Medicaid Estate Recovery in North Carolina
North Carolina recovers Medicaid medical assistance from the estates of recipients who were 55 or older when they received it, and from recipients of any age who were institutionalized and could not reasonably be expected to return home. The state does not place liens on the property, and it waives recovery entirely when the estate holds less than $50,000 in assets or the Medicaid claim is under $10,000.
Administering agency
North Carolina Department of Health and Human Services — Division of Health Benefits (NC Medicaid), Estate Recovery Program
Authority
N.C.G.S. 108A-70.5
Medicaid Estate Recovery in North Carolina: key facts
- Recovery scope
- Nursing facility services, home and community-based services, hospital care, prescription drugs, and personal care services paid by NC Medicaid; recovery cannot exceed the amount of assistance paid.
- Who is subject
- Recipients age 55 or older when assistance was received; recipients of any age who were inpatients in a nursing facility, ICF, or other medical institution and could not reasonably be expected to return home.
- Recovery deferred
- While a surviving spouse is living; while there is a surviving child under 21; while there is a surviving child of any age who is blind or disabled (42 U.S.C. 1396p(b)(2)(A)); or while a qualified undue-hardship applicant continues to meet the criteria.
- Recovery waived automatically
- North Carolina Medicaid waives recovery when the total assets in the estate are less than $50,000, or when the total Medicaid benefits paid on the recipient's behalf are less than $10,000. The State Plan's cost-effectiveness test adds a third limb for deaths on or after January 1, 2023: recovery is pursued only where the actual recovery expected from the estate is at least $5,000.
- Undue hardship waiver
- A qualified applicant (a lineal descendant of the decedent, a brother or sister, a lineal descendant of a brother or sister, or an heir) may apply for a full or partial waiver or deferral, generally tied to property that is the sole source of income for a surviving heir, or to the applicant's residence, with household income below 200 percent of the federal poverty level.
- Hardship application
- A claim of undue hardship must be made within 60 days of the date of the notice of the Medicaid claim, and is mailed to the HMS Estate Recovery Unit, PO Box 18869, Raleigh, NC 27619-8869. The Estate Recovery Administrator at 888-245-0179 provides the list of documents an undue-hardship claim may require. Each claim is evaluated within 90 calendar days of a complete application, with a written decision within 10 calendar days after the review; an heir who disagrees may appeal to the Office of Administrative Hearings within 60 calendar days of receiving the decision.
Governing law: N.C.G.S. 108A-70.5
Steps to take when someone dies
- Determine whether the deceased received NC Medicaid medical assistance at age 55 or older, or while institutionalized and not expected to return home.
- Confirm whether the estate falls under the automatic waiver: total estate assets under $50,000, or total Medicaid benefits paid under $10,000.
- Contact the NC Medicaid Estate Recovery Administrator at 888-245-0179 to confirm whether a claim applies and request the amount; the Department files its claim as a sixth-class creditor of the estate (N.C.G.S. 28A-19-6).
- Address the claim as a debt of the estate before distributing assets to heirs.
- If an heir qualifies, submit a complete undue-hardship application within 60 days of the date of the notice of the Medicaid claim.
North Carolina Department of Health and Human Services — Division of Health Benefits (NC Medicaid), Estate Recovery Program
Phone: 888-245-0179
Visit the agency website →Frequently asked questions
No. North Carolina Medicaid policy states that estate recovery does not include placing a lien on the property, and that recovery is not initiated until the beneficiary's death. The state pursues recovery from the estate after death under N.C.G.S. 108A-70.5.
North Carolina Medicaid waives recovery when the total assets in the estate are less than $50,000, or when the total Medicaid benefits paid on the recipient's behalf are less than $10,000. Either threshold on its own is enough for the waiver. The State Plan also treats recovery as not cost-effective, for deaths on or after January 1, 2023, where the actual recovery expected from the estate is under $5,000.
No. North Carolina recovers nursing facility services, home and community-based services, hospital care, prescription drugs, and personal care services paid by NC Medicaid for recipients who were 55 or older, and for recipients of any age who were institutionalized and not expected to return home. Recovery cannot exceed the amount of assistance paid.
Recovery is deferred while a surviving spouse is living, while there is a surviving child under 21, while there is a surviving child of any age who is blind or disabled, or while a qualified undue-hardship applicant continues to meet the criteria. When none of these circumstances remains, the Department may resume recovery.
Sources
Data sourced from Medicaid Estate Recovery in North Carolina primary sources (5 pages reviewed). How we research.
Administering agency
North Carolina Department of Health and Human Services — Division of Health Benefits (NC Medicaid), Estate Recovery Program
Authority
N.C.G.S. 108A-70.5