317.01 Reimbursement - Medical Assistance for Non-Institutionalized Individuals (MAM)

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Inform all non-institutionalized applicants for medical assistance under the OAA, ANB, MEAD, BCCP, and APTD programs:

. of DHHS's obligation to recover from their estate for medical assistance received by recipients age 55 and older;

. that for the purposes of recovery of medical assistance, a recipient's "estate" includes:

- all property, real or personal, in which the recipient holds an interest on the date of the recipient's death. Such interests include joint tenancy with rights of survivorship, tenancy in common, life estates, and living trusts, without regard to the date that such title or interest was established; and

- both assets that pass through probate and assets that pass outside the probate process, such as certain trust assets, assets held jointly, and unpaid annuity balances that benefit the recipient;

. that DHHS will only pursue recovery from the recipient's assets;

. that DHHS will only pursue recovery after the recipient's death, unless the property is voluntarily sold or refinanced while a lien is in place;

. that if DHHS's pursuit of recovery would cause undue hardship to the recipient's heirs, a waiver is available when recovery action begins;

. 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 and older.

Exception: If benefits were incorrectly paid, recoupment of the erroneous payment can be required while the recipient is alive or regardless of the above criteria for recovery. See PART 633, RECOUPMENT OF MEDICAL ASSISTANCE.

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

Scan the original signed DFA Form 770 into the individual's electronic case record.

References: He-W 695, RSA 167:13-16-a, RSA 167:28, 42 USC 1396p