317.04 Reimbursement - Medical Assistance Provided to Permanent Residents of Medical Institutions (AAM)

317.04 Reimbursement - Medical Assistance Provided to Permanent Residents of Medical Institutions (AAM)

SR 11-43 Dated 11/11 Previous Policy

__________________________________________________________________

Inform applicants for medical assistance as a permanent resident of a nursing facility, intermediate care facility for the mentally retarded (ICF-MR), or other medical institution, of the following:

. that DHHS has an obligation to recover from their estate when the estate is probated and from any assets that pass outside of probate after the death of the recipient;

. that recovery is limited to the actual amount paid on behalf of the recipient for medical assistance; and

. that for the purpose of recovery of medical assistance, a recipient ' s "estate" includes:

- all property, real or personal, in which the recipient holds an interest on the date of the recipient ' s death. Such interests include joint tenancy with rights of survivorship, tenancy in common, life estates, and living trusts, without regard to the date that such title or interest was established; and

- both assets that pass through probate and assets that pass outside the probate process, such as certain trust assets, assets held jointly, and unpaid annuity balances that benefit the recipient.

Recovery Prior to the Death of the Recipient

DHHS may file a lien at the county registry of deeds on real property owned by the recipient, including the home, prior to the death of the recipient only under the following conditions:

1. the individual ' s home is not currently lawfully occupied by the individual ' s:

- spouse (to be a spouse , a couple must not be divorced or legally separated);

- child who is under age 21;

- child who is blind or permanently and totally disabled as defined in Section 1619 of the Social Security Act, or

- sibling who has an equity interest in the home and who has continuously resided in the individual ' s home for a period beginning at least 1 year immediately before the date of the individual ' s admission to the medical institution.

2. DHHS has given the recipient advance notice of intent to file a lien and assurance that the recipient will have the opportunity to request an administrative appeal on the lien filing.

3. DHHS has determined that the individual cannot be reasonably expected to be discharged from the medical institution and return home.

Exceptions: Regardless of the criteria above, DHHS may pursue:

. recoupment of the erroneous payment if benefits were incorrectly paid. See PART 633 , RECOUPMENT OF MEDICAL ASSISTANCE ; and

. recovery of assistance provided, if the property on which a lien is filed is voluntarily sold or refinanced while a lien is in place.

Any lien must be released upon the individual ' s discharge from the medical institution.

Recovery After the Death of the Recipient

. DHHS will pursue recovery from the estate of a deceased institutionalized recipient ' s estate only if there is no surviving:

- spouse;

- child who is under age 21; or

- child who is blind or permanently and totally disabled as defined in Section 1619 of the Social Security Act, and

. in cases where DHHS placed a lien on the recipient ' s home prior to the recipient ' s death, only if there is no:

- son or daughter who has continuously resided in the individual ' s home for a period of at least two years immediately before the date of the individual ' s admission to the medical institution to the present, and the child establishes that he or she provided care to the individual, which permitted the individual to reside at home rather than in a medical facility, or

- sibling who has continuously resided in the individual ' s home for a period of at least 1 year immediately before the date of the individual ' s admission to the medical institution to the present, and the sibling has an equity interest in the home.

Exception: If benefits were incorrectly paid, reimbursement can be required regardless of the individual ' s survivors.

Inform the individual of DHHS ' s recovery obligations and the recipient ' s rights and responsibilities, with DFA Form 770, Reimbursement Agreement and Acknowledgment . Failure or refusal to complete the medical assistance portion of DFA Form 770 does not result in denial or termination of medical assistance.

*Scan the original signed DFA Form 770 into the individual ' s electronic case record*.