health as it happens

Ohio's 'free' Medicaid health care program that could claw back money from your estate - The Columbus Dispatch

Bob Weldon is on a mission to single-handedly educate consumers about the dangers of a particular Medicaid policy that resulted in the state trying to take thousands of dollars from his brother's estate.

He wants to do that by changing state law.

At issue is Medicaid coverage pitched by state government representatives as free for his brother, who needed health insurance while in a losing fight with cancer.

"The more I read and dig in on this, the more disturbed I get," said Weldon, who owns an insurance agency, Tom Jones Insurance, in Millersport. "I believe there are thousands of people in the state of Ohio who have no idea that the benefits they signed up for are subject to estate recovery."

Weldon's brother, Philip, was diagnosed with cancer in July 2016.

Three years later, as the disease progressed, he had to quit work. He went on Social Security disability, but needed health care coverage.

Bob Weldon, 63, went on the federal health insurance exchange and found a policy for his brother in July 2019. When the policy was renewed in January 2020, the policy costs $213 a month.

At the same time the policy was being renewed, the Central Ohio Area Agency on Aging reached out to Philip about a Medicaid program called Specialized Recovery Services that assists adults with severe and persistent mental illness, certain diagnosed chronic conditions and those actively waiting on specific transplant lists.

The pitch: The program was free. Beyond offering health care coverage, the program provided extra services such as house cleaning.

Bob Weldon said he was repeatedly assured there was no cost, even as he continued to doubt that was possible.

"Yes, Mr. Weldon, not a dime," he was told.

On Feb. 20, 2020, Fairfield County Job and Family Services told Weldon his brother qualified for the program. The coverage was backdated to Feb. 1.

Weldon canceled his brother's policy on the health care exchange and signed up for the new coverage for his brother, who by this point was in the final stages of his illness. He passed away on March 4, 2020, at the age of 63.

Following his death, the Ohio Attorney General's office placed a claim against the brother's estate for $3,570, basically for two months of managed care premiums for the time that policy was in effect. As it turned out, the policy that was sold to his brother as being free actually cost $1,785 a month.

Weldon's brother would have been better off to stick with the policy he had bought on the federal exchange for $213 a month.

Brother's death launches Ohio Medicaid recovery campaign

Since his brother's death, Weldon has been on a campaign to understand why, in the process of signing up for the policy, he was never told the state could seek to recover those costs from his brother's estate.

"I am absolutely stunned that somebody can get signed up on this and not require a signature of understanding," he said. "I just don't understand that."

Weldon has complained to the Ohio Department of Job and Family Services, the Fairfield County Department of Job and Family Services, the Ohio Department of Aging, local and state politicians, the attorney general's office and others. When he called the state's Medicaid hotline, Weldon complained that that the material he has looked at is deceptive.

Ultimately, the estate settled the bill from the Ohio Attorney General's office for $426, the price for two months' premiums that Weldon's brother would have paid under the old policy he had on the federal health care exchange.

Weldon has been persistent in his efforts to see the state do something to better inform consumers of the possibility that the state could take money from an estate of someone who was covered under the Specialized Recovery Services program.

He has called on legislators to pass a bill requiring that consumers sign a simple form before receiving benefits that acknowledges that money spent under the program is subject to being recovered from their estate.

"I want a disclosure a fifth-grader could understand," he said. "I want it fixed. … I believe there's been other people who have been duped.

"I'm tired of people telling me, 'I'm sorry, I can't help you.'"

State Sen. Tim Schaffer, R-Lancaster, has introduced legislation that would require a disclosure.

The simple, one-page bill, Senate Bill 60, would require the Ohio Department of Medicaid to ensure that every applicant for any Medicaid program be notified of the provisions of the state's Medicaid estate recovery program. The legislation is pending in a Senate committee.

The Medicaid estate recovery program allows the state to obtain repayment for the cost of Medicaid benefits once a Medicaid-eligible person dies. Recovery happens after the death of a Medicaid recipient who was either permanently institutionalized or 55 or older and not in an institution.

The Ohio Attorney General's office recovered $57.7 million for its 2020 fiscal year, the most recent year available.

“This is an issue that was brought to my attention when it impacted a family in my district, and it was clear that legislative action was necessary since this issue has gone unresolved," Schaffer said in a statement. "Since introducing Senate Bill 60, I have had numerous conversations with the Ohio Department of Medicaid to address this important issue, and I am actively working with the department to find a suitable remedy."

The Department of Medicaid says it is stepping up its efforts to heighten visibility and awareness of the Medicaid estate recovery policy.

This includes revising notices that it provides to applicants and updating the language used online that is available to everyone who is applying for Medicaid eligibility. The changes go into effect in March.

It also includes strengthening training for county Job and Family Service caseworkers who manage and process Medicaid applications to ensure the process informs applicants of the estate recovery policy.

The Ohio Medicaid website also includes information being displayed more prominently to increase awareness of the estate recovery provision by using plain language.

"I'd love for there to be lot more knowledge about this out there," said Keith Stevens, an elder law attorney with the firm Carlile Patchen Murphy.

Still, Stevens said he's not sure how much it will help in the midst of all the paperwork that is put before applicants seeking Medicaid coverage.

"It is something pretty easy to overlook," he said.

Some of the confusion may stem from third parties that may tell clients that the service is free because there aren't fees on their end, he said.  

Still, more than one client has been surprised when the state has filed a claim against an estate over Medicaid costs, Stevens said.

Weldon is sticking with his demand that consumers sign a simple, easy-to-understand document.

"What they have is a process in place that has failed for years and years," he said. "I will not accept anything other than a signature of understanding.''

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