Medicaid Estate Recovery in New Jersey

Medicaid Estate Recovery in New Jersey: key facts

Recovery scope

All Medicaid services paid on behalf of the recipient, including institutional care, non-institutional services, and managed-care (HMO) capitation payments — not limited to nursing-home costs. Medicare cost-sharing paid under the Medicare Savings Programs is excluded (effective January 1, 2010).

Who is subject

Beneficiaries and former beneficiaries who were 55 years of age or older at the time they received the services. Recovery covers all payments for services received on or after age 55.

Recovery deferred

While there is a surviving spouse, a surviving child under age 21, or a surviving child who is blind or permanently and totally disabled under Social Security standards (42 U.S.C. 1382c). When the exception ends — the spouse dies, the child turns 21, or the disability ends — DMAHS may recover from any remaining estate assets.

Hardship waiver

The estate representative has 20 days from receiving written notice of the DMAHS claim to request a waiver or compromise for undue hardship; DMAHS decides within 45 days. Undue hardship is shown only if the estate is or would become the survivors' sole income-producing asset and recovery is likely to leave one or more survivors eligible for public assistance or Medicaid.

Liens

DMAHS files a lien against the estate for all payments for services received on or after age 55. Where a family member lived in the beneficiary's home before death and it remains that family member's primary residence, DMAHS may record a lien but will not enforce it until the property is sold or the resident dies or moves out.

Governing law: N.J.S.A. 30:4D-7.2; N.J.A.C. 10:49-14.1

Frequently asked questions