Estate recovery occurs when MO HealthNet imposes a lien or requests money be paid to MHD from a participant’s estate for the reimbursement of funds paid on behalf of the participant. Estate recovery does not apply to participants who only received Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Beneficiaries (SLMB).
42 U.S. Code § 1396p requires MO HealthNet Division (MHD) to attempt to claim assets from the estate of a participant who was 55 years or older when the participant received medical assistance, or from any participant that receives vendor coverage.
Estate recovery is not permitted in certain situations:
- If the participant is survived by a spouse;
- There is a child under 21 years of age in the home;
- There is a blind or disabled dependent in the home;
- There is a sibling residing in the home with an equity interest in such home and he/she has lived in the home for at least one year prior to the participant’s admission to a medical institution.
In addition, RSMo 208.692 mandates the disregard of resources in an amount equal to the Long-Term Care insurance benefits paid to, or on behalf of, an individual who has received MO HealthNet benefits. See 1030.055.00 Missouri Long Term Care Partnership Program.
When a participant is deceased and does not meet an exemption, MHD will send expenses paid on the deceased participant’s behalf to the Attorney General’s office for filing with the appropriate Probate Court.
According to RSMo 473.397, MO HealthNet debt is a class 7 Probate claim. It is to be paid after estate administration costs, exempt property, family and homestead allowances, funeral expenses, taxes, and expenses of last illness, but before other judgments are applied to any property and other assets.
In 2007, Missouri law was amended by RSMo 473.398, and requires that any open estate of a participant who was enrolled in MO HealthNet at the time of his/her death, may not be closed until MO HealthNet issues a release of the Estate Recovery Claim.
EXAMPLE: Andrew and Natalia are married and are both active MHABD participants. In December 2019, Andrew passes away. MHD does NOT pursue Estate Recovery as Andrew has a surviving spouse, Natalia.
EXAMPLE: Robert has active MHABD. In December 2018, Robert’s sister, Rose, moved into the home with Robert to help him so that he would not have to move into a nursing home. Robert and Rose are joint owners in the home they inherited from their mother. In January 2020, Robert passes away. MHD does NOT pursue Estate Recovery on Robert’s estate (whose only asset was his house) as Rose lived in the home for more than 12 months and has an equity interest in the property.
EXAMPLE: Donald applies for Vendor coverage when he moves into a nursing home in October 2019. Donald passes away in November 2021. MHD files a claim for Estate Recovery with the Probate Court in Vernon County where Donald lived claiming $161, 575 in medical expenses paid by MHD during his time in the nursing home. The court determines that the expenses must be repaid to MHD from Donald’s estate prior to other disbursements.
Donald’s estate was approximately $300,000 as equity from his home. MHD claimed $161,575 in medical expenses paid from October 2019 to November 2021. The remaining $138,425 of Donald’s estate would be disbursed according to the Probate Court to other debtors or as inheritance to the family.
NOTE: Do not give case specific advice regarding estate recovery. Encourage participants and/or representatives to contact MO HealthNet Division.
Estate Recovery is managed and overseen by MO HealthNet Division’s Cost Recovery Unit. They may be contacted directly:
- Phone: 573-751-2005
- Email: CostRecovery@dss.mo.gov
- Mail: Cost Recovery Unit, PO Box 6500, Jefferson City, MO 65102-6500