Minnesota’s Medicaid estate recovery program is stripping families of generational wealth and growing disparities

Some leads are too good to be true. I thought that was the case when reading an article that claimed a federal program lets the government pay for deceased Medicaid patients’ bills by taking their home. 

That program is called Medicaid estate recovery, and my project for the 2021 Data Fellowship was to investigate how it works in Minnesota. After reading dozens of pages of research, articles, data and interviews, I found that the facts are sometimes stranger than fiction.

The investigation revealed that the estate recovery program in Minnesota mirrors national trends. It blocks intergenerational wealth opportunities for modest families. The program has mostly affected people who are 55 and older, raking in more than $265 million in recent years. That’s less than 1% of what the state spends on long-term care services. Loopholes allow wealthier families and attorneys to avoid estate recovery, and in some counties the program disproportionately affects people of color. Its impact on vulnerable families proved huge for Minnesotans, as I found through my reporting.

For instance, I told the story of Kevin White, a blue-collar worker whose mother died while owing $187,000 in Medicaid expenses. White planned to pass his family home on to his son, but the state put a lien on the home to collect on his mother’s expenses. That lien doubled when the home’s appraised value increased, pushing White to fight the issue in court. That battle is draining his funds, and he’s not the only person affected by the program. 

In recent years, more than 35,000 Minnesotans have experienced estate recovery. More than half are women, and experts say the program may have a chilling effect on Medicaid enrollment among people of color and vulnerable Minnesotans. As if those facts were not striking enough, Geneva Finn, the special recovery unit manager for the state’s Department of Human Services, said she and six staff members run the estate recovery program. Escape routes from the program, like hardship waivers and appeals, are handled by county officials with little oversight.

“Counties track their estate recovery program internally,” Finn said. “Some counties are in paper file. Some counties have various databases set up.” She added: “You could have your hardship waiver granted — it wouldn't go to our appeals office, it would just go to the county office. It would just happen on the county level, and I wouldn't necessarily have reason to know about it, unless there was some question about it.”

The state has some of the worst racial disparities in the nation, especially when it comes to poverty and homeownership. For instance, 76% of white families in Minnesota own a home compared to 25% of Black families. And a higher share of Black families spend a third of their paycheck on their home. The aging population in Minnesota is expected to grow in coming decades, and Medicaid enrollment across the nation broke records during the pandemic. 

What this project taught me as a reporter

This project and its dramatic findings would not have been possible without spending a lot of time on research, and reporters who are thinking about investigating similar projects should do the same. Although research is a big part of preparing for your project, here are some lessons I learned while investigating my topic.

• When looking for sources, consider the snowball method. People know people who can be vital sources for your reporting. Find them by researching who might know your sources, ask them to help you, and see where it takes you. You may be surprised.

• Start asking for data early. The first salvo in getting data for your project does not have to be a FOIA request. Contact the person or agency your project is about. Ask about their data sources, and what kind of data is available. Negotiate the costs and ask for line-item breakdowns if the cost seems exorbitant. It took weeks of correspondence and negotiating to get my data. Getting it done earlier will serve you and your project well.

• Be persistent. You may not get an immediate call back from a source you’d like to interview, or from an agency you plan to investigate. Don’t stop. Send emails. Leave voicemails. Call other agencies or the front-desk clerk. Others will not take your project as a priority, and that’s OK. Move on, and you may find that they’ll circle back to you when you most need them.

• Don’t be discouraged if a source becomes uncooperative. When one door closes, another opens. I pivoted between agencies, data and sources that no longer worked until I found what did. Whether that was finding sources through social media, or asking sources who stopped cooperating for suggestions, I accepted when ideal sources could not help, and moved on.

• Other reporting outlets can be your friend. To spread the story and its impact, it helps to be proactive in pitching it to other organizations. We pitched my project to other news outlets who covered the same topic. We pitched different angles for newsrooms to pick up, and different mediums for organizations to use. By serving your project and the audience it could reach in a cooperative way, you can deepen its impact and better your reporting. In my case, one outlet ran a version of my story. Three others have expressed interest in doing the same.

• Less is more, and simplicity can be sophisticated. You may have a deluge of interviews and data to sift through once you’re preparing to finish your project. While my first inclination was to add as much as I can, it’s better to be selective with your reporting. What points will the audience find most engaging? How can I report this in a way that the audience can relate to? Self-editing was crucial for me to do so, and it helped to sharpen my reporting.

Since starting this project, I’ve heard from dozens of Minnesotans. Many have offered themselves as sources, and introduced new angles to continue my coverage of the topic. I doubt much of that would have been possible were it not for the research I did on the issue beforehand, and for the efforts to include other newsrooms in distributing the story.