Liens and Recoveries 510-03-10-30

(Revised 1/1/2022 ML #3652)

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No lien or encumbrance of any kind shall be required from or be imposed against the individual's property prior to his death, because of Medicaid paid or to be paid in his behalf (except pursuant to the judgment of a court incorrectly paid in behalf of such individual). (42 CFR 433.36)

A recovery of Medicaid correctly paid will be made from the estate of an individual who was 55 years of age or older when the recipient received such assistance or who had been permanently institutionalized regardless of age, with the exception of payments made for coverage through a private carrier. Recovery is pursued only after the death of the recipient's spouse , if any, and only at a time when the recipient has no surviving child who is under age 21, or who is age 21 or older and who is blind or permanently and totally disabled defined by the Social Security Administration. Note : Individuals eligible under Medicaid Expansion currently receive their coverage through an Alternative Benefit Plan (ABP), which is considered receiving coverage through a private carrier. Effective August 1, 2015, the department CANNOT file a claim against the estate to recover premiums paid by Medicaid, for insurance received through a private carrier, which meets this definition. All other Estate Recovery provisions remain unchanged.

The recovery of Medicaid paid for individuals under age 65 is only for assistance paid on or after October 1, 1993. Medicaid benefits incorrectly paid because of a recipient error can be recovered regardless of the individual’s age at the time the assistance was received. Overpayments due to recipient errors that are still outstanding are subject to recovery upon the individual’s death without regard to whether or not there is a surviving spouse ‘Permanently institutionalized individuals ’ are persons who, before reaching age 55, began residing in a nursing facility, the state hospital, an intermediate care facility for mental disease (IMD), a Psychiatric Residential Treatment Facility (PRTF), an intermediate care facility for the intellectually disabled (ICF-IID), or receiving swing bed care in hospitals, resided there continuously for at least six months and did not subsequently reside in any other living arrangement for at least 30 consecutive days, and have received written notice that they are consider to be permanently institutionalized. Permanently institutionalized individuals have a right to appeal their permanently institutionalized status.