Estate Recovery
Overview
Under certain circumstances, Medicare will provide for an individual’s nursing home coverage
for a limited time. Most people, pay for nursing home care out of their own pocket until they have exhausted their savings, and then
rely on Medicaid to pay for their remaining medical expenses.
HMS, a Gainwell Technologies Company, is contracted with WVDHHR, Bureau for Medical Services (BMS) to provide Recovery Services for the Estate Recovery Program. 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 BMS for medical expenses paid on behalf of the recipient.
History
In 1993, Congress enacted the Omnibus Budget Reconciliation Act of 1993 (OBRA ‘93) requiring
the recovery of medical assistance payments from the estates of deceased Medicaid recipients age 55 and older. In the State of West
Virginia, the recovery of medical assistance payments is accomplished by filing a claim against the deceased recipient’s estate with
the probate court. The identification and verification of estates and the calculation of the appropriate claim amount are conducted
in compliance with the state and federal laws and the Medicaid State Plan.
Resources
Notification of Death Form
Nursing Home Administrators and Waiver Care Providers: The Notification of Death form is to be filled out and returned for every resident of your facility or participant of your program who was receiving Medicaid benefits. We ask that this form be filled out and returned to us within three days of the recipient's passing.
The Estate Recovery Brochure will give you a general description of the program and hopefully answer questions you may have. The brochure contains contact information for any further questions.
During the Estate Recovery process family members are able to request a hardship waiver so that recovery may be waived or, at least, delayed. Please see the complete Hardship Waiver Guidelines.
All recoveries are returned to WV BMS and the Federal Government.
Federal and State law require the State to pursue repayment of Medicaid funds from any third party responsible for injuries suffered by a Medicaid recipient.