Medicaid Estate Recovery in North Dakota
North Dakota files a preferred Medicaid claim against the estate of a deceased Medicaid member who was 55 or older when they received services, or who was permanently institutionalized at any age. The claim is paid as a debt of the estate after funeral, last-illness, and administration expenses.
Administering agency
North Dakota Department of Health and Human Services — Estate Recovery Unit
Authority
N.D.C.C. 50-24.1-07
Medicaid Estate Recovery in North Dakota: key facts
- Who is subject
- A Medicaid member who was age 55 or older when services were received, or who was permanently institutionalized at any age and received a Notice of Permanent Institutionalization.
- Recovery scope
- The total medical assistance paid following the member's 55th birthday or institutionalization, allowed as a preferred claim against the estate after recipient liability, funeral expenses up to $3,500, last-illness expenses, and estate administration costs are paid.
- Recovery deferred
- No claim is required to be paid, and no interest accrues, during the lifetime of a surviving spouse, or while there is a surviving child under 21 or a surviving child of any age who is blind or permanently and totally disabled. A deferral does not stop the claim being filed: HHS still files it against the estate (a surviving spouse gets an informational claim instead) and it may be paid voluntarily. Only the share passing to the protected survivor is shielded — distributions to the decedent's other children remain subject to recovery.
- Surviving spouse's estate
- Deferral is not forgiveness. When the recipient's surviving spouse later dies, HHS may enforce the claim against that spouse's estate to the extent it holds assets traceable to the Medicaid recipient — and by statute all assets in the surviving spouse's estate are presumed to be assets the recipient had an interest in at death.
- Undue hardship waiver
- Federal law (42 U.S.C. 1396p(b)(3)) requires a hardship waiver process. North Dakota limits undue-hardship claims to surviving spouses, children under 21, and adult children with disabilities.
- Interest on an allowed claim
- An allowed claim begins earning interest 60 days after the claim-filing period expires, at 6% per annum, unless a deferral applies.
- Personal representative duty
- The personal representative must send the department a copy of the petition commencing probate, heirship, or joint-tenancy tax-clearance proceedings, with a list of legatees, devisees, surviving joint tenants, and heirs at law. If the department's claim is not paid in full, the personal representative must also provide a statement of assets and disbursements in the estate (N.D.C.C. 50-24.1-07(3)). HHS files its claim with the clerk of district court after Letters are signed and the probate paperwork reaches it; heirs cannot be paid until the debts are paid in full.
Governing law: N.D.C.C. 50-24.1-07
Steps to take when someone dies
- Determine whether the deceased received Medicaid at age 55 or older, or was permanently institutionalized.
- As personal representative, forward to the department a copy of the probate or heirship petition with a list of heirs, devisees, and surviving joint tenants.
- Contact the Estate Recovery Unit to confirm whether a claim applies and request the amount.
- If the estate passes to a surviving spouse, a child under 21, or an adult child with disabilities, ask the Estate Recovery Unit about the undue-hardship waiver — North Dakota limits it to those three groups.
- Pay the department's preferred claim as a debt of the estate, in the statutory order, before distributing remaining assets to heirs.
North Dakota Department of Health and Human Services — Estate Recovery Unit
Phone: (701) 328-2311
Visit the agency website →Frequently asked questions
No. North Dakota recovers the total medical assistance paid on behalf of a member after their 55th birthday, or after permanent institutionalization. The amount is a preferred claim against the estate after recipient liability, funeral expenses up to $3,500, last-illness expenses, and estate administration costs are paid.
Under N.D.C.C. 50-24.1-07, no claim is required to be paid during the lifetime of a surviving spouse, or while there is a surviving child under 21 or a surviving child of any age who is blind or permanently and totally disabled. A timely filed claim is not disallowed by these deferrals.
The personal representative must forward to the Department of Health and Human Services a copy of the petition commencing probate, heirship, or joint-tenancy tax-clearance proceedings, along with a list of the legatees, devisees, surviving joint tenants, and heirs at law of the estate. If the department's claim is not paid in full, the personal representative must also provide a statement of assets and disbursements in the estate.
No — it defers it. No claim has to be paid while the spouse is living, and the department sends an informational claim rather than enforcing one. When the surviving spouse later dies, the department may enforce the claim against that spouse's estate to the extent it holds assets traceable to the Medicaid recipient, and N.D.C.C. 50-24.1-07(5) presumes all assets in the surviving spouse's estate were assets the recipient had an interest in at death.
Federal law requires every state to have an undue-hardship waiver process. North Dakota's Estate Recovery Policy Manual limits undue-hardship claims to surviving spouses, children under age 21, and adult children with disabilities. Ask the Estate Recovery Unit how to request one.
Sources
Data sourced from Medicaid Estate Recovery in North Dakota primary sources (3 pages reviewed). How we research.
Administering agency
North Dakota Department of Health and Human Services — Estate Recovery Unit
Authority
N.D.C.C. 50-24.1-07