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Wisconsin Medicaid Estate Recovery Program

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Estate Recovery Program

What is Medicaid?

Medicaid is a joint federal/state program that provides health care services to persons who have limited income and resources. The services paid for by Medicaid include the long term care services provided to some elderly persons and persons who are disabled.

What is the Estate Recovery Program?

The Wisconsin Medicaid Estate Recovery Program seeks repayment for the cost of certain long term care services paid for by Medicaid on behalf of members. Recovery is made from the estates of members and from liens placed on their homes. The money recovered is returned to the Medicaid Program and used to pay for care for other Medicaid members.

Long term care services for which the program seeks repayment mainly include nursing home services and community-based waiver services. (For information on other programs that are subject to Estate Recovery.) Wisconsin spends approximately 50 percent of its total Medicaid budget to provide these long term care services.

The U.S. Congress and the State Legislature passed Estate Recovery Program laws to recover some of the money used to pay for services for other Medicaid members. Those laws are designed to recover from the assets of those who received benefits from the Medicaid program. Recovery is made when a member and the member’s dependents no longer need those assets.

Which Medicaid members are affected by the Estate Recovery Program?

  • Medicaid members of any age who live in nursing homes may have the cost recovered for all benefits that were paid by Medicaid while they lived in a nursing home on or after October 1, 1991. Recovery is made by filing claims in estates and by filing liens against homes.
     
  • Medicaid members of any age who received inpatient hospital benefits on or after July 1, 1995, and who are considered institutionalized members, may have the cost recovered for all benefits paid by Medicaid that were received during such stays. Institutionalized members are members who have been, or are expected to be, inpatients in a hospital for 30 or more days, and who are required to pay their monthly income toward their cost of care. Recovery is made by filing liens against homes for all recoverable costs incurred after April 1, 2000, and by filing claims in estates for costs incurred after July 1, 1995, not recovered through a lien.
     
  • Medicaid members age 55 or older may have the cost recovered for only certain benefits received while they lived in the community. The benefits received on or after July 1, 1995, that may be recovered are:
     
    • Skilled nursing services.
    • Home health aide services.
    • Home health therapy and speech pathology services.
    • Private duty nursing services.
    • Personal care services received on or after April 1, 2000.
       
  • Medicaid members age 55 or older who reside in the community and receive services through a home and community-based waiver program (Community Options Program Waiver [COP Waiver], Community Integration Programs IA, IB, and II, Brain Injury Waiver, Community Supported Living Arrangements, and Family Care) may have the cost recovered for certain benefits received on or after July 1, 1995. The cost of Family Care Waiver services received on or after February 1, 2000, by enrollees are recovered as home and community-based Medicaid waiver program services. The benefits recovered from waiver members are:

  •  
    • All services received through a home and community-based waiver program.
    • All inpatient hospital services received while the member was eligible for a waiver program.
    • All prescription drugs received while the member was eligible for a waiver program.
       
  • An individual who receives all or a combination of the services listed above may have the cost of those services recovered from his or her estate or through a lien.

How does the state recover the cost of benefits?

The Estate Recovery Program uses two methods, claims in probate estates and liens, to recover the cost of Medicaid benefits.

The state seeks repayment by filing claims in probate estates to recover the cost for community-based services, services received while a member lived in a nursing home, and services received while a member was considered an institutionalized member in an inpatient hospital. If the member’s estate includes a home, the state may, in certain circumstances, receive a lien on the home rather than immediate repayment. (For more information on these types of liens, see the Probated Estates section regarding situations when the state’s estate claim will be delayed.)

Liens may also be filed on homes of members who live in inpatient hospitals and are required to contribute to their cost of care, or who live in nursing homes. Liens are filed only when members are not expected to return to their homes to live. (For more information on these types of liens, see the Liens for Hospital and Nursing Home Residents section).

When does the state not recover benefits?

The state may not seek recovery of any Medicaid benefits from a member’s estate while the member’s spouse or a minor, disabled, or blind child survives the member. However, if the member’s estate includes a home, the state will receive a lien. Repayment from the lien will be delayed until after the death of the surviving spouse and any minor, disabled, or blind children. Although the state is granted a lien by the court on the home of a surviving spouse or any minor, disabled, or blind child of a Medicaid member, if that property is sold for fair market value while the spouse or minor, disabled, or blind child lives, the state will release its lien and no recovery will be made.

The state may not file a claim on the estate of the surviving spouse to recover Medicaid benefits paid on behalf of the member.

There are similar protections in the lien portion of the program that apply to nursing home and hospital inpatient residents. The state may only place a lien on the home of a member who lives in a nursing home or in an inpatient hospital. In addition, the state may not place a lien on the home of a nursing home or hospital resident if there is a spouse or minor, disabled, or blind child residing in the home. The state may not place a lien on the home of a member living in the community. (For more information on liens, see the Liens for Hospital and Nursing Home Residents section).

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