This includes executors and administrators of any type or description. Estate Recovery - Department of Human Services (c)The Bureau of Hearings and Appeals has exclusive jurisdiction over disputes involving a request for waiver, compromise or postponement of collection. (i)Waiver requests shall be submitted to the following address: Estate Recovery Program, Post Office Box 8486, Harrisburg, Pennsylvania 17105-8486. and . The term includes: (i)Real estate and all improvements thereto. Post Office Box 8486. An honest, professional appraisal can help protect both the transferee and personal representative from liability in this circumstance. The costs of the decedents funeral and burial, and the costs of medicines furnished to him within six months of his death, of medical or nursing services performed for him within that time, of hospital services including maintenance provided him within that time, and of services performed for him by any of his employees within that time. These are the reasons a state Medicaid office will choose not to use MERP to recover costs of Long Term Care: July 27th, 2023. (d)No interest is charged on the Departments claim during the postponement period. Decree of distributionAn instrument by which heirs receive the property of a decedent. 495.21 Request For Statement Of Claim. In some states, the MERP will attempt to collect reimbursement for Medicaid expenses not related to long term care. The state can then use this money to pay for long-term care for other people. The DHS then has 45 days to provide that list, or the department cannot collect any money. Appeals involving the exercise of the Departments discretion shall be reviewed by the Bureau of Hearings and Appeals under an abuse of discretion standard, otherwise the Bureau of Hearings and Appeals shall review the matter de novo. advance of needing care. What is the statute of limitations on Medicaid estate recovery in It depends on how the deed is written. (B)For any Federally-recognized Tribe not described in clause (A), property located within the most recent boundaries of a prior Federal reservation. The family Knox Law Firm | Demystifying Medicaid Planning Box 8486; Harrisburg, PA 17105-8486. (iii)Subsequent to a transfer from a nursing facility to a hospital. Click to view our Title VI Notice to the Public. 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 Class5.1 claim. After a Medicaid Long Term Care beneficiary dies, the Medicaid Estate Recovery Program (MERP) in their state is required by law to seek reimbursement for the long term care that beneficiary received through Medicaid. the 2023 income limit for Nursing Home Medicaid through Pennsylvania Medicaid is $2,742 / month . The Community Spouse dying before the Medicaid beneficiary is a less common situation, but it can happen, and couples should plan for that possibility. We have represented clients dealing with Pennsylvania's Estate Recovery Program since it began in 1995. For information about the harms of Medicaid Estate recovery read Justice in Aging's Issue Brief: How Medicaid Estate Recovery Perpetuates Poverty. Estate recovery is postponed by the Department ofHuman Servicesin certain circumstances. Real and personal propertyAny property in which a decedent had an ownership interest. go to the family. But, there is a big loophole. Any property, like your house, has to be sold for fair market value. A lien will be filed by the state after the recipient moves out, as long as they are not expected to ever move back in. The certified mail receipt or facsimile transmission confirmation verifies the receipt date for starting the response period. The last big exception to the Estate Recovery Program is the income exception. Please contact our office at (610) 933-8069. The Department has many cases where no family member comes forward to probate a will or is willing to serve as administrator for a decedents estate. Notice may also be sent to the Department via facsimile transmission at (717) 772-6553. If the statutory priorities are not followed and the Commonwealths claim remains unsatisfied, the personal representative is personally liable to the extent estate assets were not properly applied to pay the estate recovery claim. Pennsylvania's Medicaid Estate Recovery Program Third, there may be an undue hardship exception. Pennsylvania Medicaid Programs for Long Term Care Notwithstanding, each State has different provisions for Medicaid reimbursement and recovery laws and . If she owned her house jointly with another person with rights of survivorship, then the house would not be subject to estate recovery because it would not be part of her probate estate. No part of the information on this site may be reproduced for profit or sold for profit. home and received Medicaid, his or her estate would be subject to Medicaid This number is expected to be revised upwards by a few dollars on January 1, 2024. Assistance payments made for the decedents nursing home services, home, community-based Most of the recoveries are from the sale of the homes of deceased nursing home residents, but the estate recovery program seeks payback from probate estates that exceed $2,400. Medicaid payback rules provide protection for surviving spouses of Medicaid beneficiaries. Section 223 Demonstration Program to Improve Community Mental Health Services. the elder law guides. In other words, they might have to pay back the state themselves! At a certain point a nursing home resident may not be considered as residing at home, for purposes of claiming the family exemption. (4)If the decedents estate contains protectable assets which are not adequately protected by the procedures in paragraphs (1)(3), the personal representative shall appropriately protect the assets by another method, as approved by the Department. When your spouse dies, so long as you do not have children who meet the criteria above, the state can still go after your estate. If the last day of a response period falls on a weekend,Pennsylvania holiday, or a day that the offices of the Department are closed, then theresponse period ends on the next business day. 1396n(c)). 495_2_Implementation_of_Dept_Claim - services.dpw.state.pa.us (a)This chapter applies to the estates of individuals who received MA for nursing facility services, home and community based services or related hospital and prescription drug services, who were 55 years of age or older at the time that MA was received, who died on or after August 15, 1994, and who received MA on or after August 15, 1994. you with your Medicaid Planning. 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 ofHuman Serviceswith regard to claiming the family exemption. This hearing is known as a fair hearing. The determination made by the administrative law judge at the fair hearing is subject to reconsideration by the Secretary of the Department ofHuman Servicesand appellate review in Commonwealth Court. Thanks for subscribing! not included when determining your eligibility for Medicaid, but the Estate (C)Protection of nontrust property described in clauses (A) and (B) is limited to circumstances when it passes from an Native American Indian as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C.A. 3155(b)(4). Virginia, for example, allows the intent return exemption to last a maximum of six months. Otherwise, the Departments claim shall be paid under 20 Pa.C.S. However, the regulations provide that a decree of distribution will only discharge liability of personal representative if certain conditions are met. There are several exceptions to the estate recovery payback. Your house must be their main and only place to live. (ii)While the decedent was on temporary leave from a nursing facility. In 27 states, Medicaid Estate Recovery Programs only seek reimbursement from the deceased beneficiarys probate estate. These are known as probate-only states. A strict interpretation of the statute would call for a pro-rata payment of the competing claims without priority between claims of the same class. (c)The Departments claim against assets subject to 20 Pa.C.S. This chapter does not apply to individuals who received MA before reaching 55 years of age and whose MA eligibility terminated before reaching 55 years of age. How a Trust Can Be Used in Your Medicaid Planning, New 2020 Spousal Impoverishment and Home Equity Limits, click here to sign up for our monthly newsletter. So, your family or children can buy your house, but theyll need to pay the same price any regular person would. (1)If the decedents estate contains real estate, the personal representative shall cause a mortgage or other recorded encumbrance to be placed against the real estate in favor of the Department. This is a process that can occur after a Medicaid recipient dies. 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. . Summary (b)The personal representative has a duty to insure protection of the Departments claim during the postponement period. can try to collect money from your probate estate after your death. For example, if Aunt Martha spent a year in a nursing home receiving Medicaid and then died owning a house worth $200,000, the estate recovery program would try to recover the Medicaid dollars spent for her care from Aunt Marthas probate estate. Eventually, when the spouse dies or the child is old enough, the estate recovery process will start. An estate is just the property left over after a person dies. 55 Pa. Code Chapter 258. Medical Assistance Estate Recovery Your access to this service has been limited. 3155(b)(4). This section cited in 55 Pa. Code 258.12 (relating to administrative enforcement). 1412. Whether the state succeeds or not depends on a number of things. The law requires every state to try to get back the money that the state pays for someone's Medicaid benefits. When someone has been on Medicaid at the end of their life, the home is usually the last remaining thing of value after death, and MERPs will try to collect reimbursement through the home. That process is detailed below. (b)The Departments claim against deposit accounts and patient care accounts subject to 20 Pa.C.S. Another strategy people think of is giving their house to their children, or selling it to them for a very cheap price. (HTTP response code 503). here for more articles! (e)A personal representative may extend the Departments response period. A lien prevents the sale of the home until all of the homeowners debts are paid. (c)The Department will find undue hardship and will permanently waive its claim with respect to an income-producing asset if a spouse, child, parent, sibling or grandchild of the decedent meets both of the following: (1)The asset is used to generate the primary source of income for the household. 3155(b)(5) (relating to persons entitled). (3)The date any surviving child is 21 years of age. Attorney Robert C. Gerhard, III has written extensively on the topic and for more than two decades has taught continuing legal education classes about estate recovery with the program managers and lawyers for the PA Department of Human . Texas, for example, does not try to be reimbursed from a recipient whose estate is valued below $10,000, while Georgias limit is $25,000. Estate Recovery if he or she died owning a home worth $350,000. Wordfence is a security plugin installed on over 4 million WordPress sites. the date when a sibling of the recipient (who also has an equity interest in the property and has been living in the property for at least one year prior to the death of the recipient) dies, vacates the property, or transfers the property. If you are a Funeral Director or Nursing Home facility choosing to return excess funds, for individuals over 55, click here for more information. Medicaid Estate Recovery in Pennsylvania - Alberts Law For family members/executors that have questions related to estate recovery, please contact DHS Estate Recovery using the address, phone number, or email address listed below: Department of Human ServicesEstate Recovery ProgramP.O. The Estate Recovery statute in Pennsylvania is set forth at 62 P.S. (ii)Ownership interest in trust or nontrust property, including real property and improvements including the following: (A)Property located on any Federally recognized Native American Indian Tribes reservation, Pueblo or Colony, including former reservations in Oklahoma, Alaska Native regions established by Alaska Native Claims Settlement Act and Indian allotments or near a reservation as designated and approved by the Bureau of Indian Affairs of the United States Department of the Interior. Computation of claim. If recoverable estate assets are not disclosed, then the personal representative is not discharged from liability and can be held personally liable for the value of the non-disclosed assets which should have been used to satisfy the estate recovery claim. 2932 (May 27, 2023). Assets generallynot subject to estate recovery include property owned jointly by the decedent and another, including property owned as tenants by the entireties, life insurance proceeds paid directly to a designated named beneficiary, asset placed in trust prior to the death of the decedent, irrevocable funeral reserves, certain property of Native American Indians, government repatriations to special populations (German reparations), and certain trusts for disabled persons, including special needs trusts. If you need some clarity on what exactly a "durable power of attorney" is, and why it's important to have one, watch the short video below. The Department will permanently waive the claim with respect to the residence in this instance. This monthly figure represents 300% of the federal SSI benefit amount and is usually revised upwards each year due to inflation. Many people incorrectly refer to the claim as a lien. the death of the recipient of Medicaid. Pennsylvania is one of these. Additionally, the decedents name, last address, date of birth, and Social Security Number must be in the letter together with the name, address, and phone number of the personal representative. 3101 (relating to payments to family and funeral directors) is subordinate to reasonable funeral expenses and to those claims of creditors having priority over the Department under 20 Pa.C.S. Please direct comments or questions to. The statute of limitations has expired (See below for more on statutes of limitations). Collection the estate recovery claim is delayed until: During postponement, protectable assets are to be safeguarded by the personal representative. Additionally, if the last date of the response period falls on a weekend, Commonwealth holiday or other day that the offices of the Department are closed, the response period shall end on the next business day. (b)A final administrative order in any proceeding to assess liability against a personal representative or transferee shall be binding upon the parties in any subsequent judicial proceeding to enforce the administrative order. Another big exception to the Estate Recovery Program has to do with your caregivers. and help you figure out how to protect your legacy from Pennsylvanias Medicaid The federal government has a policy that mandates all states or another attorney of your choosing contact the Estate Recovery Program, and that you not attempt to do so on your own. Recipients child who is under 21 You can also read the documentation to learn about Wordfence's blocking tools, or visit wordfence.com to learn more about Wordfence. provides healthcare for people with limited income and assets. assets are to be distributed by will or under state law. For example, if Aunt Martha spent a year in a nursing home receiving Medicaid and then died owning a house worth $200,000, the estate recovery program would try to recover the Medicaid dollars spent for her care from Aunt Marthas probate estate. the elder law guides. The personal representative of the deceased recipients (b)The estate of a an individual who was 55 years or older at the time that MA was received is liable to repay the Department for the amount of MA paid for all nursing facility services, home and community based services and related hospital and prescription drug services provided from the time the individual was 55 years of age and thereafter. These payments must have been provided on or after August 15, 1994, the effective date of the Act. Whether the state succeeds or not depends on a number of things. An overview of Pennsylvania Medicaid's long term care programs and eligibility requirements including nursing home care, assisted living and in-home care. If you need some clarity on what exactly a "durable power of attorney" is, and why it's important to have one, watch the short video below. assets in certain trusts for the benefit of disabled individuals, certain income, resources and property of Native American Indians and Alaskan Natives; and. Reform's guide. Pennsylvania law sets forth the priority in which unsecured claims are paid from an insolvent estate: If the applicable assets of the estate are insufficient to pay all proper charges and claims in full, the personal representative, subject to any preference given by law to claims due the United States, shall pay them in the following order, without priority as between claims of the same class: Estate administration expenses, including reasonable attorney fees, represent Class 1 claims and are paid first. You may have heard the term "estate recovery" before and wondered what it meant. Do not do anything until you talk to a professional. Irrevocable Funeral Trusts / Burial Contracts & Medicaid Estate Recovery What Happens After Death? 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. DecedentA deceased individual who was 55 years of age or older at the time that MA was received. Departments claim (claim)The claim of the Department computed and made under this chapter. The trust shall name the Department as remainderman and shall allow the spouse or child, or both, to consume income without court approval, shall allow the consumption of principal to pay reasonable medical expenses of the spouse or child, or both, and shall allow the consumption of principal for the benefit of the spouse or child, or both, with court approval. (f)Property within the scope of 20 Pa.C.S. (c)The personal representative will be deemed to have complied with his responsibilities to protect the Departments claim during the postponement period if, after liquidating the assets as appropriate and paying all expenses of administration and superior claims of creditors against the estate, the personal representative takes one or more of the following actions until the Departments claim is fully protected, or until all protectable assets are protected. When does Medical Assistance Estate Recovery occur? The personal representative may serve as trustee and a reasonable trustee fee may be provided by the trust document. (a)The Departments claim with respect to a decedent shall consist of the total of all MA payments made with respect to the decedent for nursing facility services, home and community based services and related hospital and prescription drug services rendered on or after August 15, 1994. Money in checking and savings accounts Typically, the recovery program is not concerned with your personal possessions. You might not be able to collect the benefits you need for many years. This chart shows which states are probate-only states and which are expanded recovery states. Arequest for a statement of claimissent by certified mail, return receipt requested to the Third Party Liability Section; Department of Human Services; Estate Recovery Program; P.O. The Pennsylvania Estate Recovery Program allows the state to Use of this content by websites or commercial organizations without written permission is prohibited. 3392(6). (2)Government reparation payments to special populations. Some states allow for a partial exemption even if Medicaid applicants are over the face value limit. In the many powers of attorney I see in my line of work, one problem recurs over and over again. There is a 5-year look back to qualify for Medicaid. seniors, the only asset remaining following an extended nursing home stay is The provisions of this Chapter 258 adopted November 2, 2001, effective February 1, 2002, 31 Pa.B. The 5-year time frame is for notification purposes only and does not limit the Departments claim. Life insurance which is payable to the decedents estate is subject to the Departments claim, even if the life insurance policy contains a facility of payment clause. 1382. If the estate contains cash or cash equivalents exceeding $50,000, the personal representative is to work with the Pa Department ofHuman Servicesto place the money in a trust which complies with the estate recovery regulations. Assets in an irrevocable trust are not owned in your name, and therefore, are not part of the probated estate.

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