Susan Hamlett, a paralegal for Maine Equal Justice Partners, talks about the Medicaid estate recovery process in Maine in her office in Augusta on Tuesday, Feb. 4, 2020. Credit: Caitlin Andrews

AUGUSTA, Maine — A proposed change to how Maine reimburses itself for MaineCare expenses is being marketed as a way to encourage older residents to sign up for expansion, even though it would reduce the amount of money the state collects from the practice.

Gov. Janet Mills and Rep. Anne Perry, D-Calais, have proposed the state reduce its use of estate recovery, a process by which Maine recovers some money spent on MaineCare from recipients who received care when they were 55 or older from their estates after they die.

The state now makes claims against estates for all services received. Both proposals would have the state seek reimbursement only for MaineCare assistance for nursing homes or home- and community-based services and related hospital and prescription drug services.

That is the minimum the federal government requires states to seek if they want to receive federal Medicaid dollars. The change would reduce the revenue the state receives from estate recovery by between 11 percent to 14 percent, according to state data.

The practice is believed to cause some older Medicaid-eligible residents to eschew signing up for coverage altogether, something the state has been trying to combat in its efforts to get more people signed up for MaineCare. Maine Department of Health and Human Services spokesperson Jackie Farwell said it may be preventing some from signing up for expansion.

“The [department] may be able to enroll more older adults under MaineCare expansion if these fears are quelled,” she said.

Residents between the ages of 55 and 64 were projected to make up almost 50 percent of MaineCare expansion’s population, but they have lagged behind for months as enrollment numbers continue to hover around 43,000. The state had 485 estate recovery cases in 2018 that generated $7.9 million, according to the Legislature’s nonpartisan fiscal office.

The Democratic governor’s supplemental budget includes $314,000 in general fund monies and $552,000 in federal dollars this year to amend MaineCare rules to mandatory federal requirements. While Perry’s bill makes an identical change, it was estimated at a slightly higher cost in January before the Mills proposal was released on Monday.

Both measures are supported by the Mills administration, although they still have to be approved by the Legislature before they could go into effect later this year.

Estate recovery has specific rules, so it can be hard for people to understand the concept, said Susan Hamlett, a paralegal at Maine Equal Justice. Maine must wait until the person who received benefits no longer has a spouse or children over the age of 21 or who are blind or disabled to make a claim, and things like “reasonable” funeral expenses and attorneys’ fees are not recoverable, as are estates below $20,000. Hardship and caregiver waivers are available. The state is allowed to recover homes, land, liquid assets or vehicles.

“It’s clear right away that when you start talking about estate recovery, you’re talking to people about their death,” Hamlett said, “and it’s totally about what’s going on in the most intimate places of people’s lives.”

Jacqueline Kennedy, 58, of Naples, testified to a legislative panel last month that MaineCare allowed her to survive breast cancer and treat ulcerative colitis. But she fears that care may come at the cost of a trailer home she paid off with “sweat and tears” when she dies.

“It is not much of a place, but it is our home,” she testified. “I shouldn’t have to choose between my health and keeping my home — our home — for my sons.”