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B. Definitions:

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:

Beneficiaries 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.

Beneficiaries aged 55 or older:

1. Living in a medical facility where Medicaid paid a portion of their 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, 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: DHB 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 beneficiary 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 beneficiary 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

Explain the following:

Same as Group 1. DocuSign Envelope ID: FDC5A36F-C20D-40ED-8E94-3167F2A747A6 DocuSign Envelope ID: 9CB30F35-4CFE-41A3-8663-00DA59A946C6