1725.4 Determining Recovery Action

The determination of recovery action, if any, is a three step process: Notification of death, resource assessment, and determining the value of the claim based on the amount of medical assistance paid by the agency since 7-1-92.

Notification of Death - The Estate Recovery Unit (ERU) shall be responsible for coordinating and obtaining all information concerning the death of any medical recipient. Such information may be obtained from newspaper obituaries, eligibility staff, legal notice from representatives of a recipient's estate, other governmental agencies, or other reliable sources. Upon receipt of notification of death of an individual, the ERU will attempt to match the deceased with case information in KEES. The eligibility worker will confirm any match and other family and/or resource information prior to any ERU recovery activity. If there is a surviving spouse, recovery action will be pended until the death of the surviving spouse.

Resource Assessment - In cases where the deceased has no surviving spouse or dependent children, the ERU will begin a preliminary assessment of the individual's resources. Assessment will consist of determining the type of property, value, and title or ownership. All assets can be considered for recovery including real property, financial accounts, and other personal property (e.g., other liquid assets, cars, furniture, and jewelry).

Determining Value of Claim - ERU will research and determine the cost of medical assistance paid after June 30, 1992 on behalf of a recipient who is 55 years of age or older or who was receiving institutional PACE or HCBS services. Assistance provided to a recipient before the recipient's 55th birthday will not be considered in valuing the claim unless that person was in long term care. The value of assistance received after June 30, 2004 will also be determined and used is handling claims against the expanded estate as per 1725.1 (1) . The estate recovery claim will be reduced by the amount of payments made by a long term care insurance policy on behalf of the recipient.