Medicaid Estate Recovery in District of Columbia

Medicaid Estate Recovery in District of Columbia: key facts

Administering agency

DC Department of Health Care Finance (DHCF), the single state Medicaid agency for the District of Columbia. Estate-recovery questions go to the DHCF Health Care Operations Administration, Third Party Liability Division, at 202-698-2000.

Who is covered

A Medicaid beneficiary who received Medicaid coverage at age 55 or older is covered by estate recovery, and DHCF must ask the estate to repay the District for the services Medicaid paid for. Estate recovery does not include Medicare Part A and B premiums, deductibles, coinsurance, and copayments with dates of service on or after January 1, 2010.

What counts as the estate

An estate includes all real and personal property, including a home, owned by the deceased beneficiary that does not pass to another person at the time of death. Assets that pass outside probate by beneficiary designation or by operation of law are outside the estate.

How the District makes its claim

The District notifies the estate of its intent to file a claim by placing a lien on the estate (a Notice of Proposed Recovery). No lien is placed if an exemption is met. Once a lien is placed, the District may seek recovery only after the surviving spouse, a child under 21, or a blind or disabled child no longer lives in the home and the home is sold.

Exemptions

The District will not pursue the lien if the surviving spouse lives in the home, if the beneficiary's child under age 21 lives in the home, or if the beneficiary's child who is blind or disabled under Social Security rules lives in the home.

Undue hardship

The District will not pursue recovery where it would cause undue hardship — for example, where the home is the only income-producing asset of a family business and repayment would cost the heir their source of income, or where repayment would leave the heir without shelter they cannot otherwise afford. An heir who receives a Notice of Proposed Recovery files the Exemption and/or Undue Hardship Waiver Application sent with the notice and returns it to DHCF within 30 calendar days of receiving it.

Governing law: 42 U.S.C. 1396p(b) (federal Medicaid estate-recovery requirement); DC Medicaid State Plan Attachment 4.17-A (estate defined by D.C. Official Code 20-101(1)). D.C. Code 4-214.01 is a separate District claim against the estates of Old Age Assistance and Aid to the Disabled recipients.