Reimbursement via "estate recovery" for payments the state made under Medicaid for a person's care are only sought for the period when the individual was institutionalized (or, if non-institutionalized, at least age 55).
Medicaid - although a joint federal & state program - is administered by each state in each state's own unique way but under an overall federal guideline. All states are required to have MERP - Medicaid Estate Recovery Program. How MERP runs in your state depends on your state laws on death, probate, property rights.
As Ferris said, check with your state's Medicaid program. For TX Medicaid, almost all Medicaid paid for services for elderly are within MERP's purview. So in addition to NH Medicaid, any mental health services are included as well as any "community based" health services. MERP does not affect Medicaid programs like any WIC programs though. All details are on the TX Medicaid DAD's site.
When they applied for Medicaid, there probably was a statement of the applicants acknowledgement of MERP. Whether or not they signed off on it doesn't matter, as it is an acknowledgement of acceptance. The state can place a claim or a lien on the property because of MERP. How the claim or lien is enforced is very much dependent on your state laws. It seems that often the claim or lien only shows up when the title company is doing it's search in the days right before the act of sale on the property. Some states title companies are now requiring the seller if over 60 to do some sort of statement as to whether or not Medicaid was provided to the owner / seller before title insurance will be issued. So how the property gets sold will make a difference if this is going to be an issue at the time of sale. If this is a traditional sell with a Realtor and the buyer is getting a mortgage, they will need to get title insurance and MERP will likely show up. If it's a quit claim to family, then it won't show up but can still be there on the property only to show up as a problem years from now when it is sold or used as collateral. In either case you don't want a MERP claim or lien to be an issue, you need to contact Medicaid before the act of sale to see what to do. Good luck and please post what Medicaid says.
For TX, MERP's purview covers: -Nursing facility care (nursing homes aka long term care facilities) -Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) Plus a whole bunch of Medicaid Waiver Programs: -Home and Community-based Services (HCS) -Community Living Assistance and Support Services (CLASS) -Texas Home Living Waiver (TXHmL) -Consolidated Waiver Program (CWP) -Deaf-Blind with Multiple Disabilities (DBMD) Waiver -Community Based Alternatives (CBA) -STAR+PLUS Waiver (SPW) -Integrated Care Management Waiver (ICMW) - Community Attendant Services (CAS) That is a whole bunch of acronyms! MERP also affects the costs of certain hospital and prescription drug services received and paid for by Medicaid. For TX, average yearly Medicaid bill for NH resident is 72K or a 72K MERP claim. And TX is a very low Medicaid R & B reimbursement rate of under $ 145.00 day. If you are on the East Coast where the NH rates are $ 300 - 400 a day, easily over 6 figures. Which is just a staggering amount of money, so you can understand why MERP is required. I just think the states have done a lousy job of explaining and presenting to Medicaid applicants & their families clearly what the consequences are for accepting Medicaid.
I guess these comments are assuming that there was no transfer of deed at the approximate time Medicaid eligibility was granted. if a property was sold to family members, the Medicaid recipient would no longer be an owner of the property. at the time of sale, the owner would be the family not the recipient of Medicaid. in that scenario, perhaps there would be no threat of recovery of costs,nor lien
Great answers! Has anyone posted about transportation and waivers? It appears that only MRDD people can get transportation under the waiver? sorry to post here...just kinda lost. re Medicaid I get updates every week of new or changed Admin code. Who knows what is legal and not? I'd go straight to Medicaid and also speak to an Elder Law attorney. Some offer free 15 minutes.
As Ferris said, check with your state's Medicaid program. For TX Medicaid, almost all Medicaid paid for services for elderly are within MERP's purview. So in addition to NH Medicaid, any mental health services are included as well as any "community based" health services. MERP does not affect Medicaid programs like any WIC programs though. All details are on the TX Medicaid DAD's site.
When they applied for Medicaid, there probably was a statement of the applicants acknowledgement of MERP. Whether or not they signed off on it doesn't matter, as it is an acknowledgement of acceptance. The state can place a claim or a lien on the property because of MERP. How the claim or lien is enforced is very much dependent on your state laws. It seems that often the claim or lien only shows up when the title company is doing it's search in the days right before the act of sale on the property. Some states title companies are now requiring the seller if over 60 to do some sort of statement as to whether or not Medicaid was provided to the owner / seller before title insurance will be issued. So how the property gets sold will make a difference if this is going to be an issue at the time of sale. If this is a traditional sell with a Realtor and the buyer is getting a mortgage, they will need to get title insurance and MERP will likely show up. If it's a quit claim to family, then it won't show up but can still be there on the property only to show up as a problem years from now when it is sold or used as collateral. In either case you don't want a MERP claim or lien to be an issue, you need to contact Medicaid before the act of sale to see what to do. Good luck and please post what Medicaid says.
-Nursing facility care (nursing homes aka long term care facilities)
-Intermediate Care Facility for Persons with Mental Retardation (ICF/MR)
Plus a whole bunch of Medicaid Waiver Programs:
-Home and Community-based Services (HCS)
-Community Living Assistance and Support Services (CLASS)
-Texas Home Living Waiver (TXHmL)
-Consolidated Waiver Program (CWP)
-Deaf-Blind with Multiple Disabilities (DBMD) Waiver
-Community Based Alternatives (CBA)
-STAR+PLUS Waiver (SPW)
-Integrated Care Management Waiver (ICMW)
- Community Attendant Services (CAS)
That is a whole bunch of acronyms! MERP also affects the costs of certain hospital and prescription drug services received and paid for by Medicaid. For TX, average yearly Medicaid bill for NH resident is 72K or a 72K MERP claim. And TX is a very low Medicaid R & B reimbursement rate of under $ 145.00 day. If you are on the East Coast where the NH rates are $ 300 - 400 a day, easily over 6 figures. Which is just a staggering amount of money, so you can understand why MERP is required. I just think the states have done a lousy job of explaining and presenting to Medicaid applicants & their families clearly what the consequences are for accepting Medicaid.
re Medicaid I get updates every week of new or changed Admin code. Who knows what is legal and not? I'd go straight to Medicaid and also speak to an Elder Law attorney. Some offer free 15 minutes.