Revise the Medicaid Estate Recovery Program Law

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 318

2025-2026

Representatives Stephens, Brennan

Cosponsors: Representatives Thomas,
D., Glassburn, McNally

To
amend sections 5162.21 and 5162.211 of the Revised Code
to
make changes to the law governing the Medicaid Estate Recovery
Program.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
sections 5162.21 and 5162.211 of the Revised Code be amended to read
as follows:

Sec.
5162.21.
(A)
As used in this section and section 5162.211 of the Revised Code:

(1)
"Estate" includes both of the following:

(a)
All real and personal property and other assets to be administered
under Title XXI of the Revised Code and property that would be
administered under that title if not for section 2113.03 or 2113.031
of the Revised Code;

(b)
Any other real and personal property and other assets in which an
individual had any legal title or interest at the time of death (to
the extent of the interest), including assets conveyed to a survivor,
heir, or assign of the individual through joint tenancy, tenancy in
common, survivorship, life estate, living trust, or other
arrangement.

(2)
"Institution" means a nursing facility, ICF/IID, or a
medical institution.

(3)
"Permanently institutionalized individual" means an
individual to whom all of the following apply:

(a)
Is an inpatient in an institution;

(b)
Is required, as a condition of the medicaid program paying for the
individual's services in the institution, to spend for costs of
medical or nursing care all of the individual's income except for an
amount for personal needs specified by the department of medicaid;

(c)
Cannot reasonably be expected to be discharged from the institution
and return home as determined by the department of medicaid.

(4)
"Qualified state long-term care insurance partnership program"
means the program established under section 5164.86 of the Revised
Code.

(5)
"Time of death" shall not be construed to mean a time after
which a legal title or interest in real or personal property or other
asset may pass by survivorship or other operation of law due to the
death of the decedent or terminate by reason of the decedent's death.

(B)
To the extent permitted by federal law, the department of medicaid
shall institute a medicaid estate recovery program under which the
department shall, except as provided in divisions (C) and (E) of this
section, and subject to division (D) of this section, do
all

both

of
the following:

(1)
For the costs of medicaid services the medicaid program correctly
paid or will pay on behalf of a permanently institutionalized
individual of any age, seek adjustment or recovery from the
individual's estate or on the sale of property of the individual or
spouse that is subject to a lien imposed under section 5162.211 of
the Revised Code;

(2)
For the costs of medicaid services
described
in section 1917(b)(1)(B)(i) of the "Social Security Act,"
42 U.S.C. 1396p(b)(1)(B)(i), that
the
medicaid program correctly paid or will pay on behalf of an
individual fifty-five years of age or older who is not a permanently
institutionalized individual, seek adjustment or recovery from the
individual's estate
;

(3)
Seek adjustment or recovery from the estate of other individuals as
permitted by federal law
.

(C)(1)
No adjustment or recovery may be made under division (B)(1) of this
section from a permanently institutionalized individual's estate or
on the sale of property of a permanently institutionalized individual
that is subject to a lien imposed under section 5162.211 of the
Revised Code or under division (B)(2) or (3) of this section from an
individual's estate while either of the following are alive:

(a)
The spouse of the permanently institutionalized individual or
individual;

(b)
The son or daughter of a permanently institutionalized individual or
individual if the son or daughter is under age twenty-one or, under

section
1614 of
the
"Social Security Act,"
section
1614,
42
U.S.C. 1382c, is considered blind or disabled.

(2)
No adjustment or recovery may be made under division (B)(1) of this
section from a permanently institutionalized individual's home that
is subject to a lien imposed under section 5162.211 of the Revised
Code while either of the following lawfully reside in the home:

(a)
The permanently institutionalized individual's sibling who resided in
the home for at least one year immediately before the date of the
permanently institutionalized individual's admission to the
institution and on a continuous basis since that time;

(b)
The permanently institutionalized individual's son or daughter who
provided care to the permanently institutionalized individual that
delayed the permanently institutionalized individual's
institutionalization and resided in the home for at least two years
immediately before the date of the permanently institutionalized
individual's admission to the institution and on a continuous basis
since that time.

(D)
In the case of a participant of the qualified state long-term care
insurance partnership program, adjustment or recovery required by
this section may be reduced in accordance with rules authorized by
division (G) of this section.

(E)
The department shall, in accordance with procedures and criteria
established in rules authorized by division (G) of this section,
waive seeking an adjustment or recovery otherwise required by this
section if the medicaid director determines that adjustment or
recovery would work an undue hardship. The department may limit the
duration of the waiver to the period during which the undue hardship
exists.

(F)
For the purpose of determining whether an individual meets the
definition of "permanently institutionalized individual"
established for this section, a rebuttable presumption exists that
the individual cannot reasonably be expected to be discharged from an
institution and return home if either of the following is the case:

(1)
The individual declares that he or she does not intend to return
home.

(2)
The individual has been an inpatient in an institution for at least
six months.

(G)
Rules adopted under section 5162.02 of the Revised Code shall do both
of the following:

(1)
For the purpose of division (D) of this section and consistent with

section 1917(b)(1)(C) of

the "Social Security Act,"
section
1917(b)(1)(C),

42 U.S.C. 1396p(b)(1)(C), provide for reducing an adjustment or
recovery in the case of a participant of the qualified state
long-term care insurance partnership program;

(2)
For the purpose of division (E) of this section and consistent with
the standards specified by the United States secretary of health and
human services under
section
1917(b)(3) of
the
"Social Security Act,"
section
1917(b)(3),

42 U.S.C. 1396p(b)(3), establish procedures and criteria for waiving
adjustment or recovery due to an undue hardship

or for either of the following:

(a)
Beginning on the effective date of this amendment, waiving adjustment
or recovery when the costs of medicaid services the medicaid program
correctly paid or will pay on behalf of an individual are less than
twenty thousand dollars. In subsequent years, the department shall
adjust the amount specified in this division for inflation.

(b)
Waiving adjustment or recovery when the costs of medicaid services
the medicaid program correctly paid or will pay on behalf of an
individual do not exceed the administrative costs of making the
adjustment or recovery
.

Sec.
5162.211.
(A)
Except as provided in division (B) of this section and section
5162.23 of the Revised Code, no lien may be imposed against the
property of an individual before the individual's death on account of
medicaid services correctly paid or to be paid on the individual's
behalf.

(B)
Except as provided in division (C) of this section, the department of
medicaid may impose a lien against the real property of a medicaid
recipient who is a permanently institutionalized individual and
against the real property of the recipient's spouse, including any
real property that is jointly held by the recipient and spouse. The
lien may be imposed on account of medicaid paid or to be paid on the
recipient's behalf.

A lien imposed against the real property of a medicaid recipient
under this section shall not exceed seventy-five per cent of the
assessed value of the property.

(C)
No lien may be imposed under division (B) of this section against the
home of a medicaid recipient if any of the following lawfully resides
in the home:

(1)
The recipient's spouse;

(2)
The recipient's son or daughter who is under twenty-one years of age
or, under
section
1614 of
the
"Social Security Act,"
section
1614,

42 U.S.C. 1382c, considered to be blind or disabled;

(3)
The recipient's sibling who has an equity interest in the home and
resided in the home for at least one year immediately before the date
of the recipient's admission to the institution.

(D)
The medicaid director or a person designated by the director shall
sign a certificate to effectuate a lien required to be imposed under
this section. The county department of job and family services shall
file for recording and indexing the certificate, or a certified copy,
in the real estate mortgage records in the office of the county
recorder in every county in which real property of the recipient or
spouse is situated. From the time of filing the certificate in the
office of the county recorder, the lien attaches to all real property
of the recipient or spouse described in the certificate for all
amounts for which adjustment or recovery may be made under section
5162.21 of the Revised Code and, except as provided in division (E)
of this section, shall remain a lien until satisfied.

Upon
filing the certificate in the office of the recorder, all persons are
charged with notice of the lien and the rights of the department of
medicaid thereunder.

The
county recorder shall keep a record of every certificate filed
showing its date, the time of filing, the name and residence of the
recipient or spouse, and any release, waivers, or satisfaction of the
lien.

The
priority of the lien shall be established in accordance with state
and federal law.

The
department may waive the priority of its lien to provide for the
costs of the last illness as determined by the department,
administration, attorney fees, administrator fees, a sum for the
payment of the costs of burial, which shall be computed by deducting
from five hundred dollars whatever amount is available for the same
purpose from all other sources, and a similar sum for the spouse of
the decedent.

(E)
A lien imposed with respect to a medicaid recipient under this
section shall dissolve on the recipient's discharge from the
institution and return home.

Section
2.
That
existing sections 5162.21 and 5162.211 of the Revised Code are hereby
repealed.