Some families blindsided by MassHealth estate recovery

Boston Statehouse

BOSTON (SHNS) – Recalling constituents who had to sell the family home to repay the state’s Medicaid program for the cost of health care for an elderly or disabled loved one, Sen. Jo Comerford called for changes Tuesday to estate recovery, a policy she said is “actually, for me, hard to fathom.”

Upon the death of someone who received MassHealth benefits after the age of 55 or someone who lived permanently in a long-term care setting, MassHealth can in many cases seek reimbursement of the cost of the member’s care from their estate through a policy known as estate recovery.

“While federal law mandates that some Medicaid costs be reimbursed this way, MassHealth’s estate recovery program goes beyond the federally-set floor,” Comerford explained to the Joint Committee on Health Care Financing. “While federal law limits recovery for long-term care, MassHealth may demand repayment from families of the deceased recipients who received any Medicaid services over the age of 55, including doctor and nursing care, prescription drugs or other services. No other, to my knowledge, low-income assistance program demands repayment like this.”

Those costs add up and often lead to the sale of a family home in order to repay the cost of medical expenses, Comerford said. She cited the disabled son of a MassHealth recipient who was forced out of the house he had lived in with his mother after she died and MassHealth sought repayment of more than $108,000 for her care.

Mass. Law Reform Institute senior attorney Vicky Pulos said more than 80 percent of the money that MassHealth brings in from estate recovery comes from the sale of a family home.

“I’ll leave it to others to spell out the many adverse consequences of that and how contrary that is to both our health policy and our affordable housing policies that this state is trying to further,” she said.

MassHealth made a series of regulatory changes this spring to address some of these issues, Comerford said, including a decision to no longer file claims against some estates without a house and an expansion of the surviving family members eligible to file for a waiver. The senator said the changes “have made a really significant difference” but “don’t go as far as I would suggest we could and they can be rescinded at any time.”

Comerford and Rep. Christine Barber filed legislation (S 749/H 1246) to scale back the scope of MassHealth’s estate recovery program more permanently. The bill would limit MassHealth to just the federally-mandated recovery for nursing home care, home- and community-based services and some related costs. It would also limit recovery for managed care premiums to the lesser of the premium and the actual cost of services, and would establish broader criteria for hardship waivers from estate recovery.

“Despite the fact that Medicaid exists to provide care and services to those who cannot afford it, in these instances the benefit is essentially in the form of a loan that must be repaid upon death,” Comerford said. “At least when people take out a loan they know they’re taking out a loan. But far too many grieving families — and I know you’ve received their testimony — are caught by surprise when an exorbitant bill arrives in the mail unexpectedly and they’re grieving for a loved one.”

That was exactly the situation for Joanne Stanway and her family after her father, Elmer Bartels, died in 2014. Bartels, who served as commissioner of the Mass. Rehabilitation Commission for more than 30 years, was enrolled in CommonHealth, a program created specifically for people with disabilities to help offset the costs of employing personal care attendants.

“A couple of months after our father died, my brother and I received a notice of claim against our father’s estate seeking more than $413,000, an amount calculated by taking the PCA salaries paid through CommonHealth multiplied over seven years. Our family home, his only asset not protected by a trust, was in jeopardy. We argued that the notice of claim was made in error because for CommonHealth, which was an insurance plan created specifically for adults with disabilities who met the requirements based on income, he wasn’t a MassHealth recipient. He had health insurance, it had to be an error,” Stanway told lawmakers Tuesday. “But no, CommonHealth had at some point morphed under MassHealth and was subject to state recovery guidelines, albeit not transparently to the 23,800 people with disabilities eligible for CommonHealth as originally defined.”

To avoid losing the house, Stanway said her family was granted a hardship waiver but only under the condition that her brother, who cared for their father during overnight hours, was not otherwise employed and had lived in the house his whole life, not work for two years. Stanway said the situation was particularly upsetting because her father was “one of the visionaries of CommonHealth when it was created.”

“His mission was always to help people with disabilities, like himself, to have services they needed to go to school or to be retrained so they could work, provide for their families, and put a roof over their heads. He encouraged people to sign up for CommonHealth and then his own family suffered the travesty of a $413,000 bill from the state he served for three decades,” she said. “If this can happen to him, to us, then imagine the impact on others when estate recovery claws back what people with disabilities worked so hard to achieve.”

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