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Protections in Medicaid Estate Recovery: Findings, Promising Practices, and Model Notices

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More than 55 million Americans rely on Medicaid for their health and long-term care (LTC). The joint federal-state public health insurance program is the nation’s largest, paying for almost half of all spending on LTC. The program’s enrollment and spending spiraled sharply during the 2001 recession and thereafter and, while it has slowed somewhat, state and federal pressure to limit Medicaid spending remains high.

Estate recovery has been federally mandated since 1993 when Congress required states to recoup the costs of LTC and other related Medicaid services from recipients’ homes and bank accounts. This makes Medicaid for institutionalized and older people very different from most federal benefit programs. Requiring low-income Medicaid beneficiaries to reimburse the government for services received often stuns surviving spouses and family members of deceased Medicaid recipients.

This AARP Public Policy Institute Issue Paper is a follow-up to the 2005 ABA Commission on Law and Aging study (also published by PPI) which raised the question of “whether more rigorous and uniform notice and other procedural protections...could check misperceptions about estate recovery and ensure the effectiveness of hardship waiver requirements.”

Concentrating primarily on current state practices for clarifying protections, this study focuses attention on promising practices and model notifications that can be replicated throughout the country for the benefit of both estate recovery programs and the people affected by them. (75 pages)

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