Federal law also gives states the option to adjust or recover the costs of all payments to health care providers except Medicare cost-sharing for anyone on Medicaid over the age of 55.
[10] The federal government has made it a requirement for states to implement an estate recovery program for Medicaid in the Omnibus Budget Reconciliation Act of 1993.
[10][1] That was done with primary concern towards recipients who received long-term care services, which had required the applicant to have very low asset levels.
The Act allowed recipients and their spouses to retain a home and certain other modest assets, to avoid their total impoverishment, while they are alive.
[14] One aspect of that point of view that was raised noted the goal of providing health insurance is interfered with if states exercise their option to recover costs of all medical care (not just LTCR) for people 55 or older.
[23][24] As of August 2019, at least 12 states that have expanded Medicaid: Massachusetts,[8][21] New Jersey,[20] Iowa,[25] Nevada,[26] New Hampshire,[27][28] North Dakota,[29] Ohio,[30] Rhode Island,[31] Indiana,[32] Utah,[33] Maryland,[34] and the District of Columbia[22] maintain the estate recovery of all medical expenses for expanded Medicaid recipients in their laws and regulations.)
As well, the ACA may reflect a changed attitude intended in the law, that affordable health insurance should be available to all as an expected matter of national policy.some may consider it important to examine justifications under the assumption of expanded Medicaid.
The argument to continue non-LTCR estate recovery was expressed by an assistant commissioner for the Minnesota Department of Human Services, a state that had expanded Medicaid: “The general idea here is that people with assets should help contribute to the cost of their coverage, Many have incurred thousands of dollars of medical expenses at taxpayer expense.
[51][52] In other Medicaid expansion states with non-LTCR Medicaid estate recovery just prior to the ACA main provisions, such as Massachusetts,[8][21] New Jersey,[20] Iowa,[25] Nevada,[26] New Hampshire,[27][28] North Dakota,[29] Ohio,[30] Rhode Island,[31] Indiana,[32] Idaho,[53] Utah,[33] and Maryland,[34] as well as in the District of Columbia,[22] the recovery of non-LTCR persists.