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What is the difference between Medicaid and Medicare... ?Medicaid
is funded by the federal and state government to pay for the medical care of
certain individuals who are unable to finance their own medical expenses.
To qualify for Medicaid, an individual must have limited
income and resources. The state of West Virginia operates the Medicaid program
according to federal law. Medicaid will only pay for services covered by the
program. Medicare
is a federal program under the Social Security Administration designed
to assist in the payment of medical bills of senior citizens and certain
disabled individuals. Medicare subsidizes the cost of medical care
and recipients must pay their share of medical bills not covered by this
program. Back to TopWhen was the Medicaid Estate Recovery Law passed... ?The
Omnibus Reconciliation Act (OBRA) of 1993 was enacted on August 10,
1993. Its effective date was
October 1, 1993 which allowed the states time to adopt OBRA. As a result of OBRA,
the State of West Virginia passed legislation to
implement Medicaid Estate Recovery in March, 1995. Under this legislation the
West Virginia Department of Health and Human Resources is required to recover
Medicaid payments made after June 6, 1995 from the estates of individuals
aged 55 or older. Back to TopWhat is Estate Recovery and how does it work... ?Under
the West Virginia Probate Code, the State of West Virginia Department of Health
and Human Resources as a state agency has priority over certain other private creditors.
The personal representative or the attorney probating the estate will use
the proceeds from the sale of estate property to reimburse the Medicaid Program
for medical expenses paid on the recipient’s behalf. Example:
Mr. Roberts, a widower, left his only property, a house valued at
$75,000, to his son. Following his death, his estate incurred a total of $4,000
in funeral and administrative expenses.
In addition, West Virginia Medicaid had provided $24,000 for Mr.
Robert’s nursing home care and other related medical services.
If Mr. Roberts’ son sold the home, he would received the proceeds from
the sale of the house (i.e. $75,000), less $4000 for funeral and administrative
expenses and $24,00 for Medicaid costs. Consequently, Mr. Roberts’ son would
only receive the remaining $47,000 from the sale.
Alternatively, he could retain ownership of the house by reimbursing the
state for the $24,000 provided for his father’s medical services. Back to TopWhat is an Estate... ?Under
West Virginia Probate Code, an estate is comprised of any real and personal
property owned by an individual at the time of his/her death, including any
partial ownership interests. This includes personal property conveyed from a
deceased recipient to an heir by will or by the rules of
intestate succession (i.e. no will). If
the recipient jointly owns any property with others, then the state may only
recover the portion of any sale proceeds equal to the recipient’s ownership
interest. Back to TopWhose Estates will be effected... ?¨
Recipients, age 55 or older, whose
nursing home and/or community based waiver services were paid by Medicaid. What
costs will be recovered?
Any
payments by Medicaid for: ¨
Nursing home, ICF/MR
care or home and community based waiver care (this is a special program that
allows recipients to receive medical services in the home or a community –
based setting instead of a nursing home); ¨
Related hospital or prescription
drug services provided while the recipient was in one of the listed programs. NOTE:
Food stamps, emergency assistance and cash grants, however, are not deemed
Medicaid costs, and are exempt from the Estate Recovery Program. Back to TopWill Recovery be exempted from an Estate in any circumstances... ?Yes.
Recovery
will be deferred: ¨ if the recipient has a surviving
spouse; ¨ if the recipient has a surviving child who is under age 21, or blind or permanently disabled Recovery
may occur when the condition upon which the delay was based no longer exists (i.e.,
the surviving spouse passes away or the child becomes
age 21). Consequently,
the State may impose a property lien after the recipient’s death, which will
be executed only if the condition no longer exists that prohibited recovery. As
in other estate recoveries, only the portion of the proceeds which represents
the recipient’s interest in the property is subject to recovery. Are
there any exemptions if estate recovery would cause a hardship?
Yes.
Full recovery will not
be pursued if it would cause the recipient’s heirs undue hardship.
If action is taken to recover Medicaid expenses from the recipient’s
estate, (i.e. a creditor’s claim) the heirs may ask to have the recovery
waived or compromised based on hardship. All
undue hardship requests will be carefully considered and decisions will be based
on guidelines as set forth in Medicaid’s
regulations. If
the recipient’s heirs fail to qualify for an undue hardship exemption, they
may show evidence of financial support given to the recipient for medical care
prior to Medicaid. In such
instances, Medicaid may reduce its claim in an
amount equal to all payments made by the recipient’s heirs. Please
note: An undue hardship waiver may
only be requested after the state files a claim against the estate. Can
a recipient’s heirs keep the estate property by repaying the state of West
Virginia? Yes.
The recipient’s heirs may have the state’s claim withdrawn by paying
the lesser of: ¨
the amount the state is titled to
recover; or ¨
the fair market value of the estate
property. Back to TopAre recipients required to sell his/her home... ?No.
The program does not require a recipient to sell his/her home to be eligible to
receive Medicaid while he/she is alive.
The State of West Virginia may, however, place a lien on property while
the recipient resides in a long-term care facility and is determined to be
permanently institutionalized. The
lien is filed to ensure that Medicaid expenses paid on the recipient’s behalf
will be recovered when the property is eventually sold or transferred. How will the State recover the cost... ?When
a recipient whose nursing home, or home and community based waiver costs were
paid by Medicaid dies, the State will file a proof of claim against the
recipient’s estate. This claim is
filed with the probate court in which the recipient lived.
This claim applies to all of the property (personal, real, and intangible) owned
by the recipient at the time of his/her death. In addition, this claim will
prevent the transfer of any estate assets prior to satisfying creditor’s
claims. |
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