Ohio Medicaid seeking public comment on changing estate recovery rules through Wednesday

Ohioans who want to see changes to how Ohio Medicaid goes after the estates of deceased residents have through Wednesday, Aug. 30 to provide public comment as the agency is going through a mandated review of program rules.

The federal government requires states to have Medicaid estate recovery programs to recoup costs of providing medical care for poor residents, but leaves the particulars up to states. Ohio law in turn gives the Ohio Department of Medicaid leeway in developing program rules, which have to be reviewed every five years. A one-week public comment period on changing program rules ends Wednesday.

The Dayton Daily News has reported that Ohio is among the most aggressive states in seeking estate recovery, and is in the minority of states that puts liens on Medicaid recipients’ properties.

To submit comments on revising program rules, people can email Rules@Medicaid.Ohio.gov. Comments on draft rules are public record, so people should not submit any protected health information.

Additionally, Ohio Medicaid has two upcoming hearings on Sept. 21 and 22, both at 11 a.m., on proposed changes to rules under the department. Those hearings do not pertain to changes the state is proposing to estate recovery.

The only changes currently proposed by the agency include minor revisions from references of “son” or “daughter” to “child,” as well as removing phrases of “he or she.” The changes also add “American” in front of references to American Indians, as well as adding references to Alaska Natives.

“This rule is being amended as part of the five-year review to make minor language changes for clarity,” says a letter from Director Maureen Corcoran to all Medicaid eligibility manual holders.

Ohio Medicaid officials did not responded to phone calls and emails this week asking how Ohioans can have input in the rulemaking process after the Wednesday deadline.

One local activist says Ohio Medicaid can and should do more to incorporate changes that the public wants to programs that impact a lot of people.

“I think they should be doing more to reach people about public comment,” said Alicia Hopkins. “I also think that they need to be giving a full 30-day notice because it’s not a fair rulemaking process.”

Hopkins is a local activist who takes part in educating others about Ohio’s administrative rule-making process, which she believes is an important part of the Democratic process.

“You would be able to help be a part of changing it or making it better,” she said of why people should participate.

People can sign up for alerts when rule changes are being proposed by searching for eNotifications on the governor’s website at governor.ohio.gov. They still should be given more time to respond, Hopkins said, even after the alerts go out.

“By the time it’s put out through the email chain, you’re one or two days into the public comment, so it’s not giving enough time,” Hopkins said.

Estate recovery

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.

Estate recovery, which started in 1995, seeks to obtain repayment of the cost of benefits once a Medicaid recipient dies, according to the Ohio Department of Medicaid. Action is taken involving those who were either permanently institutionalized or 55 years or older, records show.

Groups that advocate for seniors say changes to Ohio policy should be considered. One agency that advises Congress wants to “ease the burden of estate recovery” across the U.S.

Ohio Medicaid “has made several changes to ensure Ohioans covered by Medicaid are notified of estate recovery,” including inserting a form in all approval and change notices generated by Ohio Benefits, Deputy Director Lisa Lawless told the Dayton Daily News last month.

She said the agency’s changes made during the last five-year review in 2018 “are sufficient.”

Ohio is one of 15 states that puts liens on Medicaid recipients’ properties. The Dayton Daily News recently revealed how this policy can force people from homes after their loved ones die.

Ohio is also among about 18 states that pursue recovery for non-Long-Term Service and Support benefits, according to a federal study. Those benefits include debts from doctor visits, hospital stays, scans and other medical tests, among others, according to the agency.

Some states, meanwhile, don’t collect unpaid Medicaid expenses from smaller estates. Estates valued under $25,000 are not subject to recovery in Georgia or Massachusetts while Texas sets the minimum for collections at $10,000, records show.

Ohio is one of the few states that “does not perform a cost-effectiveness test or place any predetermined dollar thresholds or real property value,” according to the 2021 study by the Medicaid and CHIP Payment and Access Commission, a group that advises Congress.

Federal rules require states to have a program in place to collect unpaid Medicaid debt from recipients. But other than requiring states to provide notice to Medicaid applicants explaining the estate recovery policy, rules are largely left up to each state.

Because of Ohio’s policies, the state collects more from its residents in Medicaid recovery than even much larger states. The national MACPAC study found Ohio’s Medicaid estate recovery program ranked among the top five states in collections four years ago, bringing in more than $55 million.

The total for the eighth most populous state has risen steadily since, topping $87.5 million last year with what one southwest Ohio senior advocacy group called aggressive collection efforts that include property of dead recipients.