Liens for Hospital and Nursing Home Residents
What is a lien and what effect does it have?
A lien is evidence of a debt or obligation that is filed against a
particular piece of property with the Register of Deeds. It is similar to a
mortgage in that it represents a debt that must be satisfied when the
property is sold. It does not affect the ownership of the property. It
does not require the member to sell his or her home.
When can the state place a lien on a home?
Under some circumstances, the state may place a lien on
the home of an inpatient hospital resident who is required to contribute
to the cost of care, or of a nursing home resident who is not reasonably
expected to return home. The state cannot place a lien on the home of a
member in the community.
Before placing a lien, the Medicaid program must notify the member (or his or her responsible party) in writing and inform the
the right to an administrative hearing concerning the lien process.
The state may place a lien on the home of a hospital or a nursing home
resident only if the member cannot reasonably be expected to
return home and none of the following people reside in the home:
- The member’s spouse or minor, disabled, or blind child.
- A brother or sister of the member who has an ownership interest
in the home and has continuously lived in the home beginning at least a
year prior to the hospital or nursing home admission of the Medicaid
If a lien is placed on the home, it must be removed when a member
returns home. If the member returns home, the local economic support
worker or the member should contact the state and the lien will be
When will payment of a lien be made?
A lien will be paid when the home is sold. The lien is paid
from the sale amount after the costs of the real estate transaction are paid
such as the realtor’s fee and any closing costs, and any mortgages on the
home which pre-date the Estate Recovery Program lien.
A lien will not be paid at the sale of a home, before or after the
member’s death, if the member has a living spouse or a minor,
disabled, or blind child. In addition, a lien will not be enforced after the
member’s death as long as either of the following resides in the home:
- A son or daughter of the member who continuously lived in the home
beginning at least 24 months before the member was admitted to the
hospital or nursing home and who provided care to the member that
delayed the member’s admission to the hospital or nursing home.
- A brother or sister of the member who continuously lived in the
home beginning at least 12 months before the member was admitted to the
hospital or nursing home.
What constitutes the amount paid by
At the time a property is sold, a lien enables the state
to recover specific amounts paid for Medicaid benefits. The Department
may recover funds for:
- All Medicaid services received while living in a nursing home on
or after October 1, 1991.
- All Medicaid services received while a member is
institutionalized in an inpatient hospital on or after April 1, 2000.
- Home health care services received by members age 55 or older
on or after April 1, 2000, consisting of:
- Skilled nursing services.
- Home health aide services.
- Home health therapy and speech pathology services.
- Private duty nursing services.
- Personal care services.
- All home and community-based waiver services (COP Waiver, CIP IA,
CIP IB, CIP II, Brain Injury Waiver, Community Supported Living
Arrangements) received by members age 55 or older on or after April
1, 2000, and
- Prescription/legend drugs received by waiver participants.
- Benefits associated with a wavier participant’s inpatient
- All pilot program Family Care services received on or after
February 1, 2000, and
- Prescription/legend drugs received by Family Care participants.
- Benefits associated with a Family Care participant’s inpatient
A lien only recovers for the amount paid by Medicaid for benefits up
to the date of sale. If more benefits are provided after the lien is
paid, or if all of the benefits already provided were not payable from
the sale, the state may file a claim in the member’s estate to
recover additional amounts.
What if I have questions about Medicaid
or the Estate Recovery Program?
If you have any questions, you may contact your local
county/tribal social or human services department or Medicaid Member
Services at 1-800-362-3002.
Does the Estate Recovery Program apply to
programs other than Medicaid?
Yes, the state also recovers:
- The cost of benefits paid by the Wisconsin Chronic Disease Program (WCDP)
for participants of any age for services that were provided on or after
September 1, 1995.
- The cost of benefits paid by the Community Options Program (COP) for
participants who are age 55 or older for services that were provided on or
after January 1, 1996.
- The actual costs of non-Medicaid Family Care services provided on or
after February 1, 2000, as reported to the Department for enrollees age 55
or older and living in the community; or that are any age and who live in
an inpatient hospital and are required to contribute to their cost of
care; or who live in a nursing home.
In the case of the COP and Family Care, any amount recovered is returned
to the program and used for the benefit of other participants.
Liens are never placed on the homes of COP and/or WCDP participants
during their lifetime because of receiving those services. Besides
recovering from the estate of the COP or WCDP participant, the State may
also recover from the estate of the participant’s spouse. For more
information about the Estate Recovery Program and these programs, contact
your COP, WCDP, or Family Care caseworker.
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