It will depend on the type of Medicaid program you are on.
My understanding in general is that IF your on a Medicaid program that is a long-term / continuous type of program AND you applied for it after age 55, THEN a Recovery (recoup of payment made to the program/s on your behalf) is required to be attempted by the state after you die from the assets of your Estate. It is done though MERP uniquely by each state as your states laws affect how Recovery is done for property or probate / after death laws. Recovery is due to Bush era DRA 2005 (deficit Recovery Act). DRA 2005 also re-set the overall guidelines for Medicaid so that all states had to follow a similar set of regulations. So Medicaid for elderly in a NH, or on a waiver at AL or in a community based or in-home provided services all will be creating a debit that will add up to eventually be a debt or lien or claim against you/your estate THAT the state or its outside contractor is required to attempt a recovery of via MERP.
MERP is not necessarily just done for LTC in a NH. It can be any of the long term or continuous Medicaid programs that your state chooses to or is required to include for recovery. AL waivers and mental health services are. Some community based programs - like PACE - need for participants to be “duals” as the program is set up to bill all actions & events either through Medicare AND/OR Medicaid & you can’t just private pay for say your flu shot or monthly health screening. To be a “dual” means you are on both Medicare AND Medicaid.
I can see it happening that an elder signs up for a 3 or 4 days a week community full day program while still living in their home like in 2012-2015 and becoming a “dual” to be in a the program (doesn’t affect their monthly income they just need to be lower household income like on SS); then she moves from her home & into an AL and private paying for the AL from 2o15 till she died in 2018 but neither the elder nor her family realizing that when she died there was that old Medicaid MERP situation lurking as a lien or claim against her estate from the “dual” community based program back in 2012-2105.
Medicaid for those under 55 is not included in MERP. Most under 55 Medicaid is low income children enrolled in CHIP or women in WIC type of programs. I imagine that as they are time limited (like for WIC it covers your pregnancy and a short period afterwards, so maybe 15 months tops for a woman’s WIC), they aren’t viewed the same for health policy & cost effectiveness for recovery like LTC NH cost are as health planning has been done to date. CHIP maybe is 5k-8k a year average cost for a child’s Medicaid costs (well baby checkup, immunizations, bi annual pediatric clinic visit) VS 5k-15k a month for room&board just on its own an elderly person in a NH.
There is Medicaid for healthcare and Medicaid for long term care. Healthcare depends on income to recieve. Medicaid for LTC they take the persons SS and pension to offset the cost. If the person has no assets, then Medicaid can't recoup anything at time of death. If there is a house that hasn't sold, when it does, Medicaid will need to be reimbursed. There is more to the process but I am giving you the basic.
so who is coming after you ...Medicaid long term you applied for and got denied or NH ? my father was in AL/NH for a few months after strokes with medicaid pending, a year ago there were $$ giving to us to help buy house- according to social worker he didn't qualify because of gift giving and there was a penalty. NH trying to charge a private stay, how far can they go to get their money ? is there a way to negotiate or settle for less? Father is home now but does he need to be concern with state or medicaid going after him??? Only the facility he staid at ?
My understanding in general is that IF your on a Medicaid program that is a long-term / continuous type of program AND you applied for it after age 55, THEN a Recovery (recoup of payment made to the program/s on your behalf) is required to be attempted by the state after you die from the assets of your Estate. It is done though MERP uniquely by each state as your states laws affect how Recovery is done for property or probate / after death laws. Recovery is due to Bush era DRA 2005 (deficit Recovery Act). DRA 2005 also re-set the overall guidelines for Medicaid so that all states had to follow a similar set of regulations. So Medicaid for elderly in a NH, or on a waiver at AL or in a community based or in-home provided services all will be creating a debit that will add up to eventually be a debt or lien or claim against you/your estate THAT the state or its outside contractor is required to attempt a recovery of via MERP.
MERP is not necessarily just done for LTC in a NH.
It can be any of the long term or continuous Medicaid programs that your state chooses to or is required to include for recovery. AL waivers and mental health services are. Some community based programs - like PACE - need for participants to be “duals” as the program is set up to bill all actions & events either through Medicare AND/OR Medicaid & you can’t just private pay for say your flu shot or monthly health screening. To be a “dual” means you are on both Medicare AND Medicaid.
I can see it happening that an elder signs up for a 3 or 4 days a week community full day program while still living in their home like in 2012-2015 and becoming a “dual” to be in a the program (doesn’t affect their monthly income they just need to be lower household income like on SS); then she moves from her home & into an AL and private paying for the AL from 2o15 till she died in 2018 but neither the elder nor her family realizing that when she died there was that old Medicaid MERP situation lurking as a lien or claim against her estate from the “dual” community based program back in 2012-2105.
Medicaid for those under 55 is not included in MERP. Most under 55 Medicaid is low income children enrolled in CHIP or women in WIC type of programs. I imagine that as they are time limited (like for WIC it covers your pregnancy and a short period afterwards, so maybe 15 months tops for a woman’s WIC), they aren’t viewed the same for health policy & cost effectiveness for recovery like LTC NH cost are as health planning has been done to date. CHIP maybe is 5k-8k a year average cost for a child’s Medicaid costs (well baby checkup, immunizations, bi annual pediatric clinic visit) VS 5k-15k a month for room&board just on its own an elderly person in a NH.
my father was in AL/NH for a few months after strokes with medicaid pending, a year ago there were $$ giving to us to help buy house- according to social worker he didn't qualify because of gift giving and there was a penalty. NH trying to charge a private stay, how far can they go to get their money ? is there a way to negotiate or settle for less? Father is home now but does he need to be concern with state or medicaid going after him??? Only the facility he staid at ?