- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- MO HEALTHNET TEFRA LIENS, ESTATE RECOVERY, AND VOLUNTARY REPAYMENTS
DISCUSSION:
The purpose of this memo is to provide information to Income Maintenance staff on Missouri's policy regarding Medicaid liens under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), and the Estate Recovery program. This memo will also provide instructions on how MO HealthNet applicants and participants can request to make a voluntary payment to the MO HealthNet Division (MHD) in order to retain MO HealthNet eligibility.
NOTE: Do not give advice to applicants, participants, or their representatives regarding how to avoid TEFRA liens and Estate Recovery, whether the MHD will pursue these actions against them, or whether they should make voluntary payments.
There are three ways in which the state recovers assets from MO HealthNet participants on whose behalf the state paid for medical care:
- TEFRA LIENS,
- ESTATE RECOVERY, OR
- VOLUNTARY PAYMENTS by the recipient.
TEFRA LIENS
Under TEFRA, the state can place a lien on the real property of MO HealthNet participants who are receiving nursing home (vendor) coverage while they are still living and are unlikely to leave the institution. The lien dissolves if the participant is discharged from the nursing facility to return home. The MHD is charged with investigating and pursuing TEFRA liens. Liens cannot be placed on real property that is occupied by the participant's:
- Spouse,
- Blind or disabled child,
- Child under the age of 21, or
- Sibling who partially owns the home and who was living there for at least a year before the participant's date of institutionalization.
Individuals who are approved for coverage under the MO HealthNet for the Aged, Blind, or Disabled (MHABD) program, regardless of whether they are approved for vendor coverage, are informed of the TEFRA lien program on their approval letter: the FA-460 MO HealthNet Action Notice.
ESTATE RECOVERY
Under Estate Recovery, the state can file a claim against the estate of a deceased MO HealthNet recipient. The recipient must have received:
- nursing home coverage at any point in his/her adult life, or
- any kind of MO HealthNet coverage at any time after he or she turned age 55.
NOTE: This policy does not apply to participants who received only Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB –1 or 2) coverage.
Estate Recovery cannot be pursued against estates of participants who are survived by a:
- Spouse,
- Child under age 21, or
- Blind or disabled dependent child living in the participant's home.
MHD identifies cases that may qualify for Estate Recovery. If MHD determines that a recovery can be pursued, it refers the case to the Office of the Attorney General, which in turn reviews the case and decides whether to file a probate claim against the estate.
VOLUNTARY PAYMENTS
MO HealthNet participants or their representatives may make voluntary payments to the MHD's Cost Recovery Unit in order to retain eligibility. To initiate a voluntary payment, they should contact the Cost Recovery Unit at 573-751-2005 and speak to a Medicaid Technician, who will process their case.
NOTE: Income Maintenance staff are authorized to share information on voluntary payments with participants; however, never advise, recommend, or demand that an individual make (or not make) voluntary payments.
NECESSARY ACTION:
- Review this memorandum with appropriate staff
- Review the attached White Papers regarding TEFRA liens and Estate Recovery
ATTACHMENTS:
AD