Medicaid Estate Recovery: Anyone have experience with requests to pay back premiums?

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Medicaid Estate Recovery: Anyone have experience with requests to pay back premiums?

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My father had Medicaid for 4 years (Feb 2014 through April 2018) he would have been 58 in 2014 and 62 in 2018. He never filed a claim, by that I mean, Medicaid never paid out for any type of medical services during that time.

Somehow he owes $40,800 dollars.

The Attorney General is saying that Medicaid is trying to recover the "premiums" that Medicaid paid to the managed care plan. Which totals about $800 a month for those 4 years.

He did not have (or qualify) for Medicare at this time.

Has anyone heard of this?

Debt Elder Law Financial Planning Medicaid

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A very thorough article on this issue just ran yesterday (Sat., 7/29/23) on Yahoo. Go to this URL below. Then, also, type the title of the article, starting with "I'm going to be homeless...'' into the Google search engine and you will find a lot of further information on this topic.

https://news.yahoo.com/im-going-homeless-ohio-medicaid-140300730.html

First published in Springfield News-Sun, Ohio. Sat. July 29, 2023

Title of article:
"I'm going to be homeless': Ohio Medicaid collects $87.5M from families after loved ones' death."

Important Paras in article: “This news organization requested records on how many properties were impacted by the Medicaid estate recovery program statewide with breakdowns of southwest Ohio counties from 2017-2022. The Ohio AG's office, however, could not provide them "due to the ongoing system upgrades," Irwin said.”

"The amount each state collects annually varies widely. Hawaii's Medicaid estate recovery program collected $31,000 in 2019 while Iowa recovered more than $26 million, according to the federal report."

"The five states with the largest estate collections — Massachusetts, New York, Pennsylvania, Ohio and Wisconsin — account for 38.5% of all recoveries in FY 2019," the report stated."

"Last year, more than $87.5 million was collected by Ohio, state records show. That total was "a peak" annual amount, Irwin said."

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SaraLJ531: Retain an elder law attorney.

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Seek attorney's advise about your father's Medicaid situation. Was he on disability and unable to work?

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Sorry to hear about your late father.

I am unable to edit what was posted. No date or time shows for replies, either. It appears that restrictions are in the answers.

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Well, I retired at 58 and have paid about $600 a month each for my and my husband's health insurance. So I suppose it's possible. If you live in a more expensive area than mine (Iowa) maybe even likely.

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Yes. When my brother unexpectedly died from Covid and had no Will, I had to handle everything. It was a long process because I didn't understand what was going on at the time. They ended up taking $10,000 of what was left in his paltry account. I was however, allowed to subtract what I spent on a few things. I think the lawyer fee was one of them.
But my brother was on Medicare.

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If you did not take advantage of it, check to see if FEMA will still pay for his funeral expenses. The benefit period may have expired but it is worth checking. My sister was reimbursed when her husband died from COVID. Of course it may be subject to Medicaid recovery.

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How did he qualify for Medicaid at age 58? He must have had some type of disability or illness that prevented him from working and having health insurance. There must have been a doctor involved to submit documentation to Medicaid stating that he qualified. If not, why did he sign on with Medicaid?

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I don't think any certification from a doctor is necessary to qualify for Medicaid. It's income based. The eligibility was broadened for most states at about that time.

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I’m curious. I have been avoiding tapping that for my wife’s care. Since I am much younger 17 years do you think they will come after me before I die. And since it will have been such a long time since her death do you think they will forget.

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They do not come "after" you. Because you are married, you need to see an Elder Lawyer. Medicaid allows for assets to be split. Wife's split would go towards her care then Medicaid applied for. If she is in LTC, then u remain in the home. get a car and enough or all of your monthly income to live on. When wife passes, if she co-owner of your house, then a lien will be placed on her half of the house. The lien will need to be satisfied when you pass or sell the home. If you have no home then Medicaid cannot recover.

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It seems that is what Medicaid does; collect from estates of people for the monies expended on their behalf which is owed to Medicaid. In your father's case, four years worth of premiums for health care coverage amounting to $40,800. Every single month, Medicaid paid his healthcare premium to the managed care organization so that he had coverage. Someone applied for Medicaid for your father and there must have been signed contracts. If you or I don't utilize our medical benefits, our premiums are not returned to us. The same holds true for your father. Who was it that thought it was important that he have medical coverage? If he had to go into the hospital because of ill health, your father could have ended up losing his home. It happens. I'm unclear as to your lack of comprehension. It'a a bill for a monthly monetary outlay on his behalf which must be paid back. Nothing is free. By paying his monthly premiums, they just shifted the timeline (to later) as to when his bill would come due.

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Some people believe that Medicaid is a free medical program. Medicaid is not a free program. Medicaid is a joint Federal and state program for people with limited income and resources. Medicaid is supplemented by taxpayers’ dollars and this is why your state will seek to recoup any money they paid out on your father’s behalf while he was alive. Perhaps Medicaid found out that your father has assets and income and this is why they are seeking to collect. If your father owned a house they will seek to recoup their payments from that house. Otherwise, if your father had no asset or income there would not be any recoupment. The best advice I can give you is to speak to an elder law attorney.

This is just an afterthought. It seemed that your father was eligible for Medicare while he was alive and I am wondering why he did not apply for Medicare. Some recipients can get both Medicare and Medicaid at the same time.

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You need an attorney to help you with this. They can get some answers better than we can.

Prayers

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They were all happy and accomodating to me once I produced a court document but they would not work with me without it.

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Yes, they go back on all health care costs & will put a Lien on your property, banking account, funeral funds, rings, personal property of any value. Vehicles, stocks,bonds, any monetary value assets they have. They don’t tell you that in the beginning. However my situation they came after me over my Dads Care. And they take everything you own to repay the debt you’re family member accrue over the years. My dad had Medicaid/ Medicare
they appointed a lawyer to take over all assets of my father to repay said medical care Bills & facility care.

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If you have all those assets, why do you need welfare?

It is intended to help the poor, not preserve assets for future generations or engorge someone's asset portfolio.

If you get social services, it should be repaid if the assets exist.

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This may help too. Many states have statue of limitations and exemptions

https://www.medicaidplanningassistance.org/question/medicaid-estate-recovery-statute-of-limitations/

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Statute won't apply here. They already put a lien on home and the father didn't die until 2022, so the state is collecting in correct and timely manner. OP fills us in on all that further down. He did die with an estate. They will collect on this at the time of sale of the home. OP may apply for exemption (hardship), but she should see an attorney.

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Also look into hardship. exemptions regarding the attempted recovery. Depending on the value of the house etc.

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Sara: Re, my inquiry about whether you are dealing directly with the Ohio AG. If you are dealing directly with this office (and not collection agencies working on behalf of the AG), then I have nothing to say. Regarding Identity Theft, you write:
"I wouldn't even know how to look into identity theft." One finds out about Identity Theft whether you are the victim, or in your case a relative, in different ways. Oddly enough, the branch of the Federal government that deals with this, in my experience, is the FTC (Federal Trade Commission). At least this is the branch of Federal government that deals with it, when the IRS is involved (i.e. a false tax return is filed in your name). If you think this is a serious possibility with your relative, you might want to give them a call. Good luck.

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You might want to ask for copies of his application and renewal documents. They should have a passage that explains what types of expenses paid by the Medicaid program could be recovered from his estate. There might be a reference to the state law that governs this. As I recall from my work in this area in Washington state there were certain expenses that applied to people of a certain age and other expenses that applied to everyone. And generally no one read what you would call the fine print on the paperwork before they signed it. Just saying, make them prove that the liability is correct under state law and that he agreed to this when he signed up for the coverage. If they can't prove it get a lawyer to fight it. If it is a valid lien it needs to be paid when the property is sold.

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It does not matter he never used Medicaid health services, they paid premiums every month so when he did use it Medicaid was there. Its not just the health premium, its the vision, dental and prescription (if the health insurance does not provide it)premiums too. At $800 a month it does come out to almost 40k.

You should get a form asking about Dads assets after death.
Is Mom still alive? She is not responsible for the debt. If there is a house, a lien will be placed on it. It will need to be satisfied at her death by the sale of the home or she leaves or sells the house. Same goes for a disabled child living in the home.

I have dealt with Medicaid for LTC and actually contacted them when a lien was not put on my Moms house, in a timely manner, I was selling. I needed that lien placed so they got their money at time of closing.

I think you may need an Elder Lawyer to help u understand what is going on and how to manuver it. If Dad had no assets at time of death, he owes nothing. But since he has a home, thats an asset and Medicaid can recover if Mom is gone and no disabled child. The home will need to be sold to cover the lien.

Like I said, there should be a form that you fill out. Medicaid has to try and recover by law. If there is no money, they cannot recover. You just have to show them there was no money. But the, looks like Dad has a house.

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Are you dealing directly with the Ohio AG (i.e. the AG's office has directly notified you saying you owe this money for past Medicaid premiums, and has put the lien on the home to collect this sum), or have you been contacted by a collection agency, acting "on behalf of" the AG's office. It makes a difference.

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Directly with the AG

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I was also informed that Medicaid ordinarily picks up the premiums, by a member who is no longer here. In her own state it is Blue Cross.

This needs checking on. Afraid only an attorney can do it.

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Sara
Were any of the charges from doctors that he would have seen?
Were there charges to labs that he would have or have not used?
I would ask for a copy of detailed billing
Look for any date that might be "off"
Look for any name that might be "off"

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No, both Medicaid and the MCP have confirmed there were NO bills paid during those 4 years he simply never used his medicaid.

But during that time, I guess medicaid was still paying a premium of $800 per month to Paramount Advantage (MCP)

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There is a good possibility that this might have to do with Identity Theft.
Someone may have used his information I would look into this and see if that is the case. I would also check Credit Card info as well.

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He didn't have any credit cards or much money.
Medicaid was the only debt that turned up after he passed.

I wouldn't even know how to look into identity theft.

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Sara, You DO know this isn't your bill to pay, don't you?

I see you say he has a lien on a house and he died actually in 2022 when he was on medicare. You honestly need an attorney.

This is HIS bill and he is gone. His estate stands to pay this legitimate bill, but if you go to court, this being a bill they CANNOT itemize, may not be collectible. This is worth seeing an attorney on. Otherwise, yes, when the home is sold this lien will be paid off.

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He had a house. Which now has a lien.

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I don't think Medicare has anything to do with this.

It sounds like Medicaid contracted with a private company (Paramount) to provide Community Medicaid to eligible customers.

It doesn't matter if you don't USE the insurance ( I pay my auto, home and umbrella premiums each year; no claim doesn't mean I get my money back).

Blue Cross has acquired Paramount, obtw.

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What managed care plan was he on?

Can the state give you an itemized bill?

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It was called Paramount Advantage, which is no longer an option for MCP in our state (Ohio).

The Attorney General litterly cannot get me an itemized statement, its crazy. This was the reply I got from the AG:

"normally we can provide a printout to show what was paid. Due to a switch to a new computer system at ODM, I am not able yet. But all it would show would be the monthly premiums paid by ODM to the health plan. "

$800 a month just seems so high.

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Just because he never went to the doctor doesn't mean Medicaid wasn't paying for his insurance.

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Im starting to realize this :( but $800 a month?
Seems so high.

Everywhere I read about Estate Recovery it talks about repaying medical expenses and nursing home stays, I cant find anything about repaying premiums, but I guess its a real thing.

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How were his medical bills being paid?

Did he have private insurance or was he on Medicaid?

Did he have end stage renal disease or one of the other conditions that qualifies one for Medicare before the age of 65?

How did your state's A G get involved?

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He never went to the doctor. Not once. There were ZERO Medicaid claims during those four years. He was never in a nursing home, never institutionalized and did not qualify for mediCARE during those times.

He passed away in December 2022 so the attorney general got involved when his death was reported. Now they want $40,800 even though he never used the medicaid. They are saying medicaid paid premiums to the managed care plan for those 4 years.

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Was he in a facility?
Was his care managed by a licensed fiduciary as POA?
Did the Social Services or APS or anyone else file for his care under Medicaid?
Did your father leave any estate (money, car, home).?

If so you will have to find out.

When were you notified that this money was owing?
Who notified you?
Who was the executor or administrator of your father's estate if there was one?

It makes no sense to me at all that your father is gone since 2018 and you are just now being notified that his estate owes money to Medicaid. Any estate would have gone through distribution to heirs in four years time.
But if this is the case YOU NEED AN ATTORNEY, or whomever was executor of any estate if there was one (home, car included) needs an attorney to look this over. Trust and estate attorney.

If there was no money, no home, no car at the time of your father's debt then this is all nonsense, as there would have been no recovery possible. Nevertheless it needs clearing up.
Hope you will update us on this curious and unusual occurance.
See a trust and estate attorney with all your facts.

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He never went to the doctor. Not once. There were ZERO Medicaid claims during those four years. He was never in a nursing home, never institutionalized, and did not qualify for mediCARE during those times.

Let me clarify though, he had Medicaid from 2014 - 2018 and then he dropped it. He didn't have insurance at all until he qualified for mediCARE at 65.

He passed away in December 2022 at the age of 66 (probably because he NEVER went to the doctor) so the attorney general got involved when his death was reported. Now they want $40,800 even though he never used his Medicaid. They are saying Medicaid paid premiums to the managed care plan for those 4 years.

He does have a house and there is now a lien on it.

Im just baffled that the premiums would be $800 a month and he would owe all of that back even though Medicaid never paid a claim on his behalf.

Medicaid Estate Recovery: Anyone have experience with requests to pay back premiums?

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