The estate recovery claim is a Class 3 claim to the extent it is comprised of medical services rendered within the last six months prior to death, and the balance represents a Class 5.1 claim. Depending on the nature of the asset or resource, it may be subject to recovery. The Pennsylvania Estate Recovery Program allows the state to recover Medical Assistance payments from the probate estate of an individual who was 55 years of age or older when he or she started receiving nursing facility services or home and community-based services. Medicaid Estate Recovery forces the sale of things, like your home, that you own when you die. If the statutory priorities are not followed and the Commonwealth’s claim remains unsatisfied, the personal representative is personally liable to the extent estate assets were not properly applied to pay the estate recovery claim. estate of a deceased individual who received MaineCare benefits at the age of 55 or older. That being said, proper titling of assets and strategies relating to beneficiary designations can make tens of thousands of dollars of difference to the Medicaid recipient’s family after his or her death. Funeral expenses and nursing home services paid within 6 months of death are both Class 3 claims. This includes excess funeral reserves which would otherwise be subject to formal estate administration but for the operation of 20 P.S. In Pennsylvania, the Department of Public Welfare (DPW) is the government arm that is empowered to seek repayment of medical assistance payments from a decedent’s probate estate. The certified mail receipt or facsimile transmission confirmation verifies the receipt date for starting the response period. Not all Medicaid payments are subject to estate recovery. Estate Recovery Program. States have developed and disseminated information, through brochures, Web sites, toll-free telephone numbers, and trained staff, to help the public understand Medicaid estate recovery. Contact us quickly with this online form: Medicaid Eligibility & Spousal Protections, Financial and Healthcare Power of Attorney, Pennsylvania Department of Human Services, Home and community-based services such as those provided through the Aging Waiver Program, and. Under present Pennsylvania law, property liable to repay the Department’s claim includes only probate estate property. A last requirement of the notice is written documentation of the gross value of the decedent’s estate. This includes all real and personal property of a decedent which is subject to administration by a decedent’s personal representative, whether actually administered or not administered. Estate Recovery Program Provided that there is an heir to claim his or her beneficial interest in the estate, the Department will find undue hardship and will permanently waive its claim for administered estates with a gross value of $2,400 or less. Medicaid Estate Recovery Program Med i ca id i s a g o v e rn m e n t pr og ra m t h a t pa y s f o r h e a l t h ca r e for people with limited incomes. Only Medical Assistance received by individuals after age 55 are recoverable, and only where the Medical assistance payments were for specific types of services. It is sometimes difficult to focus on all of the related issues during the Medicaid application process. The estate recovery regulations provide for this situation by allowing the Department to provide lists of such estates to county bar associations for local attorneys to administer. The date any surviving child is 21 years of age. Much of the original enthusiasm for mandatory estate recovery was based on the results in Oregon, where estate recovery was implemented in the 1940s as part of a comprehensive program to help senior citizens keep enough money to meet their own needs and protect their assets from unscrupulous uses by others. Estate Recovery Brochure Estate recovery applies to the following beneficiaries: A person who was 55 years of age or older when he or she received medical assistance consisting of nursing facility services, home and community-based service care to include prescriptions and hospital stays associated with either of these services paid by Medicaid; or In 1993, federal law mandated that all states enact Estate Recovery programs. §3392. Probate assets are those in the decedent’s name alone and which do not pass to a joint owner or a designated beneficiary. Federal law requires each state to operate an estate recovery program that seeks repayment from the estates of deceased recipients of Medicaid long-term care benefits. 7. Request for Medi-Cal Expenses Subject to Estate Recovery. Can the state file a lien against property during the lifetime of a person The trust would allow the surviving spouse or child to access the income without court approval but would require court approval for distributions of principal. Other states are permitted by their laws to seek recovery from jointly owned property and assets passing through beneficiary designation at death. What if the decedent leaves a will? EAU will recover the monthly fee charged to the state for Medicare Part D. See box on the other side about Part D. §1412. Pennsylvania Department of Human Services Pennsylvania’s estate recovery program has collected over $500,000,000 to date! Applicable law reads that “With the approval of the Governor, the Department may expand the estate recovery by regulation to include medical assistance for services other than those listed in this section and to recover against other real and personal property in which an individual had any legal title or interest at the time of death.” In other words, the law can change such that estate recovery may in the future apply to non-probate property such as jointly owned property. In addition to pursuing traditional remedies in court for enforcement of liability against the personal representative, the Department may administratively assess liability pursuant to 62 P.S. Content Detail. All “probate estate property” is subject to estate recovery. Please give us a call, visit, or email us so we can help you with your estate planning. MEDICAL ASSISTANCE ESTATE RECOVERY PROGRAM A. Estate recovery is sought from the probate estates of individuals who received Medicaid support after the age of 55 years. Estate recovery does not apply to medical assistance payments made before the recipient attained age 55. The PA estate recovery program was officially set out in Act 49 of 1994, Section 1412, 62 Pa. C.S. The Commonwealth’s estate recovery program generates a “claim” against the decedent’s estate. … The estate recovery act specifically relieves the bona fide purchaser of estate property from personal liability, even where the Department’s claim is not properly satisfied by the personal representative. A decedent's estate must first pay the decedent's debts. Deposit accounts and patient care accounts paid directly to specified family members outside of probate pursuant to 20 P.S. WARNING: IT IS STRONGLY RECOMMENDED THAT YOU MEET WITH AN ELDER LAW ATTORNEY BEFORE REQUESTING A STATEMENT OF CLAIM FROM THE ESTATE RECOVERY PROGRAM. 2. The estate recovery claim is subordinate to the family exemption as well, if applicable. If the gross value of the estate exceeds $2,400, estate recovery applies to the entire estate absent another applicable hardship exception. Caseworkers also do their best to explain the program to the family representatives during the application process. They are required to report and pay tax on the income (from PA’s eight taxable classes of income) that they receive during their taxable year. The death of any child who is blind or totally and permanently disabled as determined under the standards of the Supplemental Security Income (SSI) program in the Social Security Act. A major exception to the payback is waiver of recovery against the decedent’s residence where certain caregivers helped keep the decedent out of a nursing home for two years or more or provided care and support to the decedent for at least two years while home and community based services were being accessed. If the nursing home applicant intends to return home, the family member can still be considered as “residing” with the late family member and the exemption may still be claimed. The family exemption takes priority over the Department’s claim, but only if the family member who is otherwise entitled to the exemption was residing in the household of the decedent. In making the request, consider the economic status of the beneficiary of the estate. Changes to estate recovery of medical assistance This brochure includes changes made on Oct. 1, 2013, to the estate recovery program for medical assistance (sometimes called Medicaid). What happens if no one comes forward to administer an Estate? Absent actual knowledge of the existence of the claim, the only legal duty of a personal representative to request a claim hinges on the determination of whether medical assistance was paid within the 5 years prior to death where the recipient was over age 55 at the time benefits were received. Medical assistance paid on behalf of a recipient before he or she reached age 55 is not subject to repayment. The Department considers its position in these situations on a case-by-case basis, but a nursing home stay of over one year in duration would tend to indicate that the family exemption is not going to be allowed, while a stay of under one year would most likely not draw an objection from the Department of Human Services with regard to claiming the family exemption. §1412. Although Medicaid recipients do not have to be given notice of the estate recovery program, the Department of Public Welfare has an informational brochure about the estate recovery program which is provided to Medicaid recipients  and their families when benefits are initiated. Many times family members are interested in attempting to keep a home or automobile in the family and wish to purchase it from the estate. §3155(b)(4). The State of Washington's Estate Recovery Program was enacted July 26, 1987. Any money collected by the Estate Recovery Program is returned to the Pennsylvania … 4. Determinations of hardship requests are made on a case-by-case basis, the estate recovery regulations set forth some of the circumstances where hardship waivers will be granted. The Department will permanently waive the claim with respect to the residence in this instance. If there is an estate claim, the Department must submit its claim to the executor or administrator within forty-five (45) days of receipt of the notice or the claim is forfeited. *It is recommended that you have Robert C. Gerhard, III, Esq. The decedent owned a primary residence that was not sold because the owner/Medicaid recipient stated a possible intention to return. An individual who is 55 years of age or older … The Medicaid Estate Recovery Program can be a major concern during the administration of an estate and could be an important consideration in estate-planning decisions, too. An honest, professional appraisal can help protect both the transferee and personal representative from liability in this circumstance. The decedent was the named beneficiary of a deceased family member or friend and certain assets were paid to him or her after he or she had been receiving Medical Assistance. DADS-121. 1. If undue hardship is found to exist, the Department will waive estate recovery. Estate Recovery Program DADS Media Services 60P034 - April 2006 Publication No. Therefor the real estate was still there at the recipient’s death and in the decedent’s name. A facility of payment clause is a contract provision which enables an insurance company to pay policy proceeds directly to certain family members, not to the estate, even where there is no designated beneficiary. Medicaid Estate Recovery Fact Sheet (Nov. 2020) (378kb pdf) Contact Information If you have questions regarding estate recovery, call the Estate Recovery Unit at 701-328-2311, toll-free 800-472-2622 or 711 (TTY).