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OK my understanding is on how MedicAID works is that each state manages or adminsters their Medicaid program under an overall federal guideline. So each state gets to put their own spin on what is allowed to be covered by Medicaid, which programs have a lien or claim on them, and more importantly what happens with a claim or a lien on their property as per state law on property & death.

If you are looking at a possible Medicaid lien or claim, all this is pretty important to understand. Some states law is very pro property owner - like TX & FL - in that a judgement (whether that is from defaulting on CC debt or other non-secured debt) cannot be placed as a lein on a homesteaded property. While other states allow for a judgement to be placed as a lien on the property. This also holds true for how each state's law does probate, some states are easy probate (TX) while others are way more complex. Medicaid estate recovery (aka MERP) is ulimately a legal process that is done via probate court. So your state spin on all this is critical to understand to make the best of the situation.

For example, TX because of it's law, does NOT allow for a lien to be placed on the Medicaid recipients property while they are alive or after they die. What TX does is a "acknowledgement of MERP" statement on the Medicaid applications and then on the renewal required each year. Whether you sign it or not makes no difference in accepting the acknowledgement either. Then after they die, the state can makes a CLAIM on the estate (that has as it's asset the house) based on whether or not there are exemptions filed to the MERP claim. TX is a level of probate state and MERP is a class 7 claim so all other classes from 1 - 6 are required to be paid first & foremost. So MERP rates are lower in TX than in other states who do equal weight claims and lower in a state that allows for a full lien placed on the property.

MERP has all kinds of exemptions, and seem to the the key to having the MERP done or not done. Many states have turned MERP over to contractors which approach it as debt collectors and get a % of the recovery. The company that does TX gets 15% of the recovery. If you have valid exemptions with documentation and a low value property and are looking at months or years to finish out probate (if your state allows for that), MERP could view the claim as not worth the time and legal required to go after that specific house.
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Medi - you should contact the caseworker to see if the type of Medicaid service is exempt from MERP in your state. I would do this via a fax or registered mail letter and ask for a writtten response. You need to have this in a hard copy letter.

There are Medicaid programs - like SNAP, WIC - that are totally exempt from estate recovery. I'm pretty sure any NH or skilled nursing care in a facility costs could be recoverable under MERP. You need to find out what the help on her medical bills is considered.

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MERP was all crafted back in the go-go years of the real estate boom and then went into state laws in 2006 - 2008. Back when everybody thought that housing values could do nothing but increase every month and houses were goldmines of cash. Well so much for that. So many elders homes have years of delayed maintenance that they likely aren't going to be an easy sale and not at the tax assessor value either. And most likely certainly not what they could have sold for back in the top housing market of 2005 when MERP was getting put into law.
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Thanks you very much for the information.

If my sister gets Medicaid helps only the medical bills (not the home health care provided by Medicaid) will the medicaid still has lien on her home? Thanks again.
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Is it possilbe that she may SELL the house before she passes? She could remain there as a tenant. Consult with a lawyer.
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It is my understanding one is either on Medicare OR Medicaid. I guess it depends on what state she lives in, but I know my husband's ex-spouse has Medicaid, and they want her house as payback when she dies. (They are providing home health care 3Xweek. I tried to put the Deed into my step-son's name only, and they wanted back in her name with theirs on it. So, I guess it all depends where she lives. Why don't you ask Medicaid what they intend to do when your sister dies? I hope it is not soon...
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