Medicaid Estate Recovery in Hawaii

What is recovered

The department files a claim against the estate of the deceased recipient for the amount of medical assistance granted.¹

Correctly made payments are recoverable only for people who were in a nursing facility, an intermediate care facility, or another medical institution, or for benefits paid on or after October 1, 1993 to a person who was age 55 or older when the services were received (Haw. Admin. R. 17-1705-56(b)).²

Who is subject to recovery

Recipients age 55 or older when the medical assistance was received. A claim is filed only when there is no surviving spouse and no surviving child who is under 21 or blind or disabled (Haw. Rev. Stat. 346-37(a)).¹

Haw. Rev. Stat. 346-37(a) separately directs a claim against the estate of a recipient who was an inpatient in a nursing facility, an intermediate care facility for individuals with intellectual disabilities, or another medical institution, when there is no surviving spouse or child who is under 21, blind, or disabled.¹

When recovery is deferred or barred

Recovery can be made only after the death of the surviving spouse, if any, and only when there is no surviving child who is under 21 or who is blind or disabled (Haw. Admin. R. 17-1705-56(c)).²

Undue-hardship waiver

Haw. Admin. R. 17-1705-56(e) waives recovery for the period the estate is the survivors' sole income-producing asset and is a family farm or other family business producing income no greater than 100% of the federal poverty guidelines for the survivors dependent on it.²

Recovery is also waived for a homestead of modest value occupied by survivors who lived there from at least three months before the recipient entered a medical institution, provided care that let the recipient stay home, own no other real property, and have income no greater than 100% of the federal poverty limit.²

42 U.S.C. 1396p(b)(3)(A) separately requires the state agency to waive recovery where it would work an undue hardship.³

Liens on real property

Separate from an estate claim, the department may record a lien with the Bureau of Conveyances against the home of a recipient in a medical institution who cannot reasonably be expected to return home (Haw. Admin. R. 17-1705-57).²

No lien attaches while a spouse, dependent child, or a sibling with an equity interest who lived there for at least a year is living in the home, and the lien dissolves if the recipient is discharged and returns home.²

Governing law: Haw. Rev. Stat. 346-37

Request for a fair hearing on a notice of intent to file a lien

within 90 days of the date of the DHS 1170 notice⁴

Bureau of Conveyances

Records the department's lien against the home of a recipient in a medical institution²

1. 1.Haw. Rev. Stat. 346-37
2. 2.Haw. Admin. R. chapter 17-1705, Medical Assistance Recovery
3. 3.42 U.S.C. 1396p
4. 4.DHS 1170 Notice of Intent to File a Lien (Rev. 09/13), Rev. 09/13