What is Medicaid Estate Recovery?
The Medicaid program must seek repayment from the estates of certain deceased Medicaid recipients. This is called the Medicaid Estate Recovery (MER) program. Repayment only applies to recipients who are 55 or older or who are inpatients of a medical facility1. Medicaid payments subject to recovery include: home and community based services, nursing facility services, hospital, physician and prescription drug services, Medicare Part A and Part B premiums prior to January 1, 2010, Managed Care Organization (MCO) premiums after March 31, 2017 and any other payments made by the Medicaid program. The State may also place a lien against the property of a deceased Medicaid recipient.
1 Permanently institutionalized refers to an inpatient in a nursing facility, intermediate care facility for the individuals with intellectual disabilities or other medical institution and the Welfare Division determines, after notice and opportunity for a hearing, that he or she cannot reasonably be expected to be discharged and return home.
Are there exemptions to recovery?
Medicaid cannot recover correctly paid Medicaid benefits if the deceased recipient has a surviving spouse, surviving child under age 21, or surviving child of any age who is blind and /or disabled, or certain income, property and resources of Native Americans or Alaska Natives. Medicaid can only recover correctly paid benefits when these exemptions no longer exist.
What assets will the State look at?
Examples of types of assets that are recovered to satisfy the Medicaid claim are: checking and savings accounts, certificates of deposit (CDs), cash contained in safe deposit boxes, savings bonds, stocks, Patient Trust Fund and Patient Liability balances, Qualified Income Trusts, Special Needs Trusts, annuities, and any personal property of value, including mobile and manufactured homes not converted to real property.
As a beneficiary, what if I paid for funeral costs?
Any assets remaining in a recipient's estate at the date of death are recoverable by MER (NRS 422). If you have itemized receipts for funeral expenses, MER will determine which of those expenses are allowable and you will credited for those allowed. Examples of expenses not allowable are: flowers, obituaries, memory books, music, memorial services/celebrations, family food and lodging, and round trip travel costs to accompany the deceased recipient (only expenses for one person one way are allowable). Funeral expenses may not be paid form funds in a Qualified Income Trust or Special Needs Trust.
What happens to the Patient Trust Fund and Patient Liability monies?
Patient Trust Fund (PTF) and Patient Liability (PL) funds remaining at the date of death are recoverable by Medicaid Estate Recovery. If there is a surviving family member, they are sent to them. After deduction of approved funeral expenses (determined by Medicaid Estate Recovery), the balance of the funds are due to MER. If there is no surviving family member or they choose to release the funds to MER, then the entire amount of the PTF and PL is sent directly to MER.
What about Social Security payments?
Social Security benefits are considered income and, as such, are recoverable. The only exception is Social Security checks received for the month of death. Those funds are to be returned to Social Security.
What happens if MER places a lien on my home after I pass away?
If a deceased recipient held interest in property at the time of death, Medicaid Estate Recovery may place a lien against the property for the amount of its claim. This is to protect the State's interest in the estate. Nothing happens with the lien until the property is sold; at that time recovery is made from the proceeds of the sale up to the amount of Medicaid's claim or the remainder of the proceeds after priority of payment is followed (NRS 147.195),whichever is less. A surviving spouse may be asked to sign a Voluntary Lien agreement to protect the State's interest. If they refuse, a judicial lien will be placed through the courts. The types of people listed as exceptions to recovery may pay off the lien by signing a Voluntary Repayment agreement, although, in those situations, paying off the lien is not required. If a family member wishes to live in the property, no recovery will be done until the decedent's name is removed from the title.
What happens if recovery would cause hardship for my survivors?
Nevada defines hardship as undue and substantial hardship resulting in severe financial distress or a significant compromise to an individual's health care or shelter needs. Any beneficiary,heir or family member that feels they are entitled to receive the assets of the deceased Medicaid recipient may apply for a hardship waiver at the time of recovery. A completed "Request for Hardship Waiver of Correctly Paid Medicaid Benefits" (received from Medicaid Estate Recovery when a waiver request has been made, along with the Undue Hardship Waiver criteria) must be submitted within 30 days from the date the hardship papers are mailed. Additional information may be requested by the Division and must be submitted within 30 days of the request. Receipt of a timely hardship waiver request does not prevent or delay the pursuit of the recovery claim pending the waiver final decision. The Divisions will return any funds collected if the waiver is granted.
Within 90 days of receipt of the hardship waiver request, the Division Administrator, OR the appointed representative, will issue a written decision granting or denying the request. Recovery may be waived, delayed, the amount compromised, or modified regarding the collection methods. If the hardship is denied, you may appeal the decision through the appropriate court system.
What if I am enrolled in a Managed Care Organization?
If a recipient is enrolled in a Managed Care Organization (MCO), the monthly amount paid to the MCO by Medicaid after March 31, 2017 is subject to recovery, regardless of how much the actual services cost the MCO. This monthly amount is known as a capitation fee.
What if a Probate is opened for my estate?
All Probate documents filed with the court must be sent to Medicaid Estate Recovery.
Medicaid Estate Recovery prepares Creditor's Claims for all Probates subject to recovery. If there is a surviving spouse, child under 21 years old, or a blind/disabled child of any age, and there is property in the estate, then MER may do a lien in place of recovery. However, if there is no property and these exceptions exist, then no Creditor's Claim will be filed. If you have questions regarding Probates, you may contact the MER office.
When a Waiver of Notice is required by the court, the following must be faxed or emailed to MER, along with the request: A copy of the Notice of Hearing, a copy of the first page of the original petition (if it is a Set Aside,we will need the entire petition), a copy of the death certificate, and a cover sheet stating the name of the decedent, date of birth, last four numbers of the SSN, date of the hearing and a sentence saying that a Waiver is being requested. If you have questions about Waivers, you may contact the MER office to speak with a staff member who prepares the waivers.
Can I pay off my Medicaid claims (amount that Medicaid paid) prior to my death?
Claims are only determined after the date of death of the recipient. Medicaid Estate Recovery does not run claims reports for recipients that are still living nor can accept any payment for a recipient that is still
living. The amount of the claims changes continually, up to the date of death, and, in many cases, even
after death, as providers have up to one year after the date of death to submit claims.
How do I get in touch with the Medicaid Estate Recovery program?
At the time of application for Medicaid, you will be given the form "Medicaid Estate Recovery Notification of Program Operation". This form is also available in the link provided on this site. If you have questions regarding the MER program, you may contact the program office:
Medicaid Estate Recovery
1100 E. William Street, Suite 109
Carson City, NV 89701
(775) 687-8414 or (775) 684-3717
If you have questions regarding your Medicaid enrollment, eligibility, or benefit programs, you will need to contact the Department of Welfare and Supportive Services (DWSS) district office where you first applied, or your caseworker. The names, addresses and phone numbers of the district offices are available through the link on this site.