Medicaid gets harder to tap across state lines

States are in charge of qualifying people needing long-term care for Medicaid, working within federal rules, and that leaves room for different interpretations, says David Zumpano, an estate-planning lawyer and CPA in New Hartford, N.Y. "States are adopting the Nancy Reagan strategy—they just say 'no,'" he says. In some cases, states—many of which are anticipating budget shortfalls—are trying to retrieve money from the estates of people who used Medicaid to pay for long-term care, Mr. Zumpano says. Iowa, Minnesota, Missouri, Nevada, New York, North Dakota, South Dakota, Tennessee and Virginia are all tinkering with ways to recover Medicaid expenses.