317.03 Reimbursement - Medical Assistance for Non-Institutionalized Individuals SR 99-43, 03/00 (AAM-A)

Inform non-institutionalized applicants (age 55 or older) for medical assistance under the OAA, APTD, QMB, QDWI, SLMB, SLMB135, and SLMB175 programs of

• DHHS’s obligation to recover from their estate *,

• that DHHS will only pursue recovery after the recipient’s death,

• that DHHS will pursue recovery from the recipient’s estate, but only if the recipient has no surviving spouse, child who is under age 21 years, or child who is blind or permanently and totally disabled, and

• that recovery is limited to the actual amount paid on behalf of the recipient from age 55.

Exception: If a court decides that benefits were incorrectly paid, reimbursement can be required while the recipient is alive or regardless of whether the above criteria are met.

*

Inform the individual of DHHS’s recovery obligations and the recipient’s rights and responsibilities with Form 770, Reimbursement Agreement and Acknowledgment. Failure or refusal to complete the medical assistance portion of Form 770 does not result in denial or termination from assistance.