Does "free care" have to be reimbursed after the patient dies?

I think you might be referring to Estate Recovery, which is something that all States Medicaid programs have to attempt to do to recover costs paid for those who participate in LTC Medicaid (so custodial care in a NH or sometimes a MC or AL) or in community based Medicaid programs if they went onto them if over age 55 (for some States) like in-home healthcare or PACE day programs. It isn’t taking assets away from family per se, it’s more that assets that in theory could have been inherited may not necessarily get inherited due to Estate Recovery.

it’s called MERP or MERS and it’s an after death event that in theory deals with assets subject to probate and something in theory that family or heirs would deal with via the Executor. Its in my experience is not at all straightforward or ever single answer as to how it gets done. As it’s imo quite interdependent on each States probate, property and real estate laws. And on how much risk the potential heirs & the Executor are willing to take over time. And if family choose to.

Imo as Recovery has become more known, has had somewhat unintended consequences, that family walk away on the homes. Why?…. well, by & large elders who go onto LTC Medicaid are allowed to continue to own their home as an exempt asset & do a “right of return” document. But LTC Medicaid requires then to do a copay of almost all their mo income (like SS income) to the NH. So grannie has zero $ to pay on her old house which is still in her name. Gran does not have to sell it. But it still owes property taxes, grass grows, utilities need to get paid, property maintained. And grannies house probably not a nice newish condo by the beach but older housing stock with decades of delayed maintenance. Within short order family is in disagreement over dealing with the house. Spending $ to fix it up makes no sense as Medicaid can place a lien or claim on it. If grannie is in a NH for a year, could easily be $120,000.00 in Medicaid room & board costs alone.

if it gets sold, Medicaid wants it sold FMV, which means someone in the family has to have the time and sense of humor to make this happen. & probably cost them to do so. Often family just abandon dealing with it. It goes delinquent for taxes so Tax collector puts it up for tax sale. I’m on another forum where this scenario comes up regularly.

Family is basically gobsmacked on the required copay, can’t afford upkeep on grannies place on what is basically a 2nd home plus may not make sense to do this as not in their name and may not ever be as they don’t have the income to use $$$ this way and don’t like to take risk that Estate Recovery might pose a lien or a claim years from now. House gets abandoned. Most don’t like taking risk, they forget about grannie house.

I do think that this is part of the reasoning why CA is changing thier asset structure for thier NH program. They are increasing the asset limit but - as I understand it - it includes real estate. You’re going to have to sell your home if it’s over 148K. Most homes way over that. Going to be way less headache for post death recovery for CA Medicaid.

I'm trying to understand what you mean by "free care".

When I Google "free care" and Medicaid, I only found a couple of vague references to some hospitals providing free care to people who had incomes 200% or more below the federal poverty line or who showed a marked inability to afford very large medical bills based on income level (considered "hospital charity")

Beyond that the only concrete reference I could find with regards to Medicaid and an actual "Free Care Rule" had to do with children and schools.

Could you explain to us what you mean by "Free Care"?

Do you mean charities helping? I think in many cases that is free. Meals on wheels are free, tho ask for a contribution if you can afford it. There are a lot of free lunch services in my city. They ask for your income in some instances and in at least one instance they ask you nothing and let you eat.

If you have questions, ask about the care when you request it, and if it is free. Best out to you.

Nothing is free in the United States if a person has the following:

-Permanent income

-Real estate property

-Any type of asset that can be liquidated for cash. Such as stocks, bonds, savings accounts, insurance policies. annuities, etc...

If an elder receives Community Medicaid it will pay for some homecare. It can also pay for a family member to be their caregiver.

If the elder owns any property that has cash value, when they die the state (Medicaid) will come after it to recap what they paid out for their care. They will permit a surviving spouse to remain but they will recap that money when they pass. No one inherits.
The only way to prevent this is to put property into Trust. Or to transfer it out of the elder's name before they need services. It becomes an exempt asset then if it's longer than the customary 5-year look back period that Medicaid requires in most states.

What sort of "free care" are you referring to?