Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-33 - RECOUPMENTS, ESTATE RECOVERIES AND LIENS
Section 560-X-33-.05 - Estate Recovery
Universal Citation: AL Admin Code R 560-X-33-.05
Current through Register Vol. 43, No. 02, November 27, 2024
(1) Under the estate recoveries provisions in §1917(b) of the Act, the Alabama Medicaid Agency ("Agency") shall seek adjustment or recovery of any medical assistance correctly paid on behalf of the following categories of recipients:
(a) Permanently Institutionalized Recipients
of any age who are inpatients in a nursing facility, ICF/IID, or other medical
institution, and who must, as a condition of receiving services in the
institution under the State plan, apply their income (all but a minimal amount
allowed for personal needs) to the cost of care, the Agency shall seek
adjustment or recovery from the recipient's estate or upon the sale of the
property subject to a lien imposed on account of medical assistance paid on
behalf of the recipient.
(b) In the
case of a recipient who was 55 or older when the recipient received such
medical assistance, the Agency shall seek adjustment or recovery from the
recipient's estate for all approved medical assistance in accordance with
federal law and the approved State Plan, except for Medicare Cost Sharing as
described in
42 U.S.C.
§1396a(a)
(10(E)).
(c) Recipients with Long
Term Care Insurance Policies - If a recipient covered under a long-term care
insurance policy received benefits for which assets or resources were
disregarded in accordance with the Agency's State plan (State Long-Term Care
Insurance Partnership), the Agency will not seek adjustment or recovery from
the recipient's estate for the amount of assets or resources
disregarded.
(2) Delayed Recovery/Exemptions
(a) Adjustment or
recovery may be made only after the death of the recipient's surviving spouse,
if any, and when the recipient has no surviving child under age 21, or a blind
or permanently or totally disabled child as defined in
42
U.S.C. §1382c.
(b) If, after the reported death of the
recipient, the Agency is prohibited because of exemption conditions, the Agency
shall postpone recovery until all exemption conditions are no longer
present.
(c) Undue Hardship
(i) The Agency will waive or delay recovery
upon a showing that an undue hardship exists. For purposes of this Rule, "Undue
Hardship" is defined as the existence of a situation, established by convincing
evidence, that the estate subject to recovery is an asset such as a family farm
or family business which produces "limited income" (defined as equal to or less
than the income limit established in Rule
560-X-25-.14) and is the sole
income-producing asset of one or more heirs to the estate.
(ii) An undue hardship is not available in
the following circumstances:
(I) For
recipients with long term care insurance policies who became Medicaid eligible
by virtue of disregarding assets because of payments made by a long term care
insurance policy or because of entitlement to receive benefits under a long
term care insurance policy;
(II) If
the Agency determines the hardship was created by the recipient by resorting to
estate planning methods under which the recipient illegally divested assets in
order to avoid estate recovery.
(iii) Each heir with an interest in the
recipient's estate must apply for a separate undue hardship. If approved, that
heir's interest in the estate will be exempt from recovery while any of the
remaining heirs that did not apply for an undue hardship or were denied will
still be subject to recovery.
(3) Procedures
(a) The Agency may file claims against the
estate of a deceased recipient who received benefits incorrectly, in accordance
with existing law.
(b) The Agency
may file a claim against the estate of a deceased recipient as defined in
paragraph (1) above.
(c) In order
to protect its right to recover from a deceased recipient's estate, the Agency,
after obtaining the concurrence of the Attorney General, may file a petition
for letters of administration in situations where the Agency's claim warrants
the expense of administering the estate.
Author: Keith Thompson, Director, Third Party Liability
Statutory Authority: Social Security Act; State Plan; U.S.C. §1396p; 42 C.F.R. Parts 431, 433, and 455; Code of Ala. 1975, §§ 22-1-11, 22-6-8.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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