OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 681 Bill Analysis
135th General Assembly
Click here for H.B. 681’s Fiscal Note
Version: As Introduced
Primary Sponsors: Reps. LaRe and Brennan
Effective date:
Erika Kramer, Attorney
SUMMARY
▪ Narrows the categories of expenses that can be recouped from Medicaid recipients ages
55 and older under Ohio’s Medicaid estate recovery program to include only long-term
care related expenses, instead of all expenses for Medicaid services.
▪ Imposes notification requirements regarding the Medicaid estate recovery program.
▪ Requires the Department of Medicaid (ODM) to provide notice of the Medicaid estate
recovery program, including specified information, both when an individual applies for
and is approved for Medicaid.
▪ Also requires ODM to develop (1) a consumer-focused notification explaining how the
Medicaid estate recovery program works and (2) a notification for Medicaid recipients
who may be at risk of being subject to the Medicaid estate recovery program, listing
available resources.
▪ Requires ODM to adopt rules to implement the bill’s notification requirements.
DETAILED ANALYSIS
Medicaid estate recovery program
The bill narrows the categories of expenses that can be recouped from Medicaid
recipients age 55 and older under Ohio’s Medicaid estate recovery program. Federal law requires
states to implement an estate recovery program under which the state must seek to recoup funds
spent on Medicaid services from the estates of certain deceased Medicaid recipients.1 In Ohio,
when such a recipient dies, the Ohio Department of Medicaid (ODM) certifies the amount due,
1
42 United Staes Code (U.S.C.) 1396p(b), not in the bill.
November 15, 2024
Office of Research and Drafting LSC Legislative Budget Office
and the Ohio Attorney General is tasked with collecting the debt from the recipient’s estate,
including homes, bank and investment accounts, and other assets.2
Under state Medicaid recovery programs, the federal law requires recovery of the
following amounts:
1. Expenses for nursing facility services, home and community-based services, and related
hospital and prescription services paid on behalf of a Medicaid recipient age 55 or older;
and
2. All medical assistance paid on behalf of a Medicaid recipient receiving long-term services
and supports in a facility permanently (referred to as “permanently institutionalized”
individuals).
States may elect to apply estate recovery under additional circumstances, for example, by
recovering all medical assistance paid on behalf of a Medicaid recipient age 55 or older, not just
for nursing facility and associated expenses as under (1) above.3 Ohio has exercised that option.
The bill eliminates that option by narrowing the category of expenses that can be
recouped under Medicaid estate recovery for Medicaid recipients age 55 and older to include
only long-term care related expenses. Current law permits ODM to recover from the individual’s
estate all costs for Medicaid services correctly paid on behalf of a Medicaid recipient age 55 years
and older who is not a permanently institutionalized individual. Instead, the bill only permits
recovery of all costs for Medicaid services, including long-term care related prescription drug
products, for Medicaid recipients age 55 or older who received long-term care in one of the
following settings:
▪ A residential facility licensed by the Department of Developmental Disabilities;
▪ A residential facility licensed by the Department of Mental Health and Addiction Services;
▪ In-home care, such as home health services;
▪ A nursing facility;
▪ An intermediate care facility for individuals with intellectual disabilities (ICF/IID);
▪ A hospital; or
▪ Another similar long-term care facility setting.4
Under law unchanged by the bill, ODM is required to seek adjustment or recovery from
the estate of other individuals as permitted by federal law.
2
R.C. 5162.21; R.C. 5162.212, not in the bill.
3
42 U.S.C. 1396p(b).
4
R.C. 5162.21(B)(2).
P a g e |2 H.B. 681
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
Notification of the Medicaid estate recovery program
Notice upon application
Additionally, the bill imposes notification requirements regarding the Medicaid estate
recovery program. Under the bill, ODM must notify each Medicaid applicant for a Medicaid
component subject to the Medicaid estate recovery program of the existence of the program,
including:
▪ A statement that if the recipient meets the criteria for Medicaid estate recovery, the
recipient’s estate may be subject to recovery after the recipient’s death;
▪ A list of health care and other services to which Medicaid estate recovery applies; and
▪ The per member per month capitation payment or managed care premium amount paid
by ODM to each Medicaid managed care organization in the previous year.5
Notice upon approval
ODM must again notify each applicant about the Medicaid estate recovery program when
the applicant is approved for Medicaid, with the following information:
▪ How to file a complaint with ODM regarding the enrollee’s Medicaid benefits;
▪ How to inquire about the status of Medicaid benefits; and
▪ How to disenroll from Medicaid.6
Additional notice
The bill also requires ODM to create two additional notices regarding the Medicaid estate
recovery program:
1. A consumer-focused notice that explains in plain language how the Medicaid estate
recovery program works, including examples. ODM must engage Medicaid consumers to
participate in the development and review of the notification and any additional
accompanying materials; and
2. A notice for Medicaid recipients who may be at risk of being subject to the Medicaid
estate recovery program, listing available resources for consumer support (such as legal
aid and estate planning resources).7
Rulemaking
To ensure compliance with the bill’s notification requirements, ODM must adopt rules, in
accordance with the Administrative Procedure Act (R.C. Chapter 119) to do all of the following:
5
R.C. 5162.213(A)(1) and (B)(1).
6
R.C. 5162.213(A)(2) and (B)(2).
7
R.C. 5162.213(A)(3).
P a g e |3 H.B. 681
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
▪ Require the first page of the Medicaid application to be a document that includes the
information enumerated in “Notice upon application” above;
▪ Require that an eligibility determination notice sent to an applicant after approval for
Medicaid include the information enumerated in “Notice upon approval” above;
and
▪ Specify the form and dissemination of the Medicaid estate recovery notices required by
the bill, including a process for identifying Medicaid recipients who may be at risk of being
subject to estate recovery.8
HISTORY
Action Date
Introduced 10-21-24
ANHB0681IN-135/sb
8
R.C. 5162.213(B).
P a g e |4 H.B. 681
As Introduced