Compilation of Rules and Regulations of the State of Georgia
Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH
Chapter 111-3 - MEDICAL ASSISTANCE
Subject 111-3-8 - ESTATE RECOVERY
Rule 111-3-8-.02 - Definitions

(1) "Authorized representative" means a guardian or a person designated by the Member to act on his or her behalf during the Member's life.

(2) "Creditor" means an entity (person or institution) to whom an obligation is owed because a Member received something of value in exchange.

(3) "Debt" means a sum of money owed from one person to another, including the right of the creditor to receive and enforce payment.

(4) "Department" means the Georgia Department of Community Health, Division of Medical Assistance.

(5) "Discharge from the medical institution and return home" means a qualifying discharge, which involves the Member's dismissal from the nursing institution and/or facility for at least thirty (30) days wherein the Member's personal effects and bed are released at the same time of his or her discharge.

(6) "Equity interest in the home" means value of the property in which the Member holds legal interest beyond the amount owed on it in mortgages and liens.

(7) "Estate" means all real and personal property under the probate code, including real and personal property passing by reason of joint tenancy, right of survivorship, life estate, survivorship, trust, annuity, Individual Retirement Accounts, homestead or any other arrangement. Estate also includes excess funds from a burial trust or contract, promissory notes, cash, and personal property. Estates with a gross value of $25,000 or less are exempt from estate recovery.

(8) "Hearing" means a formal proceeding before an Administrative Law Judge or Probate Judge in which an aggrieved party affected by an action or an intended action of the Department shall be allowed to present testimony, documentary evidence, and argument as to why such action should or should not be taken.

(9) "Heirs" means heirs-at-law who are entitled under the statutes of intestate succession to property of a decedent and beneficiaries who are entitled to inherit the estate if there is a lawful will.

(10) "Lawfully residing" means permissive use by the owner/power of attorney at the law.

(11) "Lien" means a claim, encumbrance or charge against the Medicaid Member's real or personal property on account of medical assistance paid to the Member correctly under the State Plan. A Lien may be placed on the real property of a Member who is an inpatient of a nursing facility, intermediate care facility for individuals with intellectual disabilities, or other institution or a Lien may be placed on both real and personal property of a Member after the Member's death.

(12) "Long-term care" means a service provided in a long-term care facility or in the home, pursuant to federally approved home and community based services, as an alternative to institutionalization.

(13) "Medical assistance" means payment by the State's program under Title XIX of the Social Security Act or Medicaid program administered by the Department.

(14) "Member" means a person who has been certified as Medicaid eligible, pursuant to the terms of the State Plan, to have medical assistance paid on his or her behalf.

(15) "Member's home" means a true, fixed and permanent domicile and principal establishment to which the Member has the intention of returning to whenever absent.

(16) "Permanently institutionalized" means residing in a nursing facility or intermediate care facility for individuals with intellectual disabilities and developmentally disabled for six (6) consecutive months or more.

(17) "Personal representative" means an executor, administrator, guardian, conservator, committee, trustee, fiduciary, or other person having a status which by operation of law or written instrument confers upon such person a duty of distributing property to Heirs.

(18) "On a continuous basis" means that the qualifying relative lived with the Member in the Member's home at his or her principal place of residence during an uninterrupted timeframe. An absence of residence greater than six months is presumed to disrupt the continuity of residence.

(19) "Residing in the home for at least one or two years" means one is domiciled in the principal place of residence.

(20) "State Plan" means all documentation submitted by the Commissioner, on behalf of the Department, to and for approval by the Secretary of Health and Human Services pursuant to Title XIX of the federal Social Security Act of 1935, as amended.