Medicaid estate recovery collections - ASPE - U.S. Department of ...

Most of the higher recovery states have more mature programs and long experience with estate recovery.Changes in Collection Rates Between 2002 and 2004*• National collections rose by over $40 million (12.4%).• State-specific changes in collections were roughly similar to the average change nationally in onlyfour states: California, Massachusetts, New York and South Dakota. Though their rates of increasewere close to the national average (12-13%), the increases in funds they collected comprisednearly one-third (30.1%) of the total increase in national collections. Similarly, their share of totalcollections in 2004 was just under one-third (30.0%).• All other state collections between 2002 and 2004 departed significantly from the national average.• Thirty-five states increased their collections between 2002 and 2004. The five states with thehighest percent increases were Kentucky (184.7%), Louisiana (100.0%), New Mexico (100.0%),Wyoming (90.8%), and Tennessee (85.1%).• Twelve states collected less in 2004 than in 2002. The five with the largest percent decreaseswere: Utah (-97.7%), Pennsylvania (-74.7%), West Virginia (-64.6%), Nevada (-64.3%) andMississippi (-57.4%).• Factors explaining volatile rates of change within a given state over time are speculative andinclude: programs in early and unsettled states of implementation; gains or declines in a smallnumber of relatively large estates (which can have disproportionate effects on rates of change,especially in smaller states); and errors or inconsistencies in reporting.* See Table 1, Table 2, and Table 3.Reasons for Wide State Variations in Reported Estate Recovery ActivitiesVariations in implementation of federal recovery options:States can choose to implement the minimal estate recovery guidelines mandated by OBRA 93, or theycan implement a variety of options permitted by federal law to expand their estate recovery activities toreach more people and include more types of assets (see Table 4, below). For example, they can: useliens to secure Medicaid’s right to recover; recover from recipient assets that bypass probate; or recoverMedicaid spending for additional services beyond the required minimum of long-term care and relatedservices.There appears to be only a weak connection between a state’s reported collections and the policy optionsit has chosen. Although states that exercise the fewest estate recovery policy options (e.g., Arkansas,Mississippi, New Mexico, North Carolina, Pennsylvania, Vermont, and West Virginia) tend to have thelowest rates of collection, some states have relatively low collection rates (e.g., Delaware or Oklahoma),despite having chosen a broad range of options to maximize collection opportunities. Clearly, factorsother than a state’s chosen policy options are also at work.September 2005Page 4