Elder advocacy groups are calling for the elimination of Medicaid estate recovery after a congressional advisory commission concluded the practice recoups a tiny percentage of Medicaid spending while contributing to generational poverty and inequity.

Medicaid long-term care benefits traditionally pay mainly for nursing home care, but the federal government can grant “waivers” to states allowing them to expand Medicaid to include home and community-based services. The downside is that receiving care in a nursing home is an entitlement, while getting care at home is not.  

The government has expanded access to protections for spouses of reverse mortgage holders who are not named in the loan document, allowing more such spouses the ability to stay in their home if the borrowing spouse dies or moves to a care facility.