‘Heartbreaking and destructive’: Ohio lawmakers seek to rein in Medicaid home liens

Stephens is a primary sponsor of HB 318, along with State Rep. Sean Patrick Brennan, D-Parma.

The Medicaid estate recovery program allows states to seek repayment of Medicaid costs from a beneficiary’s estate after they die, but HB 318 would limit how much the state could seek to recoup from a beneficiary’s estate through a lien on their home.

Reform provisions target estate recovery efforts involving homes

While originally one of those limits in the bill would have prohibited the state from imposing a lien against the real property of a Medicaid recipient that exceeds 75% of the assessed value of the property, in the Ohio House Medicaid Committee’s most recent meeting this month, Stephens added an amendment to the bill that changed that provision.

The bill now would prohibit imposing a lien that exceeds the 75% limit for property if the property has an assessed value of $150,000 or less.

For property with an assessed value greater than $150,000, the amendment specifies that the amount of a lien imposed against the real property can go beyond that 75% limit, but it may not exceed the assessed value of the property.

Additionally, HB 318 would waive recovery against an estate when the cost of the Medicaid services to be recovered is less than $10,000, according to Stephens’ amendment, which is down from $20,000 under the original bill.

In addition to putting limits on what the state can do in terms of putting liens on people’s properties for estate recovery, HB 318 would prohibit the state from seeking to recoup costs from someone’s estate for reasons beyond what is required by the federal government.

Federal law requires states to have a Medicaid estate recovery program, but gives states leeway in administering it. In 2023, a Dayton Daily News investigation found Ohio Medicaid is more aggressive than other states in recouping Medicaid costs from deceased residents and is in the minority of states that puts liens on Medicaid recipients’ properties.

The state collected more than $91.1 million in 2023 through Medicaid estate recovery, according to the Ohio Attorney General’s Office. The amount collected has climbed annually since 2017, state data show.

‘These liens assure these properties will never be occupied’

Medicaid liens on properties can deter homebuyers if they cannot afford the lien, such as when the lien is greater than the value of the property, Stephens said, which then leaves those homes vacant.

“These liens assure these properties will never be occupied,” Stephens said.

The only method to end the cycle involves land bank acquisition, he said, which is when a public or nonprofit entity acquires the property to clean up complex title issues. A land bank could acquire a property with a Medicaid lien through through tax foreclosure, which can wipe out or settle these liens.

“In the end, Medicaid never gets repaid, homebuyers have difficulty finding houses, the neighborhood deteriorates, and the government loses additional funds in paying for demolition,” Stephens said.

The payoff for Ohio’s aggressive efforts to recoup Medicaid expenses from the estates of residents is less than 1% of what is spent through the Ohio Medicaid program, a Dayton Daily News analysis found.

“No other public benefit requires repayment,” said Erin Campbell, an attorney at Pro Seniors Inc., a Cincinnati nonprofit that provides free legal advice to people 60 years old and older.

While the millions collected through Medicaid estate recovery efforts are fractions compared to the billions spent through the entire program, the decision for a family to give up a home to the program in exchange for medical care of a loved one is one that can impact future generations in that family, according to Campbell.

“Medicaid estate recovery is heartbreaking and financially devastating to families, and it’s destructive to communities because those on Medicaid generally have little to no assets. A home is the primary source of estate recovery. The next generation will have to leave the home and start from scratch,” Campbell said in her testimony in favor of the bill.

Bill seeks more estate recovery notification requirements

Last year, the Ohio House passed legislation to add notification requirements for Medicaid estate recovery efforts in order to try to create more transparency with recipients.

HB 130 would require the Ohio Department of Medicaid to provide notice of the Medicaid estate recovery program both when an individual applies for and is approved for Medicaid.

The bill would require Ohio Medicaid to develop the notification explaining how the Medicaid estate recovery program works, along with a notification for Medicaid recipients at risk of being subject to the estate recovery program.

It would also list resources related to the following questions, the lawmakers said:

HB 130 passed the Ohio House in May 2025 and was then referred to the Ohio Senate Medicaid Committee. The committee held its first hearing for the bill in November.