{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:55:31Z","timestamp":1791262531781,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>This study examines the association between the implementation of Medicaid estate recovery and homeownership, home equity, and Medicaid enrollment among low\u2010income adults.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Estate recovery is associated with a decrease in Medicaid enrollment among unmarried, low\u2010income older adults and a decrease in home equity overall and among Black respondents, White respondents, and adults over 74\u00a0years of age.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>These findings suggest that low\u2010income adults may behave as intended, avoiding Medicaid and extracting housing wealth to cover care costs; still, it is worth reconsidering a policy that recoups less than 1% of the Medicaid budget to the detriment of low\u2010income families with few assets.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>In response to the high cost of state\u2010run Medicaid programs, the 1993 Medicaid estate recovery policy was established to enable states to recover assets from the estates of beneficiaries after death. Estate recovery may trigger behavioral responses from older adults who may no longer view real estate as an attractive asset, may borrow money from home equity to cover the cost of increasing care needs, or may avoid enrolling in Medicaid altogether.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using 1992\u20102008 data from the Health and Retirement Study, this study exploits the time variation in state adoption of estate recovery to determine the association of recovery policies with homeownership decisions, home equity, and Medicaid enrollment among low\u2010income older adults using a difference\u2010in\u2010difference fixed\u2010effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The implementation of estate recovery significantly decreased home equity in the overall sample and among Black and White subgroups as well as those over age 74\u00a0years. Additionally, estate recovery implementation was associated with a significant decrease in Medicaid enrollment among unmarried, low\u2010income individuals aged 65\u00a0years and older. No significant association was found between homeownership and estate recovery overall or among subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that those most at risk for Medicaid estate recovery, namely, low\u2010income older adults, may behave exactly the way policymakers intended, avoiding enrollment in Medicaid and extracting housing wealth to cover the cost of their care. Still, it is worth reconsidering a policy that recoups less than 1% of the long\u2010term services and supports budget from Medicaid estate recovery to the detriment of low\u2010income families who already had few assets. These findings reflect the limited choices that older adults and their families have in making long\u2010term care decisions, filling a gap in the extant literature, which has not adequately explored the impacts of estate recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70087","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T08:27:31Z","timestamp":1777278451000},"page":"731-753","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association of Medicaid Estate Recovery with Homeownership, Home Equity, and Medicaid Enrollment"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-261X","authenticated-orcid":false,"given":"AMANDA","family":"SPISHAK\u2010THOMAS","sequence":"first","affiliation":[{"name":"Center for State Health Policy Rutgers University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12114\u2010011\u20109100\u20108"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.26509\/frbc\u2010ec\u2010201903"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.red.2019.06.004"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2307\/2937789"},{"key":"e_1_2_6_6_1","doi-asserted-by":"crossref","unstructured":"BrickerJ BucksB KennickellAB MachT MooreKB.Surveying the Aftermath of the Storm: Changes in Family Finances from 2007 to 2009. 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