317.04 Reimbursement - Medical Assistance Provided to Permanent Residents of Medical Institutions SR 95-68, 01/96 (AAM-A)

Inform applicants for medical assistance as a permanent resident of a nursing facility, intermediate care facility for the mentally retarded (ICF-MR), other medical institution of DHHS’s right to recover from their estate or the estate of their spouse when the estate is probated. Recovery is limited to all medical assistance received by the recipient.

A lien can be filed on real property owned by recipient. A lien can also be filed on the recipient’s home while the recipient is still living provided that all of the following conditions are met:

• the individual’s home is not currently occupied by the individual’s:

- spouse,

- child who is under age 21,

- child who is blind or permanently and totally disabled as defined in Section 1619 of the Social Security Act, or

- sibling who has equity value in the home and who was resided in the individual’s home for a period of at least 1 year immediately before the date of the individual’s admission to the medical institution.

• the recipient is given an advance notice period and opportunity for a fair hearing, and,

• the District Office determines that the individual cannot be reasonably expected to be discharged from the medical institution and return home.

Exception: If a court decides that benefits were incorrectly paid, reimbursement can be required even though the above criteria are met.

Any lien must be removed and dissolved upon the individual’s discharge as a permanent resident of a medical institution.

• A lien is not filed on occupied real property, nor is reimbursement pursued until the deceased recipient has no surviving :

- spouse,

- child who is under age 21,

- child who is blind or permanently and totally disabled as defined in Section 1619 of the Social Security Act, or

- sibling who has equity value in the home and who was resided in the individual’s home for a period of at least 1 year immediately before the date of the individual’s admission to the medical institution.

Exception: If a court decides that benefits were incorrectly paid, reimbursement can be required regardless of the individual’s survivors.

Inform the individual of this potential action with Form 770, Reimbursement Agreement and Acknowledgment. Failure or refusal to complete Form 770 will result in denial or termination of assistance.