Medicaid Policy
Medicaid Policy
Effective Date: July 1, 2019
Background
Estate Recovery is an operation of law. The Omnibus Reconciliation Act of 1993 required all states to implement an estate recovery program. Utah has had the program in effect since 1985. Additional changes to the law were made by the Deficit Reduction Act of 2005 and the American Recovery and Reinvestment Act of 2009.
Congress did not intend for the taxpayers to bear the entire cost of the recipient's medical expenses, nor did Congress intend to allow recipients to maintain significant assets or shelter assets for the benefit of heirs. Estate recovery recoups some of the expenses paid by the state and federal government for people who receive Medicaid after age 55 if they do not have a surviving spouse, surviving minor children, or surviving blind or disabled children.
Estate recovery occurs after the Medicaid recipient's death.
Policy Requirements
The Office of Recovery Services, on behalf of the State of Utah, has the right, and federal obligation, to recover from the recipient's estate, after the recipients death, all Medicaid funds expended on behalf of a recipient who is 55 years of age or older and has received Medicaid, if all of the following conditions are met:
There is no surviving spouse.
There are no surviving children under age 21.
There are no surviving blind or disabled children.
Medical costs paid after the recipient is age 55 or older that will be recovered include the following but are not limited to:
Monthly payments made on the recipient's behalf to a Medicaid Health Plan (Capitation Payments), or mental health services provider
Premiums paid for any health insurance plan
Pharmacy charges
Doctor and hospital charges
Ambulance charges
Medical equipment
Nursing Home services
Home and Community Based Waiver services
Other Medicaid State Plan services
NOTE: Medicaid will recover money used for capitation payments and any other payments directly paid by Medicaid. Monthly capitation payments are recovered from your estate whether or not Medicaid services were used.
Medicare premiums, deductibles and co-payments paid under the Medicare Cost-Sharing programs are excluded from recovery.
ORS may file probate and/or place liens on the assets of the estate to assure the States claim on the estate.
Estate recovery may be initiated after the death of a surviving spouse, or blind or disabled child; or when a surviving child turns 21.
In some cases, the state will place a lien on a Medicaid recipient's property before the individual dies. These liens are called TEFRA liens, after the name of the law passed to allow them.
TEFRA Liens may be placed on real property of an unmarried recipient living in a nursing home and not expected to return home.
The state determines a recipient is not expected to return home once the recipient has been a resident of a nursing facility for 180 consecutive days.
NOTE: Any questions regarding estate recovery should be discussed with the Office of Recovery Services. For more information go to https://medicaid.utah.gov/Estate-Recovery