0880.000.00 Cost Recovery – DSS Manuals

IM-177 December 16, 2019

MO HealthNet is to be the payer of last resort ( RSMo 208.215 ) and can take action to recover funds that were paid on behalf of a participant, if funds become available from another source.

This allows MO HealthNet Division (MHD) to pursue recovery from participants’ estates through various processes including Estate Recovery, TEFRA Liens, and Voluntary Repayment:

Estate Recovery occurs when MHD claims a debt owed for medical expenses paid for a participant on the estate of a deceased participant, while the estate is in probate court (see 0880.005.00 Estate Recovery )

TEFRA Liens are placed on real property owned by a participant who is receiving MO HealthNet benefits while they are permanently institutionalized in a long-term care facility. The lien requires MHD to be repaid for expenses when the property is sold while the participant is still alive, or as part of the estate after the participant is deceased (see 0880.010.00 TEFRA Liens )

Voluntary Repayment is a process where participants make voluntary payments to MHD to retain eligibility (see 0880.015.00 Voluntary Repayment )

Other cost recovery actions may be taken if there is legal action taken regarding an injury or illness when MO HealthNet paid medical expenses. This may include, but is not limited to a settlement or court decision for:

an auto injury

a medical malpractice or negligence claim

a wrongful death claim

NOTE: Do not give case specific advice regarding any cost recovery efforts. Encourage participants and/or representatives to contact MO HealthNet Division.

MO HealthNet Division’s Cost Recovery Unit is responsible for all cost recovery efforts. They may be contacted directly:

Phone: 573-751-2005

Email: MHD.CostRecovery@dss.mo.gov

Mail: Cost Recovery Unit, PO Box 6500, Jefferson City, MO 65102-6500