Depending on where they lived, demands for repayment can drain the assets that a patient on Medicaid leaves behind after they die. Iowa aggressively collects 'clawback' funds.
Henry Ruhl of Perry, Iowa, lost his wife, Fran, in January 2022. A few weeks after her death, he was startled by a notice saying her estate owed a huge bill to Iowa's Medicaid program for her dementia care.Henry Ruhl of Perry, Iowa, lost his wife, Fran, in January 2022. A few weeks after her death, he was startled by a notice saying her estate owed a huge bill to Iowa's Medicaid program for her dementia care.States have leeway to decide whom to bill and what type of assets to target.
Critics say families with resources, including lawyers, often find ways to shield their assets years ahead of time — leaving other families to bear the brunt of estate recoveries. For many, the family home is the most valuable asset, and heirs wind up selling it to settle the Medicaid bill. Fran Ruhl often left affectionate notes for her husband, Henry, in their home in Perry, Iowa. Several are still posted, a year after her death.Fran Ruhl often left affectionate notes for her husband, Henry, in their home in Perry, Iowa. Several are still posted, a year after her death.Coghlan still has paperwork the family filled out.
Matney notes families can apply for"hardship exemptions" to reduce or delay recovery of money from estates. For example, she said,"if doing any type of estate recovery would deny a family of basic necessities, like food, clothing, shelter, or medical care, we think about that."KC McGinnis/For Kaiser Health NewsFrances Ruhl's chair now sits empty in the home of surviving husband Henry in Perry, Iowa.
Supporters of estate recovery programs say they provide an important safeguard against misuse of Medicaid.argues that other statesWarshawsky says many other states exclude assets that should be fair game for recovery, including tax-exempt retirement accounts, such as 401s. Those accounts make up the bulk of many seniors' assets, he said, and people should tap the balances to pay for health care before leaning on Medicaid.
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