families who are losing their homes and to taxpayers who don’t see much benefit from recovery efforts.
“This is one of the cruelest and most inefficient programs we’ve ever seen,” Schakowsky told The Associated Press. “This is a program that doesn’t work for anyone.”
With Congress gridlocked and some Republicans pushing for cuts to Medicaid eligibility, the bill is unlikely to garner the bipartisan support needed to pass.
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At least one person admits that this rule isn’t working. It’s the man who designed the rules.
Stephen Moses, who now works at the conservative Paragon Health Institute, said many people don’t know about this decades-old mandate, which encourages people to save for long-term care. He explained that the purpose was to do so, or else risk losing the equity in his home.
“The plan here is to make sure that people who need long-term care have access to it, and that they can pay for it privately so that they don’t end up participating in public health insurance programs. It was about planning ahead so we could do it,” Moses said.
