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Adult Medicaid Manual MA-2285 – ESTATE RECOVERY

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II. POLICY PRINCIPLES

REVISED 05/01/11-CHANGE NO. 09-11

(II. A)

REVISED 05/01/11-CHANGE NO. 09-11

(II)

 

Group 1

Under age 55

This is not applicable to SA recipients under age 55

Group 2

Age 55 or older

Who Falls in this Group:

Recipients under age 55 who reside in a medical facility on a permanent or indefinite basis. Permanent or indefinitely means the individual cannot reasonably be expected to be discharged to return home to live.

Recipients age 55 or older:

1. Living in a medical facility where Medicaid paid a portion of his/her cost of care, or

2. Received services under CAP, or received Personal Care Services (PCS).

Permanent or Indefinite Basis

Documentary evidence is used to make the determination that an individual is residing in a medical facility on a permanent or indefinite basis.

Documentary evidence may include:

1. No plans for discharge are indicated on the FL-2/MR-2, plan of care, hospital discharge summary or physician’s statement, or

2. The individual has already been in a medical facility for 6 months and there is no discharge plan for the near future.

N/A

Payments Subject to Recovery:

DMA does not recover more than the amount paid on individual’s behalf by the Medicaid program.

Recovery includes:

1. Certain Medicaid claims paid for any period of time the recipient was budgeted for LTC after October 1, 1994, and

2. Services received under CAP beginning at age 55.

Recovery includes:

1. Certain Medicaid claims paid for any period of time the recipient was budgeted for LTC after October 1, 1994, and

2. Claims paid for nursing facility cost of care, related hospital expenses while residing in a nursing facility, CAP services, PCS services and prescription drugs.

Explanation of Estate Recovery

The IMC is responsible for explaining estate recovery to an applicant.

If an a/r chooses not to apply for Medicaid or withdraws his application after learning of possible estate recovery, treat this as an inquiry or withdrawal. Follow application processing rules.

Explain the following:

1. Who is subject to estate recovery, and

2. What Medicaid payments are subject to recovery, and

3. Medicaid does not recover prior to the death of the recipient, and

4. Medicaid never recovers more than what was paid by Medicaid on his behalf, and

5. Estate Recovery Waiver rules.

6. Appeal rights.

If the recipient or representative has other questions regarding

Estate Recovery, refer them to Third Party Recovery.

Same as Group 1.

Assets Subject to Estate Recovery

There are certain assets that may be subject to Estate Recovery at the time of the recipient’s death.

Assets subject to recovery may include:

1. Real property; such as the recipient’s home site, income-producing property, Tenancy-In-Common, and life estates. Please note: When a life estate is measured by the life of someone other than the recipient who owns the life estate, the life estate does not end at the time of the death of the recipient, but continues until the death of the person on whose life the life estate is measured. As a result, the life estate, in this situation is an asset that is subject to claims against the estate of the recipient.

2. Personal property; such as motor vehicles and home furnishings, and

3. Liquid assets; such as annuities and certain life insurances policies without a living beneficiary.

4. For individuals with a qualified Long Term Care Partnership policy, assets subject to estate recovery include all of the above and assets owned by the a/r immediately prior to his death, including:

    • All real and personal property available for the discharge of debt in which the recipient had any legal interest at the time of death.

    • Assets conveyed to a survivor, heir or assignee.

    • Life estates and living trusts

    • Ownership interests in joint tenancy with rights of survivorship

    • Tenancy-In-Common

    • Any other arrangement

Same as Group 1

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