Medicaid Estate Recovery in Virginia

Medicaid Estate Recovery in Virginia: key facts

Recovery scope

Medical assistance paid for a recipient who was age 55 or older when the assistance was received, consistent with the State Plan for Medical Assistance.

Estate reached

Under 12VAC30-20-141, "estate" includes all real and personal property held by the individual at death and any other property in which the individual had any legal title or interest at the time of death — broader than the probate estate alone.

Recovery deferred

Recovery can only be made after the death of a surviving spouse, if any, and only when there is no surviving child under age 21 and no blind or disabled child (as defined in Social Security Act § 1614).

Hardship waiver

DMAS waives recovery for undue hardship, with special consideration where the estate is the sole income-producing asset of survivors (family farm or business) or a homestead of modest value. Recovery is also waived when the heirs are themselves Medicaid eligible, and when recovery would not be cost effective. For dual eligibles, Medicare cost-sharing (Part A and B premiums, deductibles, coinsurance, copayments) with dates of service on or after January 1, 2010 is not recovered.

Governing law: Va. Code §§ 32.1-326.1, 32.1-327; 12VAC30-20-141

Steps to take when someone dies

1. Determine whether the deceased received Virginia Medicaid medical assistance at age 55 or older.
2. DMAS determines after the member's death whether estate recovery is appropriate and, if so, files a claim against the estate for the medical assistance payments made.
3. Address the claim as a debt of the estate before distributing assets to heirs. Heirs who want to keep the home instead of selling it may contact DMAS to arrange other repayment options.
4. Apply for an undue-hardship waiver if the estate is a homestead of modest value, a family farm or business, or the sole income-producing asset of survivors. If the request is denied, a written appeal may be filed within 30 days after receipt of the DMAS denial letter or the distribution of estate assets, whichever occurs first.
5. Direct questions about a specific case to an eligibility worker at the local department of social services, which is the contact route DMAS publishes.

Frequently asked questions