Mitigating the Dangerous Results of Medicaid Property Restoration: Methods for State Advocates

Introduction

Medicaid property restoration, mandated by federal legislation, requires states to pursue payback for sure Medicaid advantages from the estates of deceased beneficiaries. This coverage perpetuates inequities and deepens present disparities by deterring entry to important companies, hindering intergenerational wealth accumulation, and exacerbating monetary and housing instability for surviving members of the family.

Though restoration is obligatory for sure advantages, many states have exercised the flexibleness to develop their insurance policies past federal minimums. On the identical time, there are additionally alternatives to mitigate hurt of restoration via extra expansive protections like hardship waivers. This information equips advocates with methods to mitigate the dangerous results of Medicaid property restoration by analyzing state practices and figuring out alternatives for advocacy. It explores key areas akin to narrowing the scope of restoration, enhancing hardship waivers and deferral protections, implementing cost-effectiveness thresholds, and enhancing public transparency and accessibility via enhanced reporting, coaching, and spot necessities.

Desk of Contents

What’s Medicaid Property Restoration?

Since 1993, federal legislation has required states to hunt restoration of sure Medicaid funds from the estates of beneficiaries after their loss of life.^[1] Notably, no different public profit program requires accurately paid advantages to be repaid. States should get better the prices for long-term companies and helps (LTSS)- together with institutional care, home- and community-based companies, and associated hospital and prescription drug companies supplied to people 55 or older.^[2]

States even have the choice to transcend these federal minimal necessities and get better prices for different Medicaid state plan companies supplied to beneficiaries age 55 and older.^[3] Presently, 36 states decide to get better prices past what federal legislation requires (See Desk 1).^[4] In all circumstances, restoration is proscribed to the deceased recipient’s property.^[5] Importantly, Medicare cost-sharing quantities paid for by Medicare Financial savings Packages should not topic to restoration.^[6]

Desk 1: State Restoration Insurance policies^[7]

Rationales for Medicaid Restoration are Unsound

Proponents of Medicaid restoration argue that the coverage promotes program integrity and helps Medicaid’s monetary sustainability. Nonetheless, knowledge demonstrates minimal monetary returns from Medicaid restoration packages, with recovered funds accounting for less than 0.1% of nationwide Medicaid spending in 2019.^[8] Even within the states with the very best restoration quantities, recovered funds accounted for lower than 1% of state Medicaid spending.^[9] Contemplating the numerous administrative prices of pursuing recoveries, internet restoration is additional lowered, yielding restricted monetary profit for states.^[10]

Medicaid restoration penalizes the lowest-income people whereas permitting wealthier people to bypass its affect. Whereas Medicaid permits people to retain property utilizing authorized mechanisms often known as property planning, these usually require assist from a lawyer, which lower-income people usually can not afford. With out entry to property planning, many older adults are pressured to impoverish themselves to fulfill Medicaid’s stringent useful resource thresholds. Consequently, recovered estates usually encompass few property past the decedent’s house, which was beforehand an excludable asset when the particular person initially certified for Medicaid.^[11] As a result of the house was not counted towards their eligibility for Medicaid, many people and their households are unaware that it’s later topic to restoration.

Medicaid Restoration Harms Low-Revenue Households and Communities of Coloration

The price of LTSS is prohibitively excessive, usually far past what households can afford. Residence well being aide companies, for instance, value roughly $68,640 per yr for 40 hours of care per week, whereas a personal room in a nursing facility averages $116,800 yearly.^[12] Opposite to frequent assumptions, Medicare’s protection of LTSS is proscribed, employer-based insurance coverage doesn’t cowl LTSS, and entry to long-term care insurance coverage is minimal and sometimes prohibitively costly. For instance, solely 14% of people age 65 and older have a personal long-term care insurance coverage coverage, regardless of estimates that 70% will want long-term care sooner or later of their lives.^[13] Consequently, Medicaid has turn out to be the first payer of LTSS, serving as the one viable protection possibility for a lot of people.^[14]

The harms of Medicaid restoration are vital, deepening inequities in housing and wealth accumulation, whereas deterring people from in search of important advantages attributable to worry. Communities of shade face heightened hurt, as longstanding systemic boundaries lead to disproportionate affect. Low-income populations are additionally disproportionately affected, as restricted monetary assets prohibit entry to property planning mechanisms, forcing people to impoverish themselves to fulfill Medicaid’s strict eligibility thresholds.

Medicaid restoration deepens housing and wealth inequities by disrupting an important pathway for intergenerational wealth accumulation. Homeownership is usually the results of a long time of month-to-month mortgage funds, requiring vital private sacrifice—particularly difficult for low-income individuals. Usually, households can cross down their houses to their family members, offering long-term monetary stability. Medicaid restoration breaks this chain, forcing households to start out over and rising their danger of housing instability and eviction.

Medicaid restoration disproportionately impacts sure populations, notably individuals of shade, for whom structural boundaries like restricted entry to credit score and discriminatory housing insurance policies have created vital disparities in homeownership and wealth accumulation.^[15] The lack of secure housing attributable to Medicaid restoration additional entrenches the racial wealth hole and undermines efforts on the federal, state, and native ranges to develop entry to inexpensive housing.

Worry of Medicaid restoration usually deters people from making use of for crucial advantages. People wish to cross down their house—the asset they’ve labored so arduous to safe and sometimes at nice sacrifice—to their households. Consequently, many delay or forgo making use of for Medicaid advantages fully.

For low-income people, this creates a big barrier to care, forcing them deeper into poverty by paying out-of-pocket for companies, counting on members of the family for assist, or going with out care altogether. With out companies, well being situations can deteriorate, contributing to the necessity for dearer and in any other case preventable hospitalizations and institutionalizations.

Medicaid Restoration Mitigation Methods

Present federal statutory authority permits—and in some circumstances requires—states to implement insurance policies to mitigate the harms of Medicaid restoration for recipients whereas additionally lowering administrative burdens for state Medicaid packages.

Justice in Growing old performed a panorama evaluation within the fall of 2024 by reviewing Medicaid State Plan paperwork, state laws and administrative code, state Medicaid restoration assets (together with web sites, reality sheets, and notices), and nationwide analyses of Medicaid restoration. The next dialogue analyzes these findings to equip advocates with mitigation methods to scale back the dangerous impacts of Medicaid restoration of their states.

Medicaid packages, together with their restoration mechanisms, fluctuate considerably from state to state. Consequently, whether or not reforms require legislative motion, administrative adjustments, or a mix of each is determined by the state. As soon as state-level adjustments are developed, they have to be submitted to the Facilities for Medicare & Medicaid Companies (CMS) for approval, a typical course of in Medicaid policymaking.

Technique: Restrict Scope of Restoration

Federal legislation requires states to get better prices for sure Medicaid companies, together with nursing facility care, home- and community-based companies (HCBS), and associated hospital and prescription drug companies.^[16] States can get better for extra advantages, particularly Medicaid state plan advantages supplied to people age 55 and older.^[17] Thirty-six states presently get better for advantages past the federal minimal.^[18] To mitigate the affect of Medicaid restoration, states recovering for extra expansive advantages ought to take into account limiting restoration to the federal minimal necessities. This mitigation technique will cut back the variety of people, and the scope of companies, topic to restoration.

For instance, Mississippi limits restoration to the federal minimal, specifying restoration “For any particular person who obtained medical help at age 55 or older, changes or recoveries of funds are made out of the person’s property for nursing facility companies, house and community-based companies, and associated hospital and prescription drug companies” whereas additionally reiterating required federal exclusions for Medicare cost-sharing.^[19]

Restrict Definition of HCBS for Functions of Restoration

The CMS State Medicaid Guide up to date in 2001 defines HCBS for functions of Medicaid restoration as companies “outlined in §§1915(c) and (d), 1929, and 1930” of the Social Safety Act.^[21] Notably, Massachusetts not too long ago proposed narrowing their restoration to solely these HCBS companies.^[22] For states utilizing an alternate HCBS waiver authority in addition to 1915(c) and (d) and 1929 and 1930 of the Social Safety Act, advocates can push to restrict restoration to solely HCBS as outlined within the 2001 steering. This method would successfully exclude restoration for HCBS supplied beneath different waiver authorities.

Restrict Scope of Restoration in a Managed Care Surroundings

For states using managed care, limiting the scope of Medicaid restoration presents distinctive challenges. States can contract with managed care plans or personal insurance coverage firms to supply care to particular populations or to all their Medicaid enrollees.^[23] As an alternative of receiving reimbursement for every service delivered, managed care plans are paid a capitated fee, or a hard and fast month-to-month price, per enrollee. In states utilizing managed care fashions, Medicaid restoration usually consists of the full capitated funds made to managed care plans, no matter whether or not people used companies equal to these quantities or really used any LTSS.

When a state opts to not get better for all Medicaid state plan companies, it should decide the portion of the capitated managed care fee attributable to recoverable companies, akin to nursing facility care or HCBS. In states with managed care, six get better for less than the portion of the premium attributable to LTSS utilized by the recipient.^[24] This requires an actuarial evaluation performed by the state to calculate the recoverable portion of the capitated fee.^[25] On this scenario, advocates should guarantee their state solely recovers for the portion of the capitated fee attributable to recoverable companies, quite than your complete capitated fee.

Restrict Restoration to Probate Property

States have discretion in defining which property are topic to Medicaid restoration. Whereas federal legislation mandates that states get better property passing via probate, states can develop their scope to incorporate non-probate property.^[27] Probate is a authorized course of used to settle an property’s affairs after a person’s loss of life, together with transferring property and settling excellent money owed.

States like Minnesota have broadened their scope of restoration to incorporate non-probate assets, akin to sure trusts and life insurance coverage insurance policies.^[28] To mitigate the affect of restoration, advocates can push states to restrict their restoration efforts to the federally required minimal: property that cross via probate beneath state legislation. This will exclude property passing via “residing trusts” and joint tenancy. For instance, California, amongst different states, modified its legislation to restrict restoration to the probate property.^[29]

Technique: Increase Deferrals

Property restoration happens solely after the loss of life of the Medicaid recipient. Federal legislation additionally requires states to delay restoration specifically cases, together with if there’s a:

• Surviving partner, no matter the place the partner lives.
• A baby beneath 21 or a blind or disabled baby, no matter the place the kid lives.^[30]

These circumstances are known as deferrals. In most states, deferrals are non permanent, and when situations are not met, the state will pursue restoration.

Importantly, undue hardship waiver flexibilities, mentioned in additional element under, present states with alternatives to develop deferral protections. As an illustration, California and Washington prolong deferral protections to home companions along with spouses. Moreover, Utah and Louisiana each outline the presence of a surviving minor or disabled baby as undue hardship, subsequently exempting these people from Medicaid restoration altogether.

Technique: Increase Hardship Waivers

States should set up procedures to waive restoration in conditions the place pursuit would lead to undue hardship for the inheritor(s).^[31] Federal necessities don’t outline undue hardship and solely specify exemptions for American Indians and Alaska Natives.^[32] This leaves states with appreciable flexibility in defining cases of undue hardship and the scope of corresponding waivers.^[33]

Whereas some states restrict hardship waivers to intervals when undue hardship exists, many totally exempt the qualifying candidates from restoration.^[34] For this evaluation, undue hardship waivers are organized into classes, as demonstrated by Desk 2: State Hardship Waivers.^[35]

Desk 2: State Hardship Waivers

Sure – The state gives a full waiver of restoration when undue hardship exists for qualifying candidates.
Sure * – The state presents a short lived waiver (deferral) for so long as undue hardship situations exist.
No – The state doesn’t provide a hardship waiver of this sort.

**Missouri and North Dakota don’t provide any hardship waivers in contradiction to federal legislation. Advocates in these states can work with their state to adjust to federal legislation and develop undue hardship waivers that mitigate restoration as mentioned in additional element under. Supply: See Appendix A.

Revenue Producing Asset Waiver

The commonest undue hardship waiver, utilized by forty-one states, is an exemption for an inheritor’s “sole/major technique of livelihood” or “sole-income producing” asset.^[36] Whereas most states present particular consideration for a household farm or enterprise, Minnesota makes use of broader language particular to the applicant’s “commerce, occupation, or occupation.” Equally, Arizona, Minnesota, and New Hampshire enhance entry to this waiver by reducing the “sole” revenue threshold to “greater than 50 p.c” of the inheritor’s livelihood. To make sure higher accessibility for heirs, advocates ought to push their states to undertake inclusive hardship waiver language overlaying a variety of income-producing property and reducing the edge from “sole” technique of livelihood to “major,” “greater than 50 p.c,” or an outlined share of revenue.

Eligibility for Public Advantages Waiver

States generally use two related waivers associated to public profit eligibility and Medicaid restoration. Twenty states use these waivers to deal with conditions the place, with out entry to the property proceeds, the inheritor would turn out to be eligible for federal or state public advantages, or conversely, the place permitting the inheritor to inherit would disqualify them from such advantages. Whereas states like New Mexico and Virginia recommend that candidates for the waiver must turn out to be eligible for a specific program, like Medicaid or TANF, most states use broader, extra inclusive language like turning into eligible for “state or federal public advantages,” or requiring “monetary assist from the federal government” to make this waiver extra accessible. Advocates ought to push their states to undertake broad, inclusive hardship waiver language that expands eligibility past particular packages to embody eligibility for state and authorities help.

Advocates ought to push their states to undertake broad, inclusive hardship waiver language that expands eligibility past particular packages to embody eligibility for state and authorities help.

Deprivation of Requirements of Life Waiver

Typically overlapping with the earlier waiver class, 13 states waive restoration when denying an inheritance would deprive the inheritor of “requirements of life,” akin to meals, clothes, shelter, or medical care. States ceaselessly use language like, “restoration would endanger or compromise the well being and/or shelter of the applicant.”

For instance, Nevada finds hardship when “the monetary affect of restoration in opposition to instant members of the family of the applicant would place them in a monetary place of hardship.” New Mexico finds hardship when “the deceased recipient’s heirs could be put liable to severe deprivation with out receipt of the proceeds of the property,” and Ohio finds hardship when “restoration would deprive the survivor of essential meals, shelter, or clothes. Deprivation doesn’t embrace conditions during which the survivor is merely inconvenienced however wouldn’t be liable to severe hurt.” Advocates ought to push their states to undertake broad and inclusive hardship waiver language that explicitly acknowledges the danger of great deprivation, together with lack of meals, shelter, clothes, or medical care.

Properties of Modest Worth

Ten states waive restoration for “houses of modest worth.” Whereas CMS doesn’t specify a exact threshold, federal steering suggests defining modest worth as roughly half the typical house worth within the county.^[37] States using this waiver should define their methodology for figuring out “modest worth” of their State Plans.^[38] For instance, Arkansas finds hardship when “the property asset topic to restoration is a house with a worth of fifty p.c or much less of the typical worth of houses within the county the place the homestead is positioned.” Advocates ought to push their states to outline “houses of modest worth” in essentially the most inclusive method doable to account for rising housing prices.

Caregiver Waiver

Fourteen states acknowledge the crucial position of household caregivers in stopping or delaying Medicaid enrollee institutionalization by providing waivers to exempt or defer property restoration from caregivers who’re heirs. These waivers usually require the caregiver, usually an grownup baby, to have lived constantly within the recipient’s house for a specified interval (normally 1–2 years) and supplied care that delayed the recipient’s want for Medicaid LTSS. Eligibility standards usually additionally embrace documentation of caregiving contributions and proof that the care supplied delayed institutionalization. Some states broaden the definition of caregivers to incorporate siblings or grandchildren, whereas others impose stricter limitations, akin to requiring that the care was “unreimbursed,” or limiting eligibility to particular members of the family. A key distinction throughout states is whether or not they present everlasting waivers, which totally get rid of restoration, or non permanent waivers, which delay restoration for so long as the caregiver continues to reside within the house. Advocates ought to push for everlasting waivers versus non permanent waivers.

Revenue Primarily based Waivers

Seven states use income-based hardship waivers to focus on mitigation methods to heirs with restricted monetary means. Greatest practices on this waiver class embrace setting revenue thresholds that mirror residing prices. As an illustration, Louisiana waives property restoration for heirs with incomes as much as 300% Federal Poverty Stage (FPL) within the yr earlier than the decedent’s loss of life. Equally, Vermont permits waivers for heirs with incomes as much as 300% FPL, however provided that the property is valued at $250,000 or much less. Massachusetts waives $50,000 of the restoration declare for heirs with incomes as much as 400% FPL for the 2 years previous to the declare, with a most waiver of $100,000 for a number of qualifying heirs.

Residency Waiver

Sixteen states use residence waivers to guard heirs residing in a decedent’s house from restoration. These waivers usually require the inheritor to have resided constantly within the house for an outlined interval earlier than the decedent’s loss of life, usually 12–24 months, and don’t have any various residence. Frequent necessities additionally embrace demonstrating that the inheritor can not afford various housing or financing to repay the state.

For instance, Arizona grants a hardship exemption when an inheritor was residing within the decedent’s house on the time of the waiver utility, on the time of the enrollee’s loss of life, and for a minimum of twelve months previous to the enrollee’s loss of life, supplied the inheritor doesn’t personal one other residence. California finds hardship in circumstances the place the applicant is aged, blind, or disabled and has constantly lived within the decedent’s house for a minimum of one yr previous to the decedent’s loss of life and continues to reside there, and is unable to acquire financing to repay the state.

Different Waivers

Twenty-four states use quite a lot of waivers to deal with “different compelling circumstances” that don’t match inside commonplace hardship waiver classes.^[39] These waivers are evaluated on a case-by-case foundation, permitting states to contemplate components such because the inheritor’s dependency on the decedent, their monetary or medical wants, or the inheritor’s distinctive life circumstances. For instance, Kansas, Ohio, Pennsylvania, and Texas take into account bills incurred by heirs to take care of the decedent’s house, whereas Kentucky considers the persevering with schooling and well being wants of heirs.

Technique: Handle Boundaries to Hardship Waivers

Advocates and heirs ceaselessly report vital challenges with the Medicaid restoration waiver utility course of, stemming from a lack of information concerning the existence of those waivers. Even when people are knowledgeable, they encounter cumbersome paperwork necessities and sophisticated bureaucratic procedures that always make the method inaccessible even when they’re eligible for the waiver.

States additionally present various quantities of time to use for hardship waivers, starting from a mere 20 days in New Jersey to 60 to 90 days in different states. For these in a position to navigate these hurdles, further boundaries come up as some states fail to course of waiver purposes promptly or deny waiver purposes altogether. Advocates ought to push their states to supply heirs with extra time to use for hardship waivers and require states to reply well timed to candidates’ waiver purposes. Advocates must also push for easy-to-find data on state web sites and restoration assets on hardship waivers and apply.

Illinois state legislation requires the state to publish, on an annual foundation, a public report on the variety of Medicaid restoration circumstances pursued, the variety of hardship waivers granted, and accompanying demographic data when accessible.^[40] Between 2022 and 2024, Illinois authorized 55%, 75%, and 47% of waiver purposes obtained, respectively. Nonetheless, solely 2-3% of surviving members of the family utilized for hardship waivers throughout this time, underscoring the numerous boundaries inhibiting entry to the state’s present waivers.^[41] Advocates ought to urge their states to publish this data yearly to evaluate the coverage’s affect and consider the accessibility and use of hardship waivers.

Technique: Increase Price-Effectiveness Thresholds

Recognizing the numerous administrative prices related to Medicaid restoration, states can undertake methods to scale back administrative burdens related to the coverage.^[42] Desk 3 demonstrates vital variation throughout states in implementing cost-effectiveness methods, together with insurance policies particular to the declare quantity, property worth, and internet restoration quantity. As an illustration, Mississippi and New Jersey won’t pursue estates valued at or under $5,000 and $3,000, respectively, whereas Georgia, South Carolina, and Massachusetts use an property worth threshold of $25,000, and North Carolina makes use of $50,000. Equally, Illinois and Georgia waive claims of as much as $25,000, whereas the District of Columbia units this threshold at simply $100.

Advocates can push their states to undertake larger cost-effectiveness thresholds, aligning with greatest practices like North Carolina’s exclusion of estates valued at lower than $50,000 or Illinois and Georgia’s waiver of claims of as much as $25,000, to attenuate administrative burden and shield heirs.

Desk 3: State Price-Effectiveness Methods^[43]

No Threshold

Iowa, Ohio, and Oregon

**North Dakota, New York, Montana, and Wisconsin use completely different standards exterior of those classes to find out cost-effectiveness. The fee-effectiveness methods for Maryland and Oklahoma are unknown.

Technique: Enhance State Medicaid Restoration Notices and Training

Regardless of necessities that states present discover about Medicaid restoration when a person is making use of for Medicaid advantages, many Medicaid enrollees and their members of the family report being unaware of Medicaid restoration.^[44] To enhance data and understanding of state Medicaid restoration packages, advocates can encourage their state to:

• Improve Medicaid Restoration Notices: Guarantee notices about Medicaid restoration are supplied at a number of factors past the preliminary Medicaid utility. The Medicaid utility course of will be overwhelming, with intensive paperwork and data, making it straightforward to miss particulars about restoration. State advocates have raised considerations about inadequate or unclear notices, which might result in confusion and, in some circumstances, authorized challenges. Advocates ought to assess their state’s particular panorama and discover alternatives to enhance discover accessibility and readability to supply the best aid.^[45]
• Publish Clear and Accessible Data About Medicaid Restoration Packages: Encourage states to develop and publicly submit accessible guides with clear and concise explanations of their Medicaid restoration insurance policies. Supplies ought to be examined with Medicaid recipients earlier than launch to make sure their effectiveness and supplied in languages reflective of the state’s Medicaid inhabitants and various codecs accessible to individuals with disabilities.
  • Instance: Illinois handed laws requiring the state to supply details about hardship waivers on its web site in English, Spanish, and the subsequent 4 mostly spoken languages within the state. The laws additionally required Illinois to provide “brief guides” describing how heirs can apply for hardship waivers, whereas additionally requiring the applying course of to be “easy” to scale back boundaries. ^[46]
• Enhance Transparency Round Declare Balances: Advocate for insurance policies that permit Medicaid recipients to remain knowledgeable about their declare quantities. States can allow people to request, or proactively ship, an annual assertion of the recipient’s declare steadiness.
  • Instance: California residents can request an itemized assertion of their Medicaid restoration declare annually.^[47]
• Present Complete Coaching for Enrollment Counselors and State Workers: Guarantee enrollment counselors and state employees obtain thorough coaching on their state’s restoration insurance policies to allow them to present correct data to Medicaid enrollees and their households. Nicely-trained employees shall be higher outfitted to precisely reply questions on their state’s Medicaid restoration insurance policies, acknowledge when a person could qualify for a hardship waiver, and join people to applicable assets.

Technique: Enhance Transparency

There are not any federal necessities requiring standardized reporting on Medicaid restoration actions. Advocates can usually solely get hold of knowledge on their state’s restoration actions via public data or freedom of knowledge requests. Advocates ought to urge states to implement annual public reporting on property restoration knowledge, together with the variety of estates pursued, the full quantity recovered, administrative prices related to recoveries, and the variety of hardship waiver purposes obtained versus granted.

Advocates ought to encourage states to incorporate the demographic data of waiver candidates to higher perceive how property restoration insurance policies and mitigation methods affect particular communities. Notably, Illinois is the one state presently reporting yearly on the variety of hardship waiver purposes obtained and granted, and the applicant’s county of residence, gender, and race.^[48] Massachusetts advocates have known as for the state to supply this stage of transparency.^[49]

Conclusion

Medicaid restoration perpetuates systemic inequities and disproportionately burdens low-income people and communities of shade. Advocates can use the mitigation methods outlined on this transient, akin to narrowing the scope of restoration, enhancing hardship waivers, establishing cost-effectiveness thresholds, and enhancing transparency and accessibility necessities, to scale back the dangerous impacts of Medicaid restoration.

Endnotes

1. Estates embrace, at a minimal, the beneficiary’s probate property. The probate property is outlined beneath every state’s probate code and consists of property solely owned by the deceased that would not have a named beneficiary or joint possession. Frequent examples of probate property embrace a house, private property, and financial institution accounts. ↑

2. 42 U.S.C § 1396p(b)(1)(B)(i). Associated companies embrace any hospital care or prescription companies supplied to a person whereas receiving nursing facility care and/or HCBS. See Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See pages 3-9-3 to 3-9-4. ↑

3. 42 U.S.C § 1396p(b)(1)(B)(ii) ↑

4. KFF, “What’s Medicaid Property Restoration?” (September 2024). Because the publication of this report, Massachusetts has elected to restrict restoration to what’s federally mandated. See Mass. Gen. Legal guidelines Ch. 197 (2024), amending Mass. Gen. Legal guidelines Ch. 118E § 31. ↑

5. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See the definition of property on pages 3-9-6 and 3-9-7. ↑

6. 42 U.S.C § 1396p(b)(1)(B)(ii) ↑

7. KFF, “What’s Medicaid Property Restoration?” (September 2024). Because the publication of this report, Massachusetts has elected to restrict restoration to what’s federally mandated. See Mass. Gen. Legal guidelines Ch. 197 (2024), amending Mass. Gen. Legal guidelines Ch. 118E § 31. ↑

8. KFF, “What’s Medicaid Property Restoration?” (September 2024). ↑

9. Id.; Justice in Growing old, “When States Recoup Medicaid Prices by Seizing Household Properties, Poor Households Endure Whereas State Budgets Are Barely Effected” (Could 2024). ↑

10. MACPAC, “Medicaid Property Restoration: Bettering Coverage and Selling Fairness” (March 2021). This report analyzed program administration prices in 5 states, discovering that administrative bills accounted for between 3.7% and 32.1%, with a median of 11%. ↑

11. MACPAC, “Medicaid Property Restoration: Bettering Coverage and Selling Fairness” (March 2021). ↑

12. KFF, “10 Issues About Lengthy-Time period Companies and Helps” (July 2024). ↑

13. KFF, “The Affordability of Lengthy-Time period Care and Helps Companies: Findings from a KFF Survey” (November 2023); Administration for Neighborhood Residing, “How A lot Care Will You Want?” (February 2020). ↑

14. Justice in Growing old, “Medicaid Residence and Neighborhood-Primarily based Companies for Older Adults with Disabilities: A Primer” (April 2021). ↑

15. Id.; AARP, “Advancing Racial and Ethnic Fairness in Lengthy-Time period Companies and Helps” (September 2023). ↑

16. 42 U.S.C § 1396p(b)(1)(B)(i) ↑

17. 42 U.S.C § 1396p(b)(1)(B)(ii) ↑

18. KFF, “What’s Medicaid Property Restoration?” (September 2024); Mass. Gen. Legal guidelines Ch. 197 (2024), amending Mass. Gen. Legal guidelines Ch. 118E § 31. ↑

19. Mississippi State Plan Title XIX Of the Social Safety Act, HCFA-PM-95-3 (Could 1995). ↑

20. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See pages 3-9-4, 3-9-7, and 3-9-8. ↑

21. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). ↑

22. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001); Mass. Gen. Legal guidelines Ch. 197 (2024), amending Mass. Gen. Legal guidelines Ch. 118E § 31(3)(ii). See restoration for “just for medical help consisting of nursing facility companies, house and community-based companies and associated hospital and prescription drug companies for which property restoration is remitted beneath 42 U.S.C. 1396p(b)(1)(B)(i) or different federal legislation.” On the time of this publication, MassHealth has not up to date its state plan and written standards implementing the state’s new legislation. MassHealth has confirmed with advocates its intention to slender the scope of restoration to the definition of HCBS supplied within the CMS 2001 steering doc. ↑

23. KFF, “10 Issues to Find out about Medicaid Managed Care.” ↑

24. KFF, “What’s Medicaid Property Restoration?” (September 2024). Since this report was printed, Massachusetts additionally solely pursues restoration for the portion of the premium attributable to LTSS companies obtained. ↑

25. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See web page 3-9-5; Facilities for Medicare and Medicaid Companies, Coordination of Advantages and Third Social gathering Legal responsibility (COTPL/TPL) In Medicaid (2020). See web page 62. ↑

26. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See pages 3-9-4, 3-9-7, and 3-9-8. ↑

27. Facilities for Medicare and Medicaid Companies, Coordination of Advantages and Third Social gathering Legal responsibility (COTPL/TPL) In Medicaid (2020). See pages 64-65. ↑

28. Minnesota Division of Human Companies, “Understanding Medical Help Claims”; Massachusetts Basis et al., “Holding on to Residence: A Primer on MassHealth Property Restoration and Choices for Lowering its Affect on Members and Households” (February 2024). ↑

29. CANHR, “Medi-Cal Restoration: Restoration guidelines for Medi-Cal beneficiaries who die on or after January 1, 2017” (July 2023). ↑

30. 42 U.S.C §§ 1396p(b)(2)(A-B); Facilities for Medicare and Medicaid Companies, Coordination of Advantages and Third Social gathering Legal responsibility (COTPL/TPL) In Medicaid (2020). See web page 63. ↑

31. 42 U.S.C § 1396p(b)(3)(A) ↑

32. 42 U.S.C § 1396p(b)(3)(B); Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See pages 3-9-5 and 3-9-6. ↑

33. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See web page 3-9-7. Particularly, “particular consideration of circumstances during which the property topic to restoration is: (1) the only real income-producing asset of survivors (the place such revenue is proscribed), akin to a household farm or different household enterprise; (2) a homestead of modest worth; or (3) different compelling circumstances.” ↑

34. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). Along with granting full waivers, states can provide partial waivers or permit surviving members of the family to enter into fee agreements to fulfill the declare. ↑

35. Numerous state hardship waivers can match into quite a few classes, relying on categorization. The class complete displays the writer’s evaluation. ↑

36. Id. ↑

37. Id.; Facilities for Medicare and Medicaid Companies, Coordination of Advantages and Third Social gathering Legal responsibility (COTPL/TPL) In Medicaid (2020). See web page 64. ↑

38. Id. ↑

39. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See web page 3-9-7. ↑

40. Illinois Basic Meeting, 305 ILCS 5/5-13.1: Medicaid Property Restoration Hardship Waivers and Transparency. ↑

41. Illinois Division of Healthcare and Household Companies, “Hardship Waiver Statistics” (2024). ↑

42. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See web page 3-9-8. ↑

43. Citations present in Appendix A and MACPAC, “Medicaid Property Restoration: Bettering Coverage and Selling Fairness” (March 2021). ↑

44. Facilities for Medicare & Medicaid Companies, State Medicaid Guide Half 3 – Eligibility (February 2001). See pages 3-9-8 and 3-9-9. ↑

45. EOHHS v. Trocki Medicaid Property Restoration Resolution, No. 20-P-1234 (Mass. App. Ct. 2023). ↑

46. 305 Sick. Comp. Stat. § 5/5-13.1 ↑

47. DHCS, “Property Restoration Program.” ↑

48. Illinois Division of Healthcare and Household Companies, “Hardship Waiver Statistics” (2024). ↑

49. Massachusetts Basis et al., “Holding on to Residence: A Primer on MassHealth Property Restoration and Choices for Lowering its Affect on Members and Households” (February 2024).

Appendix A: Citations for State-Particular Medicaid Restoration Insurance policies

Alabama

Alaska

• Alaska Admin. Code 7 AAC 160.240
• Alaska Admin. Code 7 AAC 160.230
• Alaska State Plan beneath Title XIX of the Social Safety Act TN No. 03-13 (July 22, 2004).

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

• Fla. Stat. § 409.910
• Well being Administration Programs on behalf of the Company for Well being Care Administration, “Property Restoration FAQ.”

Georgia

Hawaii

Idaho

Illinois

305 Sick. Comp. Stat. § 5/5-13.1

Indiana

Iowa

Kansas

Kentucky

• Kentucky Admin. Code 907 KAR 1:585
• Third Social gathering Legal responsibility Department, “Property Restoration.”

Louisiana

Maine

• Maine Admin. Code 10-144 CMR Ch. 101, Ch. VII Part 5: Property Restoration

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

• New Mexico Admin. Code 8.200.430.19

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

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