Medicaid Estate RecoveryWhat is the estate recovery law?
After the death of a person who received Title XIX funded medical assistance (Medicaid) for Long Term Care (LTC) services, Home and Community Based services (HCBS), and related hospital and prescription drug services after the age of 55, federal law requires that the Louisiana Department of Health (LDH) seek recovery from the assets of his/her estate as repayment.
Estate recovery is mandated by:
- Federal law - Section 1917b of Title XIX of the Social Security Act (42 U.S.C. 1396P)
- Code of Federal Regulations (CFR) - 42 CFR 433.36
- Louisiana law - LSA R.S. 46:153.4
- Louisiana Administrative Code (LAC) - LAC Title 50: Part I, Subpart 9.Recovery
- Louisiana Medicaid State Plan - LA Medicaid State Plan Section 4.17 and Attachment 4.17a
What is an estate?
An estate is defined in LAC Title 50: Part 1, Subpart 9 Recovery as “the gross total of all assets owned by the deceased at death as determined by Louisiana succession law, and any interest in any property.
Who is affected?
Estate recovery affects deceased Louisiana Medicaid recipients who received LTC, HCBS, and related hospital and prescription drug services (including PACE) after age 55. Heirs of such recipients may also be affected, and may become personally liable to the Medicaid program to the extent that they receive assets of the Estate without first contacting LDH and ensuring that LDH receives its allowed recovery from the Estate.
Can the debt be deferred?
Yes, if a spouse survives the decedent, the estate recovery case must be placed in deferred status, with a deferral notice issued to the surviving spouse or other family member. Upon notification of the death of the surviving spouse, the case is opened and recovery begins.
Can the repayment be exempt or waived?
Yes, an estate may be determined exempt or waived, if certain criteria are met.
ExemptionAn estate may be exempt from estate recovery, if the decedent had one of the following at the time of death:
- A surviving child who is disabled or blind (as defined by the Social Security Administration), or under the age of 21;
- A child who lived with the decedent in his/her home to provide care for 2 years immediately preceding entry into the nursing facility; or
- A sibling who lived with the decedent in his/her home to provide care for 1 year immediately preceding entry into the nursing facility.
WaiverEstate recovery is waived, if a first-degree heir (child of the decedent) had family income 300 percent or less of the Federal Poverty Income Level the year preceding the decedent’s death (as verified by LDH).
Estate recovery may be waived, if one of the following applies to a first-degree heir (child of the decedent), is verified, and is approved by LDH:
- The property is a primary and only residence of one or more of the decedent's son(s) and/or daughter(s);
- One or more of the decedent’s son(s) and/or daughter(s) used and hopes to continue using the homestead as a means of livelihood, including farming or ranching;
- Recovery would result in one or more of the decedent's son(s) and/or daughter(s) becoming eligible for public assistance including, but not limited to, Medicaid; or,
- There are any other circumstances and evidence that recovery from the decedent's estate would jeopardize the son(s) and/or daughter(s) family or severely disrupt the family income of the decedent's son(s) and/or daughter(s), and the son(s)/daughter(s) have additional circumstances and evidence to present.
How will I know how much money is owed to LDH?
Requests for LDH's estate recovery claims are generally received from:
- The LDH/Medicaid Long Term Care Unit
- Attorneys (succession attorney or other attorney for the family/family member)
- Family member(s)
- Authorized Representative of the Recipient
- Power of Attorney
Requests for LDH's estate recovery claims should be submitted via its TPL Recovery Portal, or may be emailed to its Recovery and Premium Assistance (RPA) Unit at Medicaid.TraumaEstateRecovery@la.gov or faxed to (225) 342-1376. Note: LDH's claim does not accrue interest.
How is payment made?
Payment can be made in the form of a personal check, money order, or cashier's check, and must be made payable to Louisiana Department of Health.
Mail payments to:
LDH/Recovery and Premium Assistance Unit
Attn: Estate Recovery Team
P.O. Box 3558
Baton Rouge, LA 70802-3558
Who can help answer estate recovery questions?
LDH's Recovery and Premium Assistance Unit will assist with questions and can be reached at:
Phone: (225) 342-8662
Fax: (225) 342-1376
Mail: P.O. Box 3558, Baton Rouge, LA 70821-3558
LDH can only provide general information about the estate recovery process and cannot advise you on succession law. If you have any questions in that regard, please seek legal counsel.
What about special needs trusts and annuities?
Special Needs Trusts and annuities are not categorized as estate recovery and therefore related considerations do not apply (i.e. exemption, waiver, deferral, offsets, etc.). However, residual funds from Special Needs Trusts with a Medicaid payback clause and annuities with State of Louisiana and/or Louisiana Department of Health (f.k.a. Department of Health and Hospitals) listed as the primary beneficiary must be used for reimbursement of Medicaid payments made.