Ala. Admin. Code r. 560-X-33-.05

Current through Register Vol. 43, No. 02, November 27, 2024

Section 560-X-33-.05 - Estate Recovery

(1) Under the estate recoveries provisions in §1917(b) of the Act, the Alabama Medicaid Agency ("Agency") shall seek adjustment or recovery of any medical assistance correctly paid on behalf of the following categories of recipients:

(a) Permanently Institutionalized Recipients of any age who are inpatients in a nursing facility, ICF/IID, or other medical institution, and who must, as a condition of receiving services in the institution under the State plan, apply their income (all but a minimal amount allowed for personal needs) to the cost of care, the Agency shall seek adjustment or recovery from the recipient's estate or upon the sale of the property subject to a lien imposed on account of medical assistance paid on behalf of the recipient.

(b) In the case of a recipient who was 55 or older when the recipient received such medical assistance, the Agency shall seek adjustment or recovery from the recipient's estate for all approved medical assistance in accordance with federal law and the approved State Plan, except for Medicare Cost Sharing as described in 42 U.S.C. §1396a(a) (10(E)).

(c) Recipients with Long Term Care Insurance Policies - If a recipient covered under a long-term care insurance policy received benefits for which assets or resources were disregarded in accordance with the Agency's State plan (State Long-Term Care Insurance Partnership), the Agency will not seek adjustment or recovery from the recipient's estate for the amount of assets or resources disregarded.

(2) Delayed Recovery/Exemptions

(a) Adjustment or recovery may be made only after the death of the recipient's surviving spouse, if any, and when the recipient has no surviving child under age 21, or a blind or permanently or totally disabled child as defined in 42 U.S.C. §1382c.

(b) If, after the reported death of the recipient, the Agency is prohibited because of exemption conditions, the Agency shall postpone recovery until all exemption conditions are no longer present.

(c) Undue Hardship

(i) The Agency will waive or delay recovery upon a showing that an undue hardship exists. For purposes of this Rule, "Undue Hardship" is defined as the existence of a situation, established by convincing evidence, that the estate subject to recovery is an asset such as a family farm or family business which produces "limited income" (defined as equal to or less than the income limit established in Rule 560-X-25-.14) and is the sole income-producing asset of one or more heirs to the estate.

(ii) An undue hardship is not available in the following circumstances:

(I) For recipients with long term care insurance policies who became Medicaid eligible by virtue of disregarding assets because of payments made by a long term care insurance policy or because of entitlement to receive benefits under a long term care insurance policy;

(II) If the Agency determines the hardship was created by the recipient by resorting to estate planning methods under which the recipient illegally divested assets in order to avoid estate recovery.

(iii) Each heir with an interest in the recipient's estate must apply for a separate undue hardship. If approved, that heir's interest in the estate will be exempt from recovery while any of the remaining heirs that did not apply for an undue hardship or were denied will still be subject to recovery.

(3) Procedures

(a) The Agency may file claims against the estate of a deceased recipient who received benefits incorrectly, in accordance with existing law.

(b) The Agency may file a claim against the estate of a deceased recipient as defined in paragraph (1) above.

(c) In order to protect its right to recover from a deceased recipient's estate, the Agency, after obtaining the concurrence of the Attorney General, may file a petition for letters of administration in situations where the Agency's claim warrants the expense of administering the estate.

Ala. Admin. Code r. 560-X-33-.05

Rule effective October 1, 1982. EXHIBIT A STATE OF ALABAMA COUNTY OF LIEN FOR MEDICAL PAYMENTS UNDER ALABAMA MEDICAID PROGRAM WHEREAS,________________________________________________, ("Medicaid Recipient") is justly indebted to the Alabama Medicaid Agency ("the Agency") to the extent that the Agency has paid medical benefits for Medicaid Recipient under the Alabama Medicaid Program ("the Program"); and WHEREAS, Medicaid Recipient may hereafter become indebted to the Agency to the extent that the Agency pays future medical benefits for Medicaid Recipient; NOW, THEREFORE, in order to secure the repayment of said indebtedness and in order for Medicaid Recipient to obtain medical benefits under the Program, the Medicaid Recipient, joined by (his)(her) spouse does hereby GRANT, BARGAIN, SELL, ASSIGN and CONVEY unto the Agency, its successors and assigns, a lien for the full dollar value of said medical benefits paid and to be paid, on the following described real estate situated in __________________________County, Alabama, to-wit: Subject, however, to all existing liens now on said property. Notice of this lien will be recorded in said county and the dollar value of this lien as it may exist from time to time, may be obtained by writing to: Commissioner, Alabama Medicaid Agency, 2500 Fairlane Drive, Montgomery, AL 36130. This lien shall be due and payable upon the sale, transfer or lease of said property, or upon the death of Medicaid recipient, and shall otherwise be enforceable in accordance with the limitations of 42 USCA § 1396a(18) as the same may be amended. IN WITNESS WHEREOF, the undersigned (has) (have) duly executed this instrument to voluntarily grant the aforesaid lien on this the ____day of _______________, 19___. ________________________________ ___________________________ Spouse Medicaid Recipient Witness:_______________________ STATE OF ALABAMA COUNTY OF I, the undersigned, a notary public in and for said state and county, hereby certify that _____________________________, whose name as an Alabama Medicaid recipient, a (single) (married) person, is signed to the foregoing instrument, and ____________________ (his)(her) spouse, whose name is also signed to said instrument, acknowledged before me on this day that being informed of the contents of said instrument (they)(he)(she) executed the same voluntarily on the day the same bears date. Given under my hand and official seal this the __________ day of ______________, 19____. (SEAL) __________________________ Notary Public

Adopted by Alabama Administrative Monthly Volume XXXIV, Issue No. 03, December 31, 2015, eff. 1/25/2016.

Author: Keith Thompson, Director, Third Party Liability

Statutory Authority: Social Security Act; State Plan; U.S.C. §1396p; 42 C.F.R. Parts 431, 433, and 455; Code of Ala. 1975, §§ 22-1-11, 22-6-8.