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Is Medicaid estate recovery deepening inequities in Minnesota?

Is Medicaid estate recovery deepening inequities in Minnesota?

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(Photo by Brandon Bell/Getty Images)
(Photo by Brandon Bell/Getty Images)

It began in 1993.

The federal government passed the “Deficit Reduction Act,” seeking in part to fight the national debt with new fees and program requirements. One of those requirements was that states use Medicaid estate recovery, a program which can take the home of dead Medicaid recipients who left unpaid bills for their long-term care. Since the act passed, complaints against the program have grown. And inequities caused by it may have deepened.

A report by the Medicaid and CHIP Payment and Access Commission, a nonpartisan agency that makes recommendations to Congress, said many states’ Medicaid estate recovery programs recouped less than 1% of the money that people owed for long-term care. While they found that returns from the program have been minimal, they said strain from the program may be unevenly placed on people of color, who make up more than half of Medicaid recipients.

Further reporting from The Atlantic has detailed how detrimental losing a home can be for such families. Some will lose houses they had maintained for years, lining the pockets of state agencies instead of passing that wealth to the next generation. People who cannot afford a lawyer to fight the claim can sign a hardship waiver to try and prevent the state from seizing their home. However, states can define for themselves what qualifies as a “hardship.” As a result, different states have claimed different shares of homes from families of color. And as more Americans turn towards Medicaid, more people may fall into the program or abandon plans to own a home.

“We’re in danger of disincentivizing some of these ambitions that we have of saving for retirement or purchasing a home,” said John Kantke, a University of St. Thomas professor and attorney at Estate and Elder Law Services in Minneapolis. “If I know ahead of time that if I go into a care facility I’m going to lose every cent of that down to my last $3,000, then owning a home isn’t as significant. It’s much more temporary, and it’s not something that I can think of as benefitting my children.”

My goal for the 2021 Data Fellowship is to investigate how the program is implemented in Minnesota, analyzing estate recovery and hardship waiver data from attorneys, the state, and the federal government. We’ve identified where such data exists at the state and county level, and would tie that to real-life examples of people affected by this program. Supported by their stories, data, and critiques of the program that we’ve identified among experts, advocates and legislators at the local, state and national levels, I hope to inform people how this program may disproportionately impact Minnesotans of color. By shining a light on this issue, we hope to affect change for states across the nation that must also pursue the homes of vulnerable families.


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I am trying to help a friend who's wife died in a nursing home. Is wife was Native American and on Medicaid. She had Althimers and was in a nursing home for the past 2 1/2 years because her husband could not care for her after she broke her arm. They did not have any will/trust or any thing when she passed away last fall. He still does not have a will/trust or anything. How do I help him so he does not loose all of his land and house? Also How do I find out how much he owes for the care of his wife in the nursing home? Can you send me any resources on how to help him? He also served in the Korean war so he is a Military Vet. Please help us if you can. Thanks, Greg

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To find out how much Medicaid has paid to this man's wife he needs to contact the Minnesota Department of Human services in saint Paul.
At 651-431-3152.
He needs to ask for his wife's Medicaid claim history. This report will give month-by-month records of expenses that can be placed against his estate.
Only this claim history will give the amount that he will possibly owe when he passes away.
This man may be told that he owes nothing now and that is true ,he could only owe the debt when he passes away through his estate.
This is a common request from Medicaid beneficiaries.

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I am waist-deep in MN's Medicaid trap. While I am not a person of color, I was my mom's caregiver at home for several years. After community services purported to help recipients that require "nursing home level of care" remain in the community couldn't provide me - mom's solitary caregiver - with any respite from 24/7 caregiving. I had no choice but to apply for MA on mom's behalf in order to move her to memory care. She passed away just a year ago.

After saving the State of MN tens of thousands of dollars worth of free care, while applying for public benefits on mom's behalf, nobody advised me about the caregiver homestead transfer exemption. Mom's case and financial workers knew I was her caregiver.

I applied for an Undue Hardship Waiver and was denied because "ownership interest" had not been transferred prior to my mom's death. I'm in my 50's and am basically left to start life over again with nothing. Folks similarly situated to me (adult, single, caregivers to parents at home for several years) need to be advised of this benefit to level the playing field.

If you play this shell game correctly (if you know the rules), a person might be okay. If not, you face learning the hard way how the homestead transfer to the eligible adult child caregiver w/o penalty is permitted on the front-end (eliminating Medicaid’s right to recovery.) While granting the legitimate adult child caregiver an Undue Hardship Recovery Waiver on the back-end resulting in Medicaid forfeiting their right to recovery isn't permitted The end result is the same. One outcome doesn’t cause any more harm to Medicaid than the other or change the end result. Unless you're the adult child caregiver.

The lengths the county has gone to "guard" this house has been mind-boggling. The hopelessness and despair this has caused is just wrong on so many levels. Feel free to reach out to me if you seek any insights.

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Would you like to connect through me with a small group of minnesotans who have been actively working on legislation to change Minnesota's recovery policies? While past recoveries can't be undone we can change the future to prevent this from happening to others.

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Sure, I'd be interested in connecting with others concerning the recovery fiasco. There has to be a better way. Thanks!

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Apologies for the delayed response, I checked the site a few times after I posted and you hadn't posted yet.
The grassroots group I was working with had a bill in the legislature this session to mitigate an aspect of Medicaid estate recovery.
If you would still like to contact me, you can reach me at 218 565 1122.
Thanks, Rick.

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Hi Heather,

I'm sorry to hear about your experience with this program. If you'd still like to chat about it, my email address is I'd love to hear from you.

Best Wishes,



The Center for Health Journalism’s 2023 National Fellowship will provide $2,000 to $10,000 reporting grants, five months of mentoring from a veteran journalist, and a week of intensive training at USC Annenberg in Los Angeles from July 16-20. Click here for more information and the application form, due May 5.


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