Six months after her mother died in 2014, Karen Craig opened her mailbox to find a bill for $9,530.06.
It came from Medi-Cal, the state’s version of the Medicaid program for low-income people, which was seeking repayment for her mother’s medical care even though she had used her coverage just once, for a routine wellness exam. (Her mother’s medical costs were primarily covered by Medicare, the federal program for seniors, Craig says.)
“I was just shocked and panicked,” says Craig, a Central Coast resident.
In the ensuing months, Craig learned that Medi-Cal’s”Estate Recovery Program” can demand posthumous payback from enrollees 55 and over for a broad range of medical costs. For many people, including Craig’s mother, these costs include the monthly payments that Medi-Cal makes to managed care plans to cover its enrollees, even if they didn’t use any medical services.
Disbelief and anxiety over the estate recovery program are widely shared among Medi-Cal enrollees and their families.
Now, to their relief, the program is changing: If you die on or after Jan. 1, new rules will dramatically reduce what can be collected from your estate after your death.
The federal government requires states to recoup specific medical costs — mostly related to nursing home care — from the estates of certain Medicaid beneficiaries after they die. California is among a minority of states that seeks repayment beyond the federal mandate.
Under current rules, the state can collect for nearly all Medi-Cal coverage you receive after you turn 55. In some cases, the state also can recover costs from Medi-Cal members under 55 who are patients in nursing homes.
Enrollees, legislators and advocates assert that the program unfairly targets older and poor Californians.
“It is an equity issue,”
says Linda Nguy, a policy advocate for the Western Center on Law and Poverty.