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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2285

ESTATE RECOVERY

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REVISED 05/22/23 – CHANGE NO. 08-23

I. INTRODUCTION

A. Background

The Omnibus Budget Reconciliation Act of 1993 mandated that states recover certain Medicaid payments from the estates of deceased Medicaid beneficiaries. 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. Beneficiaries Subject to Estate Recovery

The estates of Medicaid beneficiaries may be subject to estate recovery if the beneficiary 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 intellectual disabilities (ICF-IID), 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 a medical facility and receiving medical care services, or home and community-based services (HCBS) to include Community Alternative Program (CAP), Innovations and Traumatic Brain Injury (TBI), or Personal Care Services (PCS).

3. Effective May 1, 2007 PCS claims for Special Assistance (SA) beneficiaries ages 55 and over are subject to Medicaid estate recovery.

II. POLICY PRINCIPLES

A. Estate Recovery Explanation

Estate Recovery means a claim is filed against the estate of a deceased beneficiary to recover Medicaid dollars paid on behalf of the individual.

1. It is important to understand that estate recovery does not include placing a lien on the property.

2. Recovery is not initiated until the beneficiary’s death.

3. In some situations, recovery is waived. Please refer to V. below for information on estate recovery waiver.

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