Medicaid Estate Recovery in Virginia

What is recovered

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.¹

For people eligible for both Medicare and Medicaid, Medicare cost-sharing (Part A and B premiums, deductibles, coinsurance and copayments) with dates of service on or after January 1, 2010 is not recovered.¹

What counts as the estate

The estate recovery regulation defines the estate as 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, which is broader than the probate estate alone.¹

When recovery is deferred or barred

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).¹

Undue-hardship waiver

DMAS waives recovery for undue hardship, with special consideration where the estate is the sole income-producing asset of survivors (a family farm or business) or a homestead of modest value.¹

Recovery is also waived when the heirs are themselves Medicaid eligible.¹

When the state does not pursue a claim

Recovery is waived when it would not be cost effective, and no hardship has to be asserted for that waiver.¹

How the state files its claim

After a member's death, DMAS determines whether estate recovery is appropriate and, if so, files a claim against the estate for the medical assistance payments made on the member's behalf.^{2, 3}

Heirs who want to keep the home instead of selling it may contact DMAS to arrange other repayment options.²

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

Written appeal of a denied undue-hardship request

within 30 days, from whichever of the two occurs first of receipt of the DMAS denial letter or the distribution of estate assets²

Local department of social services

Questions about a specific estate recovery case, through an eligibility worker²

• A phone number for this

1. 1.12VAC30-20-141, Estate recoveries
2. 2.Estate Recovery Fact Sheet (Virginia Department of Medical Assistance Services), rev. 08-24-2022
3. 3.Va. Code § 32.1-327