Not sure how to deal with this letter from Medicaid?

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My mom died July 15, 2018. I received a letter from Medicaid stating they are trying to recover the $32,000.00 they paid out on Mom for services. They want to know from her estate (which is me) all about her assets. Which were none obviously because she qualifies for Medicaid. She only had $6,000.00 in life Insurance which I paid for over the years and had to drop a lot because Medicaid said it was to much. She received her SS, which August payment will be returned to Medicare, she owned no homes, no cars, no anything. If she did she wouldn’t qualify for Medicaid.


She had no will, no assets, nothing. So what do they expect? I have on my credit card where I paid for her cremation and she is still in my living room and some of her ashes went back to be buried with her parents. She was poor in material things but rich in love. I loved her more than anything. Please help me to understand what they want. Thank you...it has been a very rough month.

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Meowzer - The letter you got is probably a NOI / Notice of Intent (to file a claim or lien against an Estate). Look at the letter to see IF it actually came from the States Medicaid/ DHHS or (more likely) if it actually has been sent by the states outside contractor for MERP/ Medicaid Estate Recovery. There are 2 main outside contractors - HMS & PCG - and in my experience they very much function like a debt collectors & are very proactive. Contractors have an overall management / administration fee and get a % of the Recovery. HMS is the bigger player and has around 1/3+ of the states. This is just a part of what the parent HMS as a huge company does for health systems cost containment across the US.

Sometimes a letter with the debt Medicaid paid for the deceased is sent first & then a larger packet with a multi page questionnaire is sent after that within a few days later. Unless your mom died still owning her home OR had her term life insurance policy to have the beneficiary to be her Estate OR died with farm/ranch land OR somehow she inherited $, there will be no “estate”, no $, no assets upon her death. There can be no recovery as nothing to recover from.

To be on Medicaid they cannot have more than 2k in nonexempt assets to start with, so the likelihood is they died with under 2k in assets. The questionnaire is all about your (as her old DPOA or contact person in Medicaid files) providing the information with documentation to show why no a Recovery to be done as it’s not cost efficient to persue a federally required attempted Recovery action against your mom’s estate. All done so that MERP can close out your mom’s file. There will be a ? as to her bank balance on day of death, so you put that in and attach a copy of the bank statement. If bank account was POD to you, then that info is written in the questionnaire. Another will be about her life insurance, the amount and who beneficiary was. As long as the “estate” wasn’t the beneficiary of the insurance, it’s not an asset of her estate. There will be ?s on property, auto, inheritance, which you fill in as zero as she had none of these. Personally I’m of the opinion that you fill it out, attached whatever paperwork and make a xerox of all then mail it and supporting paperwork certified mail with the return registered receipt IF it will get it all closed out. So you stop getting collections letters and phone calls. There will be a tight submission date indicated on the letters, please try to get it in before then.

If your Recovery is actually done by state so done by state employees, it will likely be an initial questionnaire with no response back for months. If it’s the state, put in a line somewhere on the questionnaire, that unless you received a written response of the states concerns on specific assets within 30 days that you consider this matter closed by the mailed submission. Again you mail it certified with the return registered card. The duo from USPO is like $ 8.00 and considered legal.

It is NOT your debt.
It is a debt of your mothers, who is deceased.
Unless there are assets that can be an estate, there is no reason or requirement to open probate or do any other type of probate action - even if you mom had a valid will naming you as Executor.

About MERP, that was put into place by Geo. Bush era law the DRA / Deficit Recovery Act of 2005. DRA also put in to have Medicaid gifting / transfer penalty to be uniformly done by all states. Within DRAs MERP there are federal cost benefit/ cost effective requirements:
- value of the Estate has to be over 10k or
- assets of the deceased are under 3k or
- Medicaid's LTC bill under a set amount. I think this one varies by state (as each state manages thier medicaid uniquely) but it’s low like 5k.
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Reply to igloo572
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It is just the way to try to recover monies spent. It really is just a formality.

If you're concerned, call Medicaid and they will tell you the same thing. You are NOT responsible to repay that - and if you start, they'll never leave you alone.

Call Medicaid today.
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ItHappenedToMe Aug 28, 2018
This is true - as it is for any collection - if you start paying, it's seen as an admission of responsibility. Totally agree - it's a formality.
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If no home to sell then no recovery. This is just standard with them. If the letter doesn't say anything about how you go about proving there is no money, call them and ask what proof they need to show there was no money to recover. Family is not responsible for the debt.
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Ahmijoy Aug 25, 2018
JoAnn, this person’s post made me tear up. My mom and I were in the same situation. Thanks for your answer. I’m sure it made her feel better. We’re very lucky to have you here.
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Thank you all for,the advice ,,I wrote him a letter and put a copy of mom’s funeral bill in the letter like they requested and told him she had nothing of value ..I didn’t send a copy of the bank statement but I will if I hear from them again wanting more info ,,,the only thing in her bank account is her social security that was August’s payment so they can take it back ,,I have to go,to the bank Friday with her death certificate to,show them that they have to return her social security then there will be $10.00 left ,,I was hoping social security would just take the payment back on their own but it looks like the bank will have to send it back ,,,ughhhhhh
that Medicaid letter I will look over igloo and see where it’s from I think merp is who sent it ,,,it’s so long to read and not a questionnaire..
i,have to work the next 3 days at the hospital and hopefully no letters from Medicaid or Medicare will come ..I’m afraid to go to the mailbox ,,,thank you all for your comments and prayers and hugs. I need all I can get ,,I miss Mom so much I cry myself to sleep ..it’s lonely without her and I always kissed her goodnight .,and good morning...and hugged her even when she was in a bad mood ,,at least she is with my sister who died 5 years ago suddenly of a heart attack ,,,I miss,them both. Anyway thank you all I couldn’t do it without you
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Agingmyself Aug 28, 2018
Dear one, Ohmeowzer, May God bless you with sweet reminders of your mom and sister that bring you joy and comfort!
You did the right thing with your reply. You do not need to fear anything. As some have said, it's just a formality that Medicaid has to follow up on. This is because Medicaid will pay for care even if a person owns a home, but once the person isn't going to go back to that house, the expectation is that the house will be sold to repay what they received from Medicaid. They will accept your explanation, and all will be well.
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Unfortunately it is SOP (Standard Operating Procedure) to send out a letter to the family of a deceased person who received Medicaid assistance whether that person had any assets or not.  In some states, this SOP is even written as a LAW that the State's Medicaid Office MUST ATTEMPT TO RECOVER any assets that the deceased person had; otherwise the State Medicaid Office could be fined by the State Department of Health and Human Services for not doing their job in recovering assets from those who received benefits from Medicaid while they were alive.

I am sorry that you are having to experience this SOP.  All you can do is contact the State Medicaid Office and ask them what do you need to do to verify that your Mother had no assets.  Try not to dwell on it.  It is just "one of those items on the checklist" that need to be done when someone dies.   {{{HUGS}}}
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Thank you ahmijoy I think we are very lucky to have jo ann,,I saw that letter and bawled ..I still cry over moms death it was very difficult to let her go but I had to ,,she fought to live believe me ..I stayed with her until the end ..I hugged and kissed her thanked her..we played her fav songs , prayed ..oh I loved her so much ..my heart belonged to Mom and she went without nothing ,,I miss her ..now I get this stupid letter and almost peed my pants ,,,thank you all for your love and concern and for helping me ,,,Mom lived with me so I go in her room and see her belongings and miss her so much ,,I talk to her all time anyway thank you
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Ahmijoy Aug 25, 2018
Sending you many, many hugs, honey. My mom looks out for me from “up there”. So does my dad and grandma. Keep that in your mind. We’re never all alone. XOXO
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I'm sorry for your loss. Not only is it difficult to cope with such a terrible loss, you will find out how greedy and dirty the government is. Medicaid has an estate recovery law. I'm no lawyer, but I tend to think this is a blanket form letter. In other words, anything that goes into probate will end up as Medicaid's property. If nothing is going into probate, they can't recover. If she still has a bank account--if your name is also on there it won't go to probate so they can't get that.
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Agingmyself Aug 28, 2018
Greedy and dirty? I find that comment somewhat offensive. Our tax money pays for care for those who need it without requiring them to live off their family or loved ones or to even sell their home. I don't consider it greedy or dirty to request information or to recover some of that payment from the estate of the person we generously provided care for.
It's a painful time for those who miss their loved one, but it's just another step in the finalizing of their financial affairs.
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I love the name - Ohmeowzer!
Sorry to hear about the Medicaid issue - Caregivers have enough stress without these types of headaches.
But, in regard to your issue with Medicaid here's my suggestion
- First off, they are just doing their job and what they want is a response from you - My suggestion - don't ignore their claim. 
That being said, based on the information you've listed here it will probably be resolved in your favor. But I would suggest the following:  get some legal advice. 
Please note:  I am not an attorney, but here is a list I
got from a workshop I attended of items  you might gather and/or have on hand for future reference - make note whether she did or didn't have these
†##SUGGESTED Itemized list of assets
(e.g., bank accounts, contents of safe-deposit boxes, vehicles, real estate), including current value and the individuals listed as owners, account holders and beneficiaries. † Copies of all estate planning
documents, including wills, trusts and powers of attorney.
† Copies of all real estate deeds.
† Copies of recent income tax returns.
† Life insurance policies, including their cash values.
† Long-term care insurance policies or benefits booklets.
† Health insurance policies or benefits booklets.
† List of names, addresses and telephone
numbers of those involved in decision making,including family members, domestic partners and caregivers,
as well as financial planners and/or accountants
Prepare to meet with your lawyer
(an Elder law attorney)  by gathering
all of the documents related to the assets of the person living with dementia.
##
The information was very helpful to me -Again, I'm not giving legal advice, I'm just sharing information shared with me when I had to go thru similar issues and if your situation is like mine was when my mom passed, away, I had to go back to work as I had tapped out my own retirement savings etc taking care of her so I was definitely not in any position to repay any services she had received from agencies.

So, my suggestion: Don't ignore the letter! - Get your records organized for a response as quickly as
possible.  

In terms of getting any legal advice, I would first check with organizations like your local Office On Aging,
The Alzheimers Assoc (if that was her issue) Even local Senior Centers often have a list of referral services for these types of issues. In other words you want to check with as many agencies as possible to get their input to help you with your response. They are experts in these types of issues and can help or refer you to find the right sources of help. 

Good Luck and God Bless!
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elaineSC Aug 29, 2018
She just needs to go to DHHS in person. The representative you see in person will help. I tried this by phone and you get a front line intake person but if you drive on down to the nearest DHHS office, the rep will tell her exactly what they need and have a list. My Mom is in the nursing home. I learned this is the best way.
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This is standard operating procedure. It is done just in case there are any funds that were not known about at the time of filing for Medicaid that could have been used to cover her costs. It seems unlikely but there are instances where money was tucked away and was unknown to family and only comes to light after a death.
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Hi ohmeowzer,

I'm so sorry about your mom. Did you receive a form to fill out or just a letter? I don't believe we needed to send any documentation besides my mom signing a form saying that he had no valuable assets or possessions. We provided documentation of his finances when he applied for Medicaid and was in the same boat as your mom (no assets -- no house, etc.) He was only on Medicaid for a few months. I think in those kinds of cases (where they already know the person was in poverty) it is a formality, and an opportunity for the govt. to let the "estate" know that they need to first reimburse Medicaid if there is anything left of value. Please try not to worry though it is even harder not to when you are already so sad. Hoping you feel a little better day by day. Hugs.
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