Medicaid Estate Recovery Collections. CONCLUSION

09/01/2005

Medicaid estate recovery gets to the heart of the issue of who should pay for long-term care -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including those remaining after death. Amounts collected from Medicaid recipients' estates are not insignificant in absolute terms. They do, however, pale next to total Medicaid spending for long-term care. This is not surprising, given that Medicaid is available only to those with very limited resources. Nevertheless, the wide state-to-state variation in recovery rates and estate recovery practices suggests that program efficiency could be improved and greater amounts could be recovered.

 

TABLE 1: Medicaid Collections and Expenditures -- Fiscal Year 2004
State Collections: Probate FY 2004 FY 2004 Medicaid Nursing Home Expenditures Collections as $ of Nursing Home Spending State Nursing Home Spending as % of National Nursing Home Spending
Alabama $6,204,836 $766,521,275 0.8% 1.7%
Alaska $0 $107,091,559 0.0% 0.2%
Arizona $2,403,306 $23,172,901 10.4% 0.1%
Arkansas $2,104,052 $540,193,697 0.4% 1.2%
California $44,668,847 $3,033,946,724 1.5% 6.6%
Colorado $6,241,993 $423,944,387 1.5% 0.9%
Connecticut $8,204,283 $1,015,579,338 0.8% 2.2%
Delaware $436,370 $158,840,995 0.3% 0.3%
Florida $13,478,207 $2,250,455,672 0.6% 4.9%
Georgia $0 $1,466,092,237 0.0% 3.2%
Hawaii $1,684,280 $182,705,650 0.9% 0.4%
Idaho $5,695,851 $126,613,061 4.5% 0.3%
Illinois $21,254,742 $1,608,092,952 1.3% 3.5%
Indiana $7,649,409 $948,116,230 0.8% 2.1%
Iowa $12,194,616 $426,181,610 2.9% 0.9%
Kansas $4,866,505 $344,645,407 1.4% 0.8%
Kentucky $5,391,045 $627,317,272 0.9% 1.4%
Louisiana $103,853 $593,234,878 0.0% 1.3%
Maine $6,178,845 $248,697,265 2.5% 0.5%
Maryland $5,456,547 $867,262,512 0.6% 1.9%
Massachusetts $32,577,301 $1,617,497,416 2.0% 3.5%
Michigan $0 $1,704,056,909 0.0% 3.7%
Minnesota $24,999,595 $904,205,889 2.8% 2.0%
Mississippi $391,933 $563,151,164 0.1% 1.2%
Missouri $8,597,322 $789,726,442 1.1% 1.7%
Montana $2,363,322 $164,145,366 1.4% 0.4%
Nebraska $1,125,970 $359,714,726 0.3% 0.8%
Nevada $420,429 $141,377,842 0.3% 0.3%
New Hampshire $4,362,641 $276,085,727 1.6% 0.6%
New Jersey $8,329,882 $1,479,889,851 0.6% 3.2%
New Mexico $78,037 $179,818,250 0.0% 0.4%
New York $29,953,334 $6,486,722,331 0.5% 14.2%
North Carolina $5,529,652 $1,096,619,059 0.5% 2.4%
North Dakota $2,000,766 $166,456,173 1.2% 0.4%
Ohio $13,987,964 $2,722,643,741 0.5% 5.9%
Oklahoma $1,573,913 $462,935,035 0.3% 1.0%
Oregon $13,843,592 $238,642,419 5.8% 0.5%
Pennsylvania $5,888,558 $4,069,955,523 0.1% 8.9%
Rhode Island $2,792,488 $292,744,235 1.0% 0.6%
South Carolina $6,206,820 $461,865,198 1.3% 1.0%
South Dakota $1,222,693 $118,375,810 1.0% 0.3%
Tennessee $8,895,934 $1,006,485,725 0.9% 2.2%
Texas $0 $1,781,030,713 0.0% 3.9%
Utah $47,443 $105,854,730 0.0% 0.2%
Vermont $402,156 $104,364,396 0.4% 0.2%
Virginia $776,866 $656,180,320 0.1% 1.4%
Washington $10,770,875 $593,061,233 1.8% 1.3%
Washington, D.C. $1,789,570 $188,211,034 1.0% 0.4%
West Virginia $214,656 $367,149,385 0.1% 0.8%
Wisconsin $16,772,729 $917,421,595 1.8% 2.0%
Wyoming $1,632,368 $60,552,927 2.7% 0.1%
United States $361,766,396 $45,835,646,786 0.8% 100.0%

 

TABLE 2: Medicaid Collections as a Percentage of Nursing Home Expenditures-- Fiscal Year 2004 State Rankings
State Collections as % of Total Nursing Home Spending* State Collections as % of Total Nursing Home Spending
Arizona** 10.4% US -- all states 0.8%
Oregon 5.8% Connecticut 0.8%
Idaho 4.5% Indiana 0.8%
Iowa 2.9% Maryland 0.6%
Minnesota 2.8% Florida 0.6%
Wyoming 2.7% New Jersey 0.6%
Maine 2.5% Ohio 0.5%
Massachusetts 2.0% North Carolina 0.5%
Wisconsin 1.8% New York 0.5%
Washington 1.8% Arkansas 0.4%
New Hampshire 1.6% Vermont 0.4%
California 1.5% Oklahoma 0.3%
Montana 1.4% Nebraska 0.3%
Kansas 1.4% Nevada 0.3%
South Carolina 1.3% Delaware 0.3%
Illinois 1.3% Pennsylvania 0.1%
North Dakota 1.2% Virginia 0.1%
South Dakota 1.0% Mississippi 0.1%
Rhode Island 1.0% West Virginia 0.1%
Washington, D.C. 1.0% Utah 0.0%
Hawaii 0.9% New Mexico 0.0%
Tennessee 0.9% Louisiana 0.0%
Kentucky 0.9% Alaska 0.0%
Alabama 0.8% Texas 0.0%
* Listed in descending order.
** Arizona's estate recovery collections, as a percentage of nursing home spending, are not comparable to any other state because comprehensive prepaid managed care contracts dominate the state's Medicaid program, and nursing home care provided under these contracts is not identified separately for reporting purposes.

 

TABLE 3: Changes in Medicaid Estate Recovery Collections 2002-2004*
State Collections: Probate 2002 Collections: Probate 2003 Collections: Probate 2004 Change from 2002-2004
(percent)
Alabama $4,485,886 $4,222,784 $6,204,836 38.3%
Alaska $0 $0 $0 0.0%
Arizona $1,790,755 $2,150,260 $2,403,306 34.2%
Arkansas $1,545,931 $1,730,100 $2,104,052 36.1%
California $36,335,161 $44,024,077 $44,668,847 13.6%
Colorado $4,018,129 $4,649,920 $6,241,993 55.3%
Connecticut $10,243,388 $10,884,820 $8,204,283 -19.9%
Delaware $655,836 $1,108,545 $436,370 -33.5%
Florida $9,683,087 $11,474,485 $13,478,207 39.2%
Georgia $0 $0 $0 0.0%
Hawaii $1,304,625 $2,255,074 $1,684,280 29.1%
Idaho $4,034,789 $5,357,412 $5,695,851 41.2%
Illinois $17,003,820 $16,993,946 $21,254,742 25.0%
Indiana $6,366,273 $7,366,747 $7,649,409 20.2%
Iowa $9,145,536 $10,977,823 $12,194,616 33.3%
Kansas $4,762,300 $6,193,161 $4,866,505 2.2%
Kentucky $1,893,814 $2,961,800 $5,391,045 184.7%
Louisiana $0 $104,755 $103,853 100.0%
Maine $4,760,834 $5,934,701 $6,178,845 29.8%
Maryland $6,377,662 $6,919,915 $5,456,547 -14.4%
Massachusetts $28,837,456 $28,524,313 $32,577,301 13.0%
Michigan $0 $0 $0 0.0%
Minnesota $18,668,919 $12,899,750 $24,999,595 33.9%
Mississippi $920,362 $168,735 $391,933 -57.4%
Missouri $7,368,152 $7,480,548 $8,597,322 16.7%
Montana $1,663,969 $1,982,288 $2,363,322 42.0%
Nebraska $878,467 $1,409,277 $1,125,970 28.2%
Nevada $1,179,014 $1,366,359 $420,429 -64.3%
New Hampshire $4,964,422 $3,554,466 $4,362,641 -12.1%
New Jersey $5,311,581 $6,031,496 $8,329,882 56.8%
New Mexico $0 $0 $78,037 100.0%
New York $26,878,856 $27,244,711 $29,953,334 11.4%
North Carolina $4,200,000 $4,053,121 $5,529,652 31.7%
North Dakota $1,627,014 $1,684,666 $2,000,766 23.0%
Ohio $10,814,457 $12,382,674 $13,987,964 29.3%
Oklahoma $1,276,739 $1,873,304 $1,573,913 23.3%
Oregon $13,738,730 $13,996,362 $13,843,592 0.8%
Pennsylvania $23,288,044 $23,149,026 $5,888,558 -74.7%
Rhode Island $4,387,978 $3,559,076 $2,792,488 -36.4%
South Carolina $3,483,235 $5,150,428 $6,206,820 78.2%
South Dakota $1,096,932 $1,293,813 $1,222,693 11.5%
Tennessee $4,805,977 $2,754,258 $8,895,934 85.1%
Texas $0 $0 $0 0.0%
Utah $2,047,412 $459,400 $47,443 -97.7%
Vermont $636,899 $487,029 $402,156 -36.9%
Virginia $810,533 $953,406 $776,866 -4.2%
Washington $974,188 $1,658,606 $1,789,570 83.7%
Washington, D.C. $7,548,849 $5,816,188 $10,770,875 42.7%
West Virginia $606,746 $1,183,754 $214,656 -64.6%
Wisconsin $15,447,888 $12,812,864 $16,772,729 8.6%
Wyoming $855,348 $1,097,240 $1,632,368 90.8%
United States $321,725,993 $330,337,483 $361,766,396 12.4%
* Table prepared by MEDSTAT based on data reported by states to CMS on CMS-64.

 

TABLE 4: Scope of Policy Options in Medicaid Estate Recover: State Groupings*
States Implementing Minimum
Required by Federal Law (8)
States with a Mix of More and Less
Expansive Policy Options (29)
States Making Maximum Use
of Federal Policy Options (9)
Arkansas
Mississippi
New Mexico
North Carolina
Pennsylvania
South Carolina
Vermont
West Virginia
Alaska
Arizona
Connecticut
Florida
Idaho
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Nebraska
Nevada
New Hampshire
New Jersey
New York
North Dakota
Ohio
Oregon
Rhode Island
South Dakota
Tennessee
Utah
Virginia
Washington
Washington, D.C.
Wisconsin
Wyoming
Alabama
California
Delaware
Hawaii
Illinois
Indiana
Minnesota
Montana
Oklahoma
* Groupings are based on data reported Karp, Sabatino, and Wood, (June 2005). Medicaid Estate Recovery: A 2004 Survey of State Programs and Practices. The AARP Public Policy Institute. #2005-06 at: http://assets.aarp.org/rgcenter/il/2005_06_recovery.pdf. States using the fewest options are those that generally follow the minimum federal requirements. Those using the most option are those with more expansive definitions of estate, scope of recoverable services, liens on property of living recipients, and other options.

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