When a person receives Medicaid care when they are over age 55, in a nursing facility, or through a Medicaid Waiver Program such as PASSPORT of the Assisted Living Waiver, the State of Ohio pays for that care and will seek to recover that cost after the beneficiary’s death. It is important to remember that every family situation is different. Depending on your situation, you should get more information on how MER might impact you.
If you or a loved one qualify for Medicaid and need long-term care services and supports, you have many options available to you in Ohio. Because these programs are funded by tax dollars, the state will attempt to recover the costs for some or all of the care it provided while an individual was enrolled in a Medicaid program. This is called Medicaid Estate Recovery (MER). Many have questions about MER. While staff at Buckeye Hills Regional Council are not qualified to answer questions about Medicaid Estate Recovery or Medicaid law, these resources and common questions and answers may help!
It is important to remember that every family situation is different; there are exceptions to many MER rules and guidelines. Depending on your situation, you should get more information on how MER might impact you. For the most accurate and up-to-date MER information, consult the following resources:
When a person receives Medicaid care when they are over age 55, in a nursing facility, or through a Medicaid Waiver Program such as PASSPORT of the Assisted Living Waiver, the State of Ohio pays for that care. After the person receiving Medicaid benefits dies, the state will try to recover the cost of some or all of that care from the person’s estate. This is called Medicaid Estate Recovery (MER).
Medicaid recipients age 55 and older and those of any age who were permanently institutionalized (in a nursing facility).
The amount the state recovers from the estate is equal to the total amount Medicaid paid on behalf of the individual. Examples include Medicaid payments for:
By law, MER will take place after the Medicaid recipient’s death, AND:
An estate is all of the real and personal property (house, land, cars, and bank accounts) owned (completely or partially) by a Medicaid recipient at the time of death, regardless of whether or not it passed through probate court. This includes assets passed to a survivor, heir, or other designee through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement. Trusts are not exempt.
Yes. The state will recover Medicaid costs after the sale of your home. Certain restrictions apply if you have a surviving spouse, surviving children under age 21, or surviving children of any age who are considered blind or disabled. You will need to discuss your situation with a Medicaid attorney.
No. Ohio’s MER program is paid before any assets are distributed to your beneficiaries and heirs. Even assets that DO NOT pass through probate are subject to MER. Having a will or Revocable Living Trust designed to avoid taxes and probate does not make your estate exempt from MER.
No. There can be no MER claim while there is a surviving spouse.
Although allowed by law, this typically only happens when there is no surviving spouse, and there is evidence that the MER claim could be paid through the sale of your house or other real property (subject to restrictions described earlier). Other circumstances may apply. You should consult with a Medicaid attorney if you are concerned about Medicaid liens.
The Ohio Department of Job and Family Services and The Ohio Attorney General’s Office. While the Medicaid beneficiary is alive and receiving services, the Ohio Department of Job and Family Services is tracking the amount paid for that person’s care. Regular reports are provided to the Ohio Attorney General’s Office. After the Medicaid recipient dies, the Attorney General’s Office will send a claim for estate recovery to the person responsible for the estate or the person’s representative within one year of the Medicaid recipient’s death.
The short answer is no, but in some cases, court costs and attorney fees could consume the estate and prevent MER collection. You should consult a Medicaid attorney.
The claims made through MER are paid after the following claims:
Does the state ever waive its right to MER?
Yes. The state will not pursue MER if it would cause an “undue hardship.” This is determined on a case-by-case basis; you should consult a Medicaid attorney. Your estate will be required to prove undue hardship. Some examples of undue hardship include:
No. This is a common misconception. MER applies no matter how long the individual was enrolled and receiving services.
In cases where the state’s MER claim is greater than the value of the estate, the state will make an MER claim that is equal to the value available to it through the estate (after all higher priority claims are paid through the estate – see related claims question above).
The Qualified Long-term Care Partnership (QLTCP) program creates an MER exemption that is equal to the amount of the benefits allowed under the Medicaid recipient’s long-term care insurance policy. In other words, if you paid for a long-term care insurance policy that pays $100,000 in benefits, that same amount would be exempt from MER (it would be left in your estate). You should consult a Medicaid attorney or financial planner before purchasing long-term care insurance.
There are significant penalties for gifts made within five years from the date of Medicaid application. The value of these gifts and transfers may be used to determine a period of time in which you would not be eligible to receive Medicaid services. You should consult a Medicaid attorney or financial planner before making any such gifts or transfers.
Buckeye Hills Regional Council staff can not answer this question. We recommend that you consult with a qualified Medicaid attorney.
In 1993, the U.S. Congress passed the Omnibus Budget Reconciliation Act requiring all states with Medicaid to begin an estate recovery program. This helps sustain the Medicaid program. Ohio’s MER became effective on January 1, 1995.
