Family and Children's Medicaid MA-3326 – ESTATE RECOVERY

REVISED 05/01/11 – CHANGE NO. 09-11

I. BACKGROUND

A. The Omnibus Budget reconciliation Act of 1993 mandated that states recover certain Medicaid payments from the estates of deceased Medicaid recipients. In July 1994, the North Carolina General Assembly passed G.S 108A-70.5 to implement an estate recovery program effective October 1, 1994.

B. The estates of Medicaid recipients may be subject to estate recovery if the recipient applied or re-applied on or after October 1, 1994, and

1. Is under age 55 and an inpatient in a nursing facility, intermediate care facility for the mental retarded, or other medical institution, and cannot reasonably be discharged to return home, or

2. Is 55 years of age or older and is living in medical facility and receiving medical care services, or home and community-based services, or Personal Care Services (PCS).

3. Effective May 1, 2007 PCS claims for SA recipients ages 55 and over are subject to Medicaid estate recovery.