DID YOU KNOW? Obamacare's Medicaid Expansion Means States May Go After More Americans’ Estates to Recover Costs

Millions of people have gained health coverage through Medicaid since states began expanding the program under the Affordable Care Act. That also means more Americans may find themselves caught in a little-known law that lets states go after their assets after they die.

For more than 20 years, federal law has allowed states to recover almost all Medicaid costs if recipients are 55 or older when they die. This now applies to many of the 11 million people who joined Medicaid since the health law’s expansion of the state-federal insurance program.

The upshot: Some families are discovering they may have to sell a home or other assets of a deceased relative to reimburse the government.

States can’t seize assets during the lifetime of a surviving spouse, or when surviving children are under 21 or permanently disabled. Survivors also can apply for hardship exemptions, such as having a very low income.

Pam Cortina, at home in Sky Valley, Calif., is holding off 
on gallbladder surgery because she worries that Medicaid 
might go after her estate. Photo: David McNew for WSJ

Some lawmakers and advocates are pushing to further restrict the practice. Colorado, Connecticut, Oregon and Washington recently scaled back what costs they attempt to recover from estates, and California is weighing legislation to help protect survivors’ assets. The federal government may issue proposed regulations soon that could limit estate recovery, according to some advocacy groups.

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