Applegate said his name is on the home loan and he paid the mortgage every month, but the first name on the deed was Pierce, who was among millions of Ohio Medicaid enrollees.
Recent Dayton Daily News reporting has revealed Ohio is more aggressive than many other states in going after the estates of deceased Medicaid recipients, sometimes forcing surviving family members out of their homes.
Ohio is one of only 15 states that place liens on property of dead Medicaid recipients as a way for the state to recoup costs, a 2021 study found.
The number of Ohio properties impacted by estate recover liens since 2017 cannot currently be calculated due to ongoing system upgrades at the attorney general’s office, agency spokesman Steve Irwin said.
But the state collected more than $366 million through the estate recovery program since then and was among the top five nationally in 2019, records show.
Looking at county records, Medicaid recovery documents are routinely filed. One was made in Montgomery County July 28 for $39,722 and two on Aug. 14 seeking $358,403 and $99,404, respectively, documents state.
‘I was plenty pissed’
Medicaid is a federal program. But it’s administered by states, which set many of their own policies on issues like estate recovery.
It’s also a popular program, covering more than 470,000 people in this southwest Ohio region. Butler County has 108,900 Medicaid recipients, Clark 52,945 and Montgomery 184,945, according to state records. The highest percentage for enrollees in this news organization’s nine-county core market is Clark (39.34%), followed by Montgomery (34.74%) while Warren is the lowest (14.79%).
Applegate said he didn’t know Pierce was on Medicaid. After getting the letter, he called the AG’s office attorney who sent it.
“I was plenty pissed,” said Applegate, 70. “I called him and it got heated and they kept pushing and pushing. And I said ‘Listen. You’re talking to somebody you can’t push. I’ll push back. And sue if I have to.’ And then they hung up on me.”
Eventually, Applegate said, he wrote then-Attorney General Mike DeWine, who sent him a notice that a “stop” was placed on the case even though the state had a lien on the home, where he still lives.
The lien appears to remain, according to Montgomery County records. The office of current Attorney General Dave Yost — which handles Medicaid estate recovery — is reviewing the issue, said Irwin.
Butler County widow: ‘I had never heard of it’
Butler County resident Norma Mills said her husband Dennis began receiving Medicaid about two months before his death from cancer in 2017.
She didn’t understand the concept of estate recovery. “I had never heard of it in my life,” she said.
She and Dennis lived in Hamilton before buying a home in Monroe. She received an estate recovery letter shortly after he died.
“I had three teenagers and I was trying to work at a job and I was already defeated” by her husband’s illness, Norma Mills said.
Mills said she sought out the advice of two attorneys, but by that time she was too far in debt to Medicaid.
She ended up moving out of their family home several months after Dennis’ death.
“If I would have to do it all over again, my husband would have never signed to get on Medicaid, even though he was suffering,” Norma Mills said.
Estate recovery program policies are explained in a form provided by Ohio as part of the eligibility process, Irwin said. But many recipients and senior advocates say it is often overlooked.
The state does not notify survivors of Medicaid recipients that liens are placed, Pro Seniors Inc. Managing Attorney Miriam Sheline said.
“Once you put the lien on, you have caused damage to that property or individual,” she said. “And (survivors) prove one of the exemptions apply and they take it off. It doesn’t change the fact that (the state) has caused damage.”
The best way to avoid estate recovery is for the Medicaid recipient to transfer all assets to his/her spouse prior to death, according to Pro Seniors, a southwest Ohio organization educating older adults and their caregivers about a variety of legal and long-term care issues.
“Medicaid, in fact, requires such transfers within one year of Medicaid eligibility, but assets should be transferred as soon as possible,” Pro Seniors said on its website.
While not technically a spouse — Applegate said he and Pierce never married — the hardship rule may apply as Applegate said they lived together for about 19 years.
In a hardship case, “the right to immediate recovery may be delayed or waived” on a case-by-case basis, Ohio Medicaid records show.
There’s also ways to resolve Medicaid property liens. In Clark County, Medicaid lien releases were filed were filed on July 31 and on Aug. 10 by special counsels working with the state, according to county recorder’s office records.
“I do not believe there’s a process,” Sheline said of resolving liens. “The process is talking to special counsel and asking them to resolve it and make a deal, basically. Or say, you can’t enforce this because (exemptions apply).”
Along with a surviving spouse and hardship cases, exemptions also include a survivor being under age 21, and a child who is blind or permanently and totally disabled, according to Pro Seniors.
Ohio Medicaid has “made several changes” to help make sure enrollees are notified of estate recovery, said Lisa Lawless, deputy director for the state program.
After concerns that Ohioans were unaware of these requirements, last year it “began elevating awareness” of the policy, she said.
Hardship waivers from Medicaid Estate Recovery can be granted to survivors on a case-by-case basis for “compelling circumstances,” according to Ohio law. They include:
•The estate is their sole income-producing asset, such as a family farm or other family business.
•Without the estate, they would become eligible for public assistance.
•Recovery would deprive them of necessary food, shelter or clothing.
•They provide “clear and convincing evidence” of substantial personal financial contributions to the deceased individual, creating an equity interest in the property.
•The survivor is 65 or older and financially dependent on the estate.
•The estate proceeds are preserved for them because they are totally and permanently disabled and are financially dependent on the estate.
Source: The Ohio Administrative Code.