TRAVERSE CITY — Whenever Thomas Stowe walks into court on behalf of his mother’s estate, he brings along about 10 pounds of documents, clipped into three-ring-binders stuffed inside a bulging black messenger bag.
“I’ve learned you never know which record you’re going to need next,” Stowe said, after a hearing in Grand Traverse County’s probate court.
Stowe, 63, is not an attorney and neither is his brother, Robert Stowe, 59.
The siblings last week appeared before Judge Jennifer Whitten on their own behalf, hoping to learn whether the state intended to pursue collection of what they describe as unfair debts lodged against their mother’s estate.
At issue was a $1,484 bill for “administrative services” from attorney Nathan Piwowarski, who represented the State of Michigan, as well as an $11,416.98 Medicaid debt and a petition from another attorney, Mattias Johnson, to open the estate for collection.
Joanne Stowe, 87, died in 2020 of complications related to Alzheimer’s disease, and her estate is listed as the owner of the Stowe family home in Long Lake Township.
The two brothers and the two attorneys agree that the house, which records show is valued at about $200,000, is the estate’s only asset.
After that, opinions diverge.
The complicated task of Medicaid recovery
Piwowarski, appearing in court via Zoom, previously stated in correspondence and court filings, that the state was within its rights to recover payment for Medicaid services Joanne Stowe received in the months before she died.
And Johnson, appointed by Whitten as personal representative for the Stowe estate on a nomination from a colleague of Piwowarski, had told the brothers the only way to pay the debt was to sell their mother’s house.
This is the place Thomas Stowe has lived, after moving there in 2014 to care for his aging parents.
“We couldn’t believe it,” Robert Stowe said. “And we didn’t understand it.”
The federal government requires state Medicaid offices to recoup payment from the estates of Medicaid beneficiaries and, in Michigan, that’s handled by the state Department of Health and Human Services.
The National Council on Aging says one way to think about the process is to consider Medicaid participation as an interest-free loan that pays for long-term care and community support, then when the beneficiary is permanently institutionalized or dies, the loan comes due.
Each state handles Medicaid collections differently, but paying back the federal program from decedent estates is a standard, if not well understood, procedure.
There’s even a special office within Michigan’s Department of Health and Human Services, called the Estate Recovery & Special Liability Unit, to seek out and collect the debt.
Home care and a pandemic rule change
In the Stowe case, however, records show that Thomas Stowe provided all of his mother’s care at home. She had no lengthy nursing home stays and the in-home services, while well-meaning, did not work for the Stowe family.
That’s because Joanne Stowe, as symptoms of her Alzheimer’s disease progressed, grew increasingly suspicious of people she didn’t know, Thomas Stowe said.
“The services that might have worked out she wouldn’t go to,” he said, “and the in-home services just weren’t right for our family.”
Unbeknownst to the brothers, the Stowe family was also caught up in two seemingly unrelated issues that further complicated the after-death billing.
The first was, during the COVID-19 pandemic, the federal government waived or modified certain billing and participation requirements for aid – called 1135 waivers – which the law allows during public health emergencies.
These waivers, the Centers for Medicare and Medicaid says, are designed to get help to people who need it quickly, while also keeping resources flowing to service providers.
Records show services to Joanne Stowe qualified for a 1135 waiver, which meant she was billed automatically whether she actually received the services or not.
“What we should’ve had, what anyone on Medicaid should have, is an itemized bill that shows what you’re getting and what it costs,” said Robert Stowe. “I don’t know why they don’t do that.”
Thomas Stowe, who’d been his parents’ live-in caregiver since 2014, said if he’d had that kind of information, he would have canceled services the family didn’t need.
Instead, the debt accrued until reaching the $11,416.98 total.
“My dad was falling a lot,” Thomas Stowe said as to why he sold his mobile home to move in with his parents. “And then my mom got the Alzheimer’s.”
Edward Stowe suffered a stroke in 2018 and died two years before Joanne.
Hardship exemptions and who can apply
The second issue was that Medicaid offers hardship exemptions to address exactly what the Stowe family was experiencing.
If a sale of the family home will create an undue hardship for the family, or if a caregiver had lived in the home for at least two years, or if a disabled person still lived in the home, the state could defer collection until after the home was sold or until after the person who had lived there died.
Thomas Stowe, who receives Social Security Disability after a back injury, fulfilled at least two of those hardship exemptions, but said he didn’t know they existed or how to apply.
Here again, opinions diverge.
“I think that there has been some confusion about who’s doing what and why,” Piwowarski told Judge Whitten during the most recent hearing.
Piwowarski said Thomas Stowe received information multiple times on how to apply and, without an approved exemption, the state had to proceed with collection.
But Thomas Stowe said he first heard about hardship exemptions from Amanda Goerge, an estate recovery and special liability unit manager, but that neither she nor Piwowarski provided information on how to apply.
Asking court staff about the legalities of an exemption wasn’t a viable option — such information could be construed as giving legal advice, which state law forbids.
Hiring an attorney also was out of the question, Thomas Stowe said, since neither he nor his brother could afford to pay legal bills.
Seeking, and getting, legislative help
In late 2023, the brothers reached out to state Rep. Betsy Coffia’s office for help, and said her staff helped untangle the morass, then helped Thomas Stowe apply for the hardship waiver.
“I’ve reviewed the state statute and it appeared to me the case never should have moved ahead, given disability was a known thing as far back as July 2022,” Coffia said.
Coffia, records show, assigned staff to conduct research, wrote a letter to the probate court and had a staff member attend hearings remotely to monitor the ongoing case.
MDHHS records show the waiver was granted Feb. 23 — more than three and a half years after Joanne Stowe died and more than a year and a half after Johnson opened a probate court case that, correspondence shows, was aimed at selling the Stowe family home.
Word of the approval was apparently slow in reaching Johnson, who said during a March 12 hearing he’d only received notice of the approval in the past day or two and needed to confer with Piwowarski before withdrawing his petition.
Judge Whitten adjourned the hearing, then called it back in session Monday morning.
That’s when Piwowarski withdrew the state’s claim for estate recovery, withdrew the claim for administrative expenses, Johnson’s petition also was withdrawn and the judge closed the estate.
The Stowes, initially at least, appeared skeptical that they’d prevailed.
“Are they going to file another claim for their administrative fees?” Thomas Stowe asked. “As far as Mr. Johnson, you won’t be a creditor in the future?”
“I will not,” Johnson said.
“Part of how we got here,” Piwowarski told the court, “is that Mr. Stowe did not have an attorney.”
Thomas Stowe replied that he receives about $1,500 a month in disability benefits and, after paying the mortgage on his mom’s house, has about $200 remaining — which he didn’t think would cover the cost of an attorney.
On the steps outside the courthouse, the brothers reflected on the past four years.
They both said they hoped, by telling their story, they might help someone else.
“Without Betsy Coffia’s office, and without the stories in the newspaper, the home would have been sold,” Thomas Stowe said.
“Even all this,” he said, patting the messenger bag filled with documents, “wouldn’t have saved it.”