In June of 2025, Representatives Jason Stephens and Sean Brennan introduced House Bill 318 to limit who is subject to Medicaid Estate Recovery and the size of lien the Department of Medicaid can impose against a Medicaid participant’s real property. Legal Aid attorneys frequently represent family members who have inherited a home from a loved one only to have it seized as part of Medicaid’s recovery of the deceased’s estate. Having witnessed clients lose to Medicaid Estate Recovery the only generational wealth they could expect to inherit, several attorneys from the Health and Public Benefits Taskforce convened a group to review the bill and see what opportunities there were to educate policy makers on how Medicaid Estate Recovery impacts our clients.

What’s Medicaid Estate Recovery?

Medicaid Estate Recovery is the process by which states, after a Medicaid recipient dies, obtain repayment for the cost of any healthcare the participant received after age 55. For those now-deceased Medicaid participants who owned a home—perhaps the one asset they expected to pass on to the next generation—the means for repaying their healthcare expenses includes that home.

The Medicaid Estate Recovery workgroup includes Erin Campbell of Pro Seniors; Katherine Hollingsworth of Northeast Ohio Legal Aid; Stacey Purcell of Legal Aid Society of Southwest Ohio; Esther Herbers and Miranda Anandappa of Legal Aid of Southeast and Central Ohio; and Brandy Keesee, Athena Bowen, and Kara Jennings of Advocates for Basic Legal Equality along with Danielle DeLeon Spires of the Ohio Poverty Law Center.

The group began discussing the Medicaid Estate Recovery cases they had each represented and looking for clients who could talk to the legislature about how HB 318 would impact them. Meanwhile, Danielle met with the sponsors’ legislative aides to review key parts of the bill and coordinate efforts to support its movement. But despite everyone’s efforts, the bill lingered in committee without any hearings.

Beyond the bill

By the time it became clear HB 318 wasn’t going anywhere, the Medicaid Estate Recovery workgroup had learned enough from each other about the common problems with the recovery process, that they had their own advocacy agenda to work on, with or without HB 318.

The group identified the following advocacy priorities:

• Medicaid participants must be reasonably informed about what Medicaid Estate Recovery is when they start the program.
• Families must be reasonably informed of their options for legal counsel when the Department of Medicaid initiates the recovery process after their family member has died.
• Future attempts at Medicaid Estate Recovery reform must include eliminating the use or limiting the scope of special counsels appointed by the Attorney General’s office to pursue recovery.

Addressing the first two points, the group created a plain language “know your rights” guide to understanding Medicaid Estate Recovery* to make available to clients and community partners who serve low-income Ohioans. Those group members who work for unrestricted programs also submitted the guide to the Department of Medicaid, the Attorney General’s Office, and the Department of Job and Family Services, requesting that the state send the guide to enrollees when they first apply to Medicaid, and then to their families prior to the start of the recovery process.

Currently, the only time Ohioans get informed about Medicaid Estate Recovery is on one page of a lengthy Medicaid enrollment packet.

Preliminary feedback from the Ohio Department of Medicaid is that they expect to be able to implement some of the changes recommended by the Legal Aid attorneys.

The group’s concern with special counsels prosecuting Medicaid Estate Recovery cases is that the practice is frequently at odds with both the interests of the family and basic legal fairness. Common problems the group identified anecdotally include:

• Sending an estate recovery claim letter to a surviving spouse even though a spouse retains ownership of the home until their own death. (Surviving spouses often call Legal Aid thinking they are about to lose their home.)
• Filing unwarranted liens against the property, making it hard for heirs to keep or sell the family property.
• Not informing an heir living in the home that they have 30 days to file a hardship waiver that could allow them to remain in and maintain ownership of the home.

“These are some of the hardest cases we see,” said Brandy Keesee, attorney at Advocates for Basic Legal Equality, referring to clients up against the hardship waiver deadline. “A person has just lost their parent. They feel like they are up against the wall. And the unfortunate reality is they are up against the law.”

Given the cost of attorney fees, the workgroup questions whether the state is actually recouping any of its Medicaid expenses by paying private counsel to collect what they can from Ohio’s poorest families.

What are the group’s goals now?

Based on the group's conversations, Erin and Brandy worked on a model bill with the hope of getting changes to HB 318 before the summer break. While they were disappointed that lawmakers did not address the bill before the break, they have since received a request from Rep. Stephens to discuss their suggested changes, which include adding the new notice requirements and reforming the practice of special counsels.

Meanwhile, unrestricted members of the workgroup are taking a deeper dive into the practices, outcomes, and costs of the special counsel program having submitted a public records request to the AG’s office requesting case data, MER policies, program expenses, monetary amounts recouped on behalf of the Department of Medicaid, and more.

How to get involved

If you are interested in getting involved in the work to reform Medicaid Estate Recovery in Ohio, please contact any of the members of the workgroup listed above.

*Design credit for the Know Your Rights guide goes to Allison Kuhr, ABLE communications specialist.