Medicaid Estate Recovery

Research

The NAELA Foundation held a nationwide competition among public health graduate school students. Teams of students conducted a deep dive into data about Medicaid Estate Recovery and, from their research, offered policy ideas to address this issue.

The winning teams — from American University, the University of Michigan, and the University of Pittsburgh — reached a number of findings after researching this topic, including:

• Wealthier households, which are historically white, are often able to use estate planning tools to shield assets and are therefore less likely to be subject to Medicaid Estate Recovery, while marginalized households lack the financial and legal resources to do so, further deepening the racial wealth gap.

• Fear of Medicaid Estate Recovery may discourage eligible individuals from enrolling in Medicaid or seeking long-term care.

• Medicaid Estate Recovery does not represent a significant source of revenue for Medicaid relative to spending on long-term care.

• Medicaid does not apply cost-effectiveness ratios to be based on a person’s estate (whether the cost of going after the estate is worth the amount to be recovered), putting at risk the children of deceased Medicaid beneficiaries with the least resources available.

• States’ use of outdated information technology systems may hamper standardized evaluations of Medicaid Estate Recovery and application of cost-effective thresholds.

Their recommendations included:

• Allow states to opt out of Medicaid Estate Recovery.

• Limit Medicaid Estate Recovery to federal minimums.

• Strengthen and standardize the hardship waiver criteria.

• Protect family homes and small businesses from Medicaid Estate Recovery.

• Require states to apply consistent, evidence-based cost-effectiveness thresholds when determining when to pursue Medicaid Estate Recovery.

• Improve transparency and consumer protections, including more and clearer information about Medicaid Estate Recovery.

• Expand pre-Medicaid estate planning assistance such as state-funded legal aid.

Learn More

Additional Resources

What You Need to Know About Medicaid Estate Recovery (NAELA Fact Sheet)

Potential Reforms to Medicaid Estate Recovery (NAELA Fact Sheet)

Medicaid Estate Recovery: A Failed Program Based on an Invalid 19th Century Philosophy Is Harming Our Ability to Meet the Challenges of the 21st Century (NAELA Journal)

Medicaid Estate Recovery: Improving Policy and Promoting Equity (Medicare and CHIP Payment and Access Commission)

Communicating the Harm of Medicaid Estate Recovery (Justice in Aging)

Collecting Medicaid Costs from Heirs: How Missouri Compares to Other States (Justice in Aging)

Collecting Medicaid Costs from Heirs: How New Jersey Compares to Other States (Justice in Aging)

Medicaid’s Cost Collection Policy Hurts Families & Perpetuates Poverty (Justice in Aging)

What Is Medicaid Estate Recovery? (KFF)

Learn about the real-life experiences of people affected by Medicaid Estate Recovery here.

To go to the main Medicaid Estate Recovery page, click here.