A proposed bill would end a mandate that states try to recoup costs for long-term care provided to Medicaid beneficiaries, including by seizing homes from disproportionately poor and minority families, according to its sponsors. The legislation has the backing of at least one senior living provider advocacy group.
Last month, Rep. Jan Schakowsky (D-IL), co-founder and co-chair of the House Democratic Task Force on Aging and Families, reintroduced the Stop Unfair Medicaid Recoveries Act of 2024, first introduced in 2022. The legislation would repeal the federal Medicaid estate recovery mandate that requires state Medicaid programs to go after families and estates for repayment of Medicaid long-term care services, including home- and community-based services provided by assisted living operators and others, and nursing home care.
In a press release, Schakowsky said that often, the only means for Medicaid to reclaim hundreds of thousands of dollars spent to pay for the long-term care for a departed relative is by seizing the family home, “causing incredible emotional and financial suffering to the beneficiary’s family.”
Medicaid estate recovery, she said, keeps some families in poverty and forces older adults and disabled individuals to forego care. The program disproportionately harms low-income, blue-collar families and communities of color, Schakowsky added.
The act would ban states from pursuing funds from the families of deceased Medicaid beneficiaries, as well as from putting liens on Medicaid recipients’ homes before they die.
“This current system, which only recovers less than 1% of total long-term care spending, is ineffective and unjust, and it must end,” she said.
Argentum said it supports HR 7573 because it would protect families whose loved ones received Medicaid-funded long-term care and supports, such as assisted living, from having to repay care costs that can run into the hundreds of thousands of dollars.
“Medicaid beneficiaries are, by definition, qualified to receive services due to their income and functional needs, and families should not have to face the threat of financial ruin simply for having a loved one who requires assistance,” Argentum Senior Vice President of Public Policy Maggie Elehwany told McKnight’s Senior Living. “We urge lawmakers to pass this important legislation and safeguard the well-being of both assisted living residents and their families.”
Poverty-focused legal advocacy organization Justice in Aging also supports the legislation.
“By forcing the sale of family homes, Medicaid estate claims keep families in poverty, perpetuate the racial wealth gap, and increase the risk of homelessness,” said Eric Carlson, director of Long-Term Services and Supports Advocacy for Justice in Aging, said in a statement. “The Top Unfair Medicaid Recoveries Act will relieve low-income older adults from having to choose between getting the care they need or risking their family home.”
Policy perpetuates poverty
Justice in Aging was a signer of a March 20 letter to Schakowsky from the Consortium for Constituents with Disabilities and the Disability and Aging Collaborative voicing support for the bill.
In a 2021 issue brief, the organization called on Congress to amend federal law to eliminate Medicaid estate claims, which Justice in Aging said perpetuate poverty and inequality for minimal return. The brief was authored in collaboration with California Advocates for Nursing Home Reform, National Academy of Elder Law Attorneys, the National Health Law Program and the Western Center on Law & Poverty.
Justice in Aging also recommended limiting estate claims, as called for in a 2021 Medicaid and CHIP Payment and Access Commission (MACPAC) report to Congress. That report noted that in fiscal year 2019, states collected more than $733 million from beneficiary estates, less than 1% of annual spending on long-term care. The topic has been the focus of reporting by the Associated Press and the New York Times, among other media outlets.
Among the MACPAC recommendations were amending the 1993 federal law so that Medicaid estate claim programs are optional for states, allowing states with managed care Medicaid programs to pursue recovery of the cost of care rather than the amount of capitation payment, when the cost of care is less; and requiring the federal government to develop standards for hardship waivers of Medicaid estate claims.
“Notably, no other public benefit program requires that correctly paid benefits be recouped from deceased recipients’ family members,” the authors of the Justice in Aging issue brief wrote. “The minimal revenue generated by estate recovery is outweighed by the burdens it places on low-income families.”
