Recovery Against Elders Receiving Medi-Cal Benefits
In California, upon the death of a Medi-Cal recipient, the state can seek repayment from the estate of the deceased for the cost of certain Medi-Cal services received. For the past 20 plus years, the state of California has allowed claims to be made on the estates of those who received any Medi-Cal benefits if they were 55 years or older. After the Medi-Cal recipient dies the state will send the heirs or survivors an “estate recover claim” asking for payment equal to the benefits paid on behalf of the deceased individual. However, the recovery laws in California have recently changed for those who pass away on or after 2017.
New Medi-Cal Recovery Laws for Individuals Passing Away After January 1, 2017.
SB 33 and SB 833 incorporated Medi-Cal reform provisions which severely restrict recovery from those who die on or after January 1, 2017.
The new law limits recovery only to those estate assets subject to California probate. Property not subject to probate is exempt from an estate recovery claims. Thus, assets transferred via living trusts, joint tenancies, survivorship and life estates will generally no longer be subject to recovery.
The new law prohibits claims on the estate of surviving spouses and registered domestic partners. If a Medi-Cal recipient is survived by a spouse or a registered domestic partner, a claim is prohibited and forever barred on such deceased spouse’s estate. However if the surviving spouse or registered domestic partner also received Medi-Cal services subject to recovery, his/her estate can be subject to an estate claim after his/her death.
The new law limits recovery to those 55 years or older that receive benefits from nursing facilities and home and community based services; also those under 55 and permanently institutionalized. Thus, the state can no longer recover for basic health services such as doctor’s visits, prescription drug costs or managed care reimbursements unless the services are related to nursing home care or home and community based services.
The new law restricts the amount of interest that the state can charge on liens.
The new law requires the state to waive claims as a “substantial hardship” when the estate subject to recovery is a homestead of modest family (home whose FMV is 50 percent or less of the average homes in the county where the homestead is located).
The new law requires the state to provide current or former beneficiaries or their authorized representatives the amount of Medi-Cal expenses that may be recoverable, once per year, for a fee of $5.
You can find more information about the new law and its impact on California Medi-Cal receipients at the California Advocates for Nursing Home Reform website found at www.canhr.org.