Ohioans seeing daunting costs adding up for future Medicaid estate recovery

Spicuzza, who is self-employed, researched her billing history and learned she owes roughly $60,000 that the state will take out of her estate when she dies. And the total was adding up regardless of whether she actually received any medical care.

"It has affected my thinking on multiple levels," said Spicuzza. "I'm not going to have health insurance. I canceled two doctor appointments today because I don't want to rack up any more charges of what I owe to the state of Ohio."

The Dayton Daily News has reported how 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.

Advocates for the elderly would caution anyone against going without health care or insurance, and note there are legal ways to shield assets from recovery for those who have the means to get legal assistance. But critics of estate recovery say it's an unnecessary and costly burden on people who rely on a health care program designed for the poorest Americans.

Estate recovery

Federally, states are only required to seek estate recovery for those on Medicaid who are 55 or older and who are permanently institutionalized. Ohio goes further, and under the state's administrative code, requires the Ohio attorney general to seek recovery from the estates of:

(1) A permanently institutionalized individual of any age, in the amount of all Medicaid benefits correctly paid including managed care capitation payments; or,

(2) An individual 55 or older who is not permanently institutionalized, in the amount of all Medicaid benefits correctly paid including managed care capitation payments (with some exceptions for benefits under the Medicare premium assistance programs) after the individual turned 55.

Capitation payments are a flat rate paid monthly by the state of Ohio to Medicaid managed care organizations like Caresource. The capitation rates are set to equal the average of all recipients' health care spending, taking factors like which health plan and where the members live into account.

Managed care costs for October 2023, the most recent month of data available for Ohio Medicaid

County Managed care number of recipients Total expenditure for October 2023 Average managed care amount per member per month

Butler 88,866 $38,148,541 $429

Champaign 7,816 $3,360,261 $429

Clark 44,593 $19,562,852 $438

Darke 9,347 $3,901,352 $417

Greene 28,270 $12,366,169 $437

Miami 20,522 $8,708,635 $424

Montgomery 148,768 $66,749,369 $448

Preble 8,334 $3,532,522 $423

Shelby 8,691 $3,301,001 $379

Warren 26,833 $11,427,345 $425

All of Ohio 2,701,436 $1,213,818,533 $449

Capitation avoids the hassle of billing the state for actual services provided, and also is meant to incentivize more preventative care for patients due to health providers receiving the same amount regardless of how it is used. This method of billing means the payments can be more or less than the cost of medical care the recipient received.

Depending on the plan, average rates per month range between $420 and $521, according to Ohio Medicaid's most recent data for the month of October 2023.

Medicaid recipients are billed for this cost, whether they realize it or not. And when they die, the state can lay claim to their assets including any home or property they intended to pass along to their children.

Overall, Ohio Medicaid spent approximately $1.2 billion in October for managed care costs for all 88 counties.

For state fiscal year 2023, Ohio spent approximately $36.1 billion, including both state and federal funds, on the Medicaid program as a whole.

Options to avoid recovery

Future and current Medicaid recipients have options and resources available to minimize the potential of the state to recover their estates after they die, attorneys familiar with Medicaid Estate Recovery said.

One option in avoiding Medicaid Estate Recovery involves finding a Medicaid legal specialist and creating a trust at least five years before applying for the health care benefits, as required by law. Ohioans 60 or over can reach out to the nonprofit Pro Seniors for help by calling (513) 345-4160. Visit Pro Seniors' website for more information at proseniors.org.

An individual's enrollment in Medicaid and the level of support received is unique to each enrollee, Ohio Medicaid told the Dayton Daily News.

"Maintaining health care coverage is important for all of us. Ohio Medicaid can't provide an opinion without knowing the specifics of a given case because each is based solely on the individual's circumstances," a representative of Ohio Medicaid said.

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How to find out what you owe

Contact CareSource directly: The CareSource HIPAA and Privacy Notice offers an overview of what they're required to share and, more importantly, how to request the information. Visit caresource.com and search for HIPAA privacy practices.

The CareSource privacy officer can also be reached by mail at CareSource, Attn: Privacy Officer, P.O. Box 8738 Dayton, OH 45401-8738; by email at [email protected]; and by phone at 1-800-488-0134, ext. 12023 (TTY: 1-800-750-0750 or 711).

Contact Ohio Medicaid's Privacy Office by emailing [email protected] or written correspondence may be sent to Ohio Department of Medicaid, Attn: Health Information Privacy Official, PO Box 182709, Columbus, OH 43218-2709.

Public dashboards representing costs can be found on Ohio Medicaid's website at https://medicaid.ohio.gov/ and then searching for "reports and research" under the stakeholders and partners tab.

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