Understanding Medicaid Estate Recovery: The Experience of North Carolina and Policy Implications for Future Reforms
分析了北卡罗来纳州2017-2021年医疗补助遗产追偿的数据，发现追回金额仅占项目总成本的0.6%，且对低收入家庭影响不成比例，为政策改革提供依据。
OBJECTIVE: To estimate the prevalence of Medicaid estate recovery in North Carolina. STUDY SETTING AND DESIGN: We descriptively analyzed the number of estates, amount recovered, and hardship waiver applications using North Carolina public records data. DATA SOURCES AND ANALYTIC SAMPLE: The data contained information on the number of estates and amount recovered through Medicaid estate recovery between 2017 and 2021 (n = 2975). Additionally, we analyzed hardship waiver application data for residents who applied and had their application processed between 2018 and 2021 (n = 301). PRINCIPAL FINDINGS: We found approximately $83 billion was recovered from beneficiaries between 2017 and 2021, or 0.6% of the total cost of North Carolina's annual Medicaid program and just 0.9% of the fee-for-service annual long-term services and supports Medicaid budget. We found that Black homeowners were more likely to have lower value estates recovered, and overall, more money was recovered from white estates. CONCLUSION: While states hope Medicaid estate recovery may balance Medicaid spending through increased revenue, our findings demonstrate that these efforts may be insufficient. Policymakers should opt for strategies outside of the Medicaid program that can more precisely target high-net-worth individuals instead of policies like estate recovery that disproportionately impact low-income families.