Salvatore LoGrande’s daughters made a vow to keep him in the small, family home he had worked tirelessly to purchase years ago, as he battled cancer and its accompanying agony.

Sandy LoGrande mistakenly believed that she was being charged incorrectly when she received a bill of $177,000 from Massachusetts for her father’s Medicaid costs, a year after his passing. The state also threatened legal action to claim her father’s home if the payment was not made promptly.

“To my father,” said LoGrande, 57, “the home was everything.”

However, the invoice and corresponding warning were not an error.

However, this was simply a standard procedure mandated by the federal government for each state. Its purpose is to reclaim funds from the estates of deceased individuals who were recipients of Medicaid, the publicly-funded health insurance program for low-income Americans.

“The average individual’s residence is generally not considered eligible for Medicaid. However, if the individual is over 55 years old and utilized Medicaid for expenses related to long-term care, such as nursing home stays or in-home health services, their residence may be subject to the estate recovery process.”

This month, a member of the Democratic party put forth a proposal to completely eliminate the “inhumane” program. Detractors claim that the program only collects about 1% of the total amount spent annually by Medicaid on long-term care, which exceeds $150 billion. Additionally, they argue that many states neglect to inform individuals who enroll in Medicaid that their families may be faced with large expenses and property claims after their death.

According to LoGrande, she found herself entangled in a lengthy legal dispute with Massachusetts following her father’s passing. Prior to his death in 2016, she sought guidance from a local nonprofit regarding the care of her aging father. They advised her to enroll him in Medicaid. She specifically inquired about the family home, but was reassured that the state would only make a claim on the property if her father was placed in a nursing home.

She stated that he would never agree to anything that could possibly endanger his home.

For many years, her father received a yearly update letter from the state’s Medicaid agency. She reveals that it wasn’t until after his passing, when she received a bill for $177,000 from the state, that she saw the initial statement for his treatment, which covered a short stay in the hospital for cancer-related pain, medications, and hospice care.

“The statement from LoGrande evoked intense emotions as it felt deceitful and gut-wrenching.”

In 2019, the state reached an agreement with the LoGrandes and relinquished its claim on the property.

The 2021 report from the Medicaid and CHIP Payment and Access Commission, which advises Congress on policy recommendations, reveals significant differences in state policies regarding the recovery process.

Certain states may place a lien, which is a legal claim, on a property, whereas others do not. Additionally, some Medicaid offices aim to reclaim all expenses incurred by patients, such as medical appointments and medication, whereas others only pursue costs for extended care. Within the last few years, Alaska and Arizona have pursued a limited number of properties, while other states have targeted thousands of homes, leading to cumulative losses in the hundreds of millions of dollars.

According to an investigation by the Dayton Daily News, New York and Ohio were the top states in the country for recovering over $100 million in collections in one year.

The Health and Human Services inspector general recently published an analysis of the Kansas program, which revealed that the program was budget-friendly, bringing in $37 million while only utilizing $5 million to retrieve the funds. However, the state did not consistently collect the money from qualified estates.

In the previous month, a prominent health insurance company’s foundation urged Massachusetts to revamp their procedures. This involves retrieving payments for the majority of Medicaid fees, above and beyond the federal requirement for covering long-term care costs. The Blue Cross Blue Shield Foundation of Massachusetts suggested that the state’s legislative body pass a bill banning these extra collections.

According to Katherine Howitt, a Medicaid policy director at the foundation, estate recovery could contribute to the continuation of unequal distribution of wealth and poverty between generations.

After her mother’s passing in 2021, Imani Mfalme encountered a situation similar to Tennessee’s recovery of over $38.2 million from 8,100 estates last year.

As her mother’s Alzheimer’s disease progressed, Mfalme took on the responsibility of caring for her. However, in 2015, Mfalme’s breast cancer diagnosis and subsequent need for a double mastectomy prompted her to explore alternative options. She arranged a meeting at her mother’s house with a representative from the local Medicaid office. The representative advised her to deplete her mother’s savings, which Mfalme had been using to cover the cost of her mother’s assisted living facility, in order for her mother to be eligible for Medicaid.

She remembers feeling a bit hurt during the meeting when the representative asked her three times: “Is this your mother’s house?” Mfalme, the representative, did not mention the possibility of being required to sell the house to cover her mother’s Medicaid bill after her passing.

The Medicaid office in Tennessee claims that she has a debt of $225,000 and the state is requesting a court order for Mfalme to sell her house in order to settle the owed amount.

The person known as Mfalme, who is currently 42 years old, expressed her desire to make payments to what she can, but the house is causing specific difficulties. Her mother, a woman of Black descent, bought her dream house in Knoxville following her success in a noteworthy lawsuit against her previous employer, Boeing. This lawsuit was due to the company paying her less than her male colleagues.

Mfalme expressed her mother’s determination for equal pay and rights, but unfortunately, this was taken away when they both fell ill. This has been devastating for them both.

According to an email sent to The Associated Press, TennCare (the Medicaid office of Tennessee) has declined to comment on individual cases.

The report from the Medicaid and CHIP Payment and Access Commission suggested that Congress should overturn the 1993 legislation that mandated states to reclaim funds from estates, and instead make it a choice.

In the beginning of this month, Democratic Representative Jan Schakowsky from Illinois proposed a bill that would eliminate the federal government’s requirement. Schakowsky argues that the mandate negatively affects families who lose their homes and taxpayers who do not receive significant benefits from the recovery efforts.

According to Schakowsky, this program is extremely cruel and ineffective, and it does not benefit anyone.

It is unlikely that the bill will gain enough bipartisan support to pass into law due to the current gridlock within Congress, with certain Republicans pushing to decrease Medicaid benefits.

The individual who designed the rule is aware that it is not functioning properly.

Stephen Moses, currently employed at the conservative Paragon Health Institute, explained that there is a decades-old mandate aimed at motivating individuals to save for long-term care, otherwise risking the loss of equity in their homes. Unfortunately, this is not widely known among the public.

Moses stated that the intention was to secure access to long-term care for those in need, but also to encourage individuals to financially prepare themselves in order to avoid relying on the government’s healthcare program.