Medicaid; DMAS to collect data and information on estate recovery, report.

Plain English Breakdown

The official source does not specify the exact criteria or methods DMAS will use for data collection beyond what is listed.

Medicaid Estate Recovery Data Collection

This law asks the Department of Medical Assistance Services to gather information about Medicaid estate recovery in Virginia and report it.

What This Bill Does

• DMAS must collect data on whether Virginia recovers more than what federal rules require from people who used Medicaid for long-term care services, including the percentage of total recovery that applies.
• DMAS needs to check if additional assets beyond a person's probate estate are recovered by the Commonwealth and report the percentage of overall recovery from these assets.
• DMAS should see if homes worth less than a certain value are excluded from recovery efforts and explain what 'modest value' means for these houses.
• The department has to look at how it decides when it's worth trying to get back money spent on Medicaid services, including the cost-effectiveness threshold.
• DMAS must collect race and demographic data for each of the most recent five years on total collections, undue hardship waiver applications submitted, and approved or successful waivers.

Who It Names or Affects

• People who use Medicaid for long-term care services
• The Department of Medical Assistance Services (DMAS)
• Virginia state agencies that help DMAS gather information

Terms To Know

Medicaid estate recovery

A process where the government tries to get back money spent on Medicaid services from a person's estate after they die.

Probate estate

The property and assets of someone who has died, which are managed by their executor or administrator during probate proceedings.

Limits and Unknowns

• Does not specify how the collected data will be used beyond reporting.
• It does not change current Medicaid estate recovery policies but only asks for information about them.
• The bill does not provide funding to DMAS for collecting and reporting this data.

Official Summary Text

Department of Medical Assistance Services; collection of data and information on Medicaid estate recovery; report.
Requests the Department of Medical Assistance Services (DMAS) to collect data and information on Medicaid estate recovery in the Commonwealth. DMAS is requested to collect data and information on (i) whether the Commonwealth adjusts or recovers for long-term services and supports and related services provided through Medicaid beyond the federally required minimum and, if so, what percentage of the overall amount recovered by the Commonwealth is for such services; (ii) whether additional assets beyond a Medicaid enrollee's probate estate are recovered by the Commonwealth and, if so, what percentage of the overall amount recovered by the Commonwealth is from assets beyond such enrollees' probate estates; (iii) whether homes of modest value are excluded from Medicaid estate recovery and, if so, how DMAS defines "home of modest value"; (iv) the cost-effectiveness threshold followed by DMAS for pursuing Medicaid estate recovery; and (v) the criteria used to evaluate undue hardship waiver applications. DMAS is requested to also collect race and demographic data for each of the most recent five years on (a) the total number of collections, (b) the number of undue hardship waiver applications submitted, and (c) the number of undue hardship waiver applications that were approved or otherwise successful. The bill requires DMAS to submit an executive summary and such data and information to the members of the House Committee on Health and Human Services and the Senate Committee on Rehabilitation and Social Services no later than the first day of the 2027 Regular Session of the General Assembly.

Current Bill Text

Requesting the Department of Medical Assistance Services to collect data and information on Medicaid estate recovery in the Commonwealth. Report.

WHEREAS, Medicaid is a medical assistance program jointly administered by the federal and state governments; and

WHEREAS, federal law requires states to recover from the estates of deceased Medicaid enrollees age 55 or older and deceased Medicaid enrollees with disabilities the costs of long-term services and supports and related services provided through Medicaid; and

WHEREAS, studies have shown that older adults with few financial resources are more likely to have increased needs for long-term services and supports, thus concentrating the burden of Medicaid estate recovery on this population; and

WHEREAS, people of color make up almost 60 percent of Medicaid enrollees younger than the age of 65 and are disproportionately represented among the group most affected by Medicaid estate recovery; and

WHEREAS, federal law sets minimum requirements for Medicaid estate recovery, but states have considerable flexibility in the statewide implementation of the Medicaid estate recovery program; now, therefore, be it

RESOLVED by the House of Delegates, the Senate concurring, That the Department of Medical Assistance Services be requested to collect data and information on Medicaid estate recovery in the Commonwealth.

In collecting the data and information, the Department of Medical Assistance Services (DMAS) shall identify (i) whether the Commonwealth adjusts or recovers for long-term services and supports and related services provided through Medicaid beyond the federally required minimum and, if so, what percentage of the overall amount recovered by the Commonwealth is for such services; (ii) whether additional assets beyond a Medicaid enrollee's probate estate are recovered by the Commonwealth and, if so, what percentage of the overall amount recovered by the Commonwealth is from assets beyond such enrollees' probate estates; (iii) whether homes of modest value are excluded from Medicaid estate recovery and, if so, how DMAS defines "home of modest value"; (iv) the cost-effectiveness threshold followed by DMAS for pursuing Medicaid estate recovery; and (v) the criteria used to evaluate undue hardship waiver applications. DMAS shall further collect data, including race and demographic data, for each of the most recent five years on (a) the total number of collections, (b) the number of undue hardship waiver applications submitted, and (c) the number of undue hardship waiver applications that were approved or otherwise successful.

All agencies of the Commonwealth shall provide assistance to DMAS in collecting the information, upon request.

DMAS shall submit to the Division of Legislative Automated Systems an executive summary and the data and information collected on Medicaid estate recovery in the Commonwealth no later than the first day of the 2027 Regular Session of the General Assembly. The executive summary shall be submitted for publication as a report document as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website. The executive summary and the data and information collected shall also be provided to the members of the House Committee on Health and Human Services and Senate Committee on Rehabilitation and Social Services no later than the first day of the 2027 Regular Session of the General Assembly.