Any insight on the recovery of Medicaid Capatation payments to managed care plans?
Hi Everyone!!
My father passed in Dec 2022 at the age of 66. He had Medicaid for 4 years 2014-2018. (in 2018 he dropped it, and didn't have insurance again until he qualified for Medicare).
He never used his Medicaid. Never went to the doctor or long-term care. There were never any claims filed on his behalf. (this has been confirmed through Medicaid, and the fact I'm the only child, and my dad NEVER went to the doctor my entire life).
The Ohio Attorney General has bounced back saying he owes $40,800.00 to Medicaid.
They are not able to provide me a detailed statement but they are "assuming" that it is for capitation payments that Medicaid paid to his Managed Care Plan. I will copy and paste the email from the AG as to why he cannot give me a detailed statement.
I have no problem selling his home to repay this amount, BUT first I wanted to ask if anyone has any insight as to what a typical capitation amount would be.
It breaks down to $800/mo and that seems like A LOT, especially back in 2014-2018. And for never being in long-term care. But I could be wrong.
Would anyone that has actually gotten a detailed statement be able to relay what a typical capitation payment amount would look like in terms of amount per year or month?
Thank You so much for any help or insight.
Here is the email I received from the Ohio Attorney General regarding the reason they cannot provide a detailed statement:
From: Robert Byrne
Wed, Jul 5, 10:07 AM (9 days ago)
Normallywe can provide a printout to show what was paid. Due to a switch to a new computer system at ODM, I am not able yet. But all it would show would be the monthly premiums paid by ODM to the health plan. It would not show any payments that were made by the health plan. Federal regulations require ODM to recover the premiums paid by ODM to the health plan, not what was paid by the health plan to medical providers.
Robert Byrne
Assistant Attorney General – Collections Enforcement
Office of Ohio Attorney General Dave Yost
3 Answers
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MAUREEN M. CORCORAN, DIRECTOR
50 West Town Street, Suite 400, Columbus, Ohio 43215
Also, call your local state senator/representative. They have folks in their offices who follow up on this stuff.
Also, post this question at www.bogleheads.org
If it was me, my very first response would be "And that is exactly what I am asking for. I'm not asking what the health plan paid out, but what ODM paid out and is trying to recover. What is the ETA on receiving this information from the AG as I'm not able to pay a bill without an itemized printout?"
In writing, on paper, snail mail...after I researched the hard deadlines and response requirements associated with Ohio MERP.
https://www.agingcare.com/questions/medicaid-estate-recovery-anyone-have-experience-with-requests-to-pay-back-premiums-482413.htm
Besides this post, seems there a duplicates. In your first post I explained to you that it does not matter that Dad never used Medicaid the premiums were paid in case he did use it. Medicaid contracts out to insurance companies. The money is owed. The house is now an asset and can be sold to cover the lien.
You are asking questions you should be asking Medicaid or an elder lawyer. We are just lay people and not lawyers. If your still have a problem with this get an elder lawyer to explain it to you.