Medicaid Estate Recovery in Ohio: What Families Need to Know

When families are navigating long-term care for a loved one, Medicaid can feel like a lifeline. It covers nursing home costs, sometimes in-home care, and other essential services that might otherwise be financially overwhelming. But here's something many Ohio families don't realize until it's too late: Medicaid isn't exactly free money. It's essentially a loan. Ohio has what's called the Medicaid Estate Recovery program, and it can significantly impact what you leave behind for your family.

I've seen too many families caught off guard by this program, so let's break down what it means, who it affects, and most importantly, what you can do about it.

What Exactly Is Medicaid Estate Recovery?

Think of Medicaid Estate Recovery as Ohio's way of getting reimbursed for the care they helped pay for. When someone receives Medicaid benefits and later passes away, Ohio can come knocking on the estate's door, looking to recover some or all of those Medicaid expenses from whatever assets are left behind.

Who Gets Caught in the Recovery Net?

Not everyone who receives Medicaid will have their estate subject to recovery. The program targets two specific groups:

People 55 and older: If someone was 55 or older when they started receiving certain Medicaid services, their estate could be on the hook for repaying benefits received after they hit that age milestone. Probate attorneys are required to send a notice to the program when someone in this age bracket dies.

Anyone who was permanently institutionalized: This one is broader – regardless of age, if someone was permanently placed in a nursing home or other institutional care, their entire estate could be subject to recovery for all Medicaid benefits paid during that time.

The responsibility falls on the estate's executor to notify Ohio's Attorney General Office when someone who received Medicaid passes away. It's not optional – it's the law.

Ohio Plays by "Expanded Recovery" Rules

Here's where things get tricky, and frankly, where many families get blindsided. Ohio is what we call an "expanded recovery" state. While some states can only go after assets that pass through probate, Ohio casts a much wider net.

In Ohio, the recovery estate includes virtually any real or personal property the Medicaid recipient had a legal interest in at the moment before death. We're talking about:

• The family home and any other real estate
• Bank accounts and personal property
• Living trusts
• Vehicles
• Basically anything with their name on it

Here's something that surprises a lot of people: just because an asset was "exempt" for Medicaid eligibility purposes doesn't mean it stays exempt after death. That family home you thought was protected? It could very well be fair game for recovery.

The Recovery Process: How It Actually Works

When a Medicaid beneficiary dies, Ohio has up to one year to file a claim against the estate, or 90 days after receiving the mandated Medicaid notice, whichever is later. The state uses whatever assets are available to recoup Medicaid expenses before anything passes to the family.

The good news? If there are no assets left at the time of death, the state can't pursue recovery. And they absolutely cannot come after living family members for repayment. The debt dies with the person.

The Ohio Attorney General's Office handles this process, working with the Ohio Department of Medicaid. They'll review the estate, calculate what's owed, and determine how much they can recover. Sometimes a Medicaid experienced probate attorney can negotiate with the Attorney General's office on these claims.

Important Protections That Still Exist

Even with Ohio's broad recovery rules, there are some important protections built into the system:

Spousal Protection: If there's a surviving spouse, Ohio recognizes that they need resources to live independently. As of 2025, up to $157,920 in combined assets can be protected under spousal impoverishment rules.

Home Protections: The state can't touch the family home if certain family members are living there:

• A surviving spouse
• A child under 21
• A child of any age who has a disability
• A sibling who has an ownership interest and lived there for at least a year before the Medicaid recipient entered care

However, if none of these protections apply and the person was in residential care with no expectation of returning home, Ohio can place a lien on the property or force a sale  – sometimes even while the person is still alive.

What This Means for Your Family's Planning

I'll be straight with you – Ohio's expanded recovery rules make traditional estate planning more complicated. Those common strategies people use to avoid probate? Things like joint ownership, transfer-on-death accounts, and even living trusts? They don't automatically protect assets from Medicaid recovery in Ohio.

This is where proper Medicaid planning becomes crucial. There are legitimate strategies to protect assets while maintaining Medicaid eligibility, but they need to be implemented correctly and with full understanding of the rules.

Recent Efforts to Improve Transparency

Ohio lawmakers have recognized that many families are caught off guard by estate recovery. House Bill 130 was introduced to require the Ohio Department of Medicaid to inform applicants and recipients about the estate recovery program both when they apply and when they're approved for benefits.

While this legislation hadn't passed as of early 2025, it highlights an important issue: too many Ohio families aren't getting the information they need to make informed decisions about their care and their legacy.

Real-World Impact on Ohio Families

Let me paint you a picture of how this plays out in real life. Say your mom needs nursing home care and qualifies for Medicaid. She owns a home worth $200,000, which she has exempted with the help of a knowledgable Medicaid attorney. Over three years, Medicaid pays $150,000 for her care.

When she passes away, if none of the home protections apply and no other planning has taken place, Ohio can recover that $150,000 from her estate. The family might have to sell the house to pay the state back, leaving much less for inheritance than they expected.

Now imagine the same scenario, but with proper planning done before she needed care. The outcome could be dramatically different, with the home protected during her life, and after she passes away.

The Bottom Line for Ohio Families

Medicaid Estate Recovery isn't meant to punish families – it's the state's way of managing limited resources for long-term care. But understanding how it works is essential for making informed decisions about care options and protecting what you can for your loved ones.

The key is planning ahead. Once someone is already receiving Medicaid benefits, your options become much more limited. But with proper elder law planning, many families can structure their assets in ways that provide for long-term care needs while preserving at least some of their legacy.

If you're concerned about how Medicaid estate recovery might affect your family, don't wait until it's too late. The rules are complex, the stakes are high, and Ohio's expanded recovery program is more aggressive than many families realize. Getting proper legal guidance can make all the difference in protecting what matters most to your family.

Remember, this isn't about trying to "beat the system" – it's about understanding the rules and working within them to achieve the best possible outcome for everyone involved. Your family's future is worth that investment in proper planning.

Reach out to us at (614) 334-6850 to learn more.