Medicaid Estate Recovery in Kentucky

What is recovered

Payments for a period of institutionalization: nursing facility, ICF-IID, and home- and community-based waiver services (including SCL, acquired brain injury, and Michelle P. waivers), plus related prescription drugs, hospital, and physician services.¹

The amount subject to recovery also includes Medicare cost sharing and premiums, and any capitation payment Medicaid made to a managed care organization for the recipient. Recovery cannot exceed what Medicaid paid.¹

Who is subject to recovery

A recipient age 55 or older who received covered services, or a recipient permanently institutionalized (in a nursing facility or ICF-IID for six months or more) at any age.¹

When recovery is deferred or barred

No recovery is made while there is a surviving spouse, or a surviving child who is under 21 or who is blind or disabled (as defined in 42 U.S.C. 1382c).¹

None of the exemptions apply if it is adjudicated that the recipient qualified for Medicaid fraudulently.¹

Long-term care partnership policies

Resources protected during the eligibility determination by a long-term care partnership insurance policy are outside recovery.¹

Undue-hardship waiver

Recovery is waived where it would work an undue hardship, for example a sole income-producing family farm or business conveyed to the surviving recipient family member. Residential real property that produces income through a lease or rental does not count as a sole income-producing asset.¹

The estate representative makes a written request to the Department for Medicaid Services within thirty days of the notice of intent to recover. The Department decides within thirty days of receiving the request and documentation, and a denial can be appealed through a KRS Chapter 13B hearing.¹

How the state files its claim

The provider reports the death to the local Department for Community Based Services office within ten days; the Department then serves the estate representative a written notice of intent to recover.¹

When the state does not pursue a claim

The Department may waive recovery as not cost effective. It does not treat recovery as cost effective when the estate's date-of-death value subject to recovery is $10,000 or less or is less than the administrative cost of recovering.¹

Governing law: 907 KAR 1:585

Provider report of the death to the local Department for Community Based Services office

ten days after the death¹

Written request for an undue hardship exemption

thirty days after receiving the notice of intent to recover; the Department decides within thirty days of receiving the request and supporting documentation¹

Local Department for Community Based Services office

Receives the provider's report of the recipient's death¹

Eligibility Policy Branch, Department for Medicaid Services

Estate recovery questions before the member's death²

Phone: 1-502-564-3440

1. 1.907 KAR 1:585, Estate recovery
2. 2.Third-Party Liability Branch (Kentucky Department for Medicaid Services)