Medicaid Estate Recovery in District of Columbia

Who is subject to recovery

The DHCF fact sheet says 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.¹

What is recovered

29 DCMR 6701.2 makes all services and health premiums paid under the District's State Plan subject to recovery for anyone who received medical assistance at age 55 or older, including nursing facility services, home and community-based services, and related hospital and prescription drug services.²

Estate recovery does not include Medicare Part A and B premiums, deductibles, coinsurance, and copayments with dates of service on or after January 1, 2010.¹

D.C. Code 4-214.01 is a separate District claim against the estates of Old Age Assistance and Aid to the Disabled recipients.³

What counts as the estate

The State Plan, adopting D.C. Official Code 20-101(1), and 29 DCMR 6799 define the estate as 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.^{4, 2}

Assets that pass outside probate by beneficiary designation or by operation of law are outside the estate.^{4, 2}

How the state files its claim

The fact sheet says the District notifies the estate of its intent to file a claim by placing a lien on the estate (a Notice of Proposed Recovery), and no lien is placed if an exemption is met.¹

Under 29 DCMR 6704.2 the notice must itemize the medical services Medicaid paid, state the legal basis for the claim, list all exemptions from recovery, and set out the undue-hardship procedure with appeal rights and deadlines.²

Under 29 DCMR 6705.2, filing an appeal does not stop the District from filing its claim against the estate.²

When recovery is deferred or barred

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.¹

Exemptions and protected assets

Under 29 DCMR 6702.1 the District will not impose a lien on the home while the surviving spouse, or the beneficiary's child who is under age 21 or is blind or disabled, is lawfully residing there.²

Nor will it impose the lien while a sibling of the beneficiary is lawfully residing in the home who has an equity interest in it and lived there for at least one year immediately before the beneficiary entered the medical institution.²

When the state does not pursue a claim

29 DCMR 6702.3 treats recovery as not cost-effective, and allows the claim to be waived, when the amount of the claim is less than $100.^{2, 4}

Undue-hardship waiver

Under 29 DCMR 6703.1 the District will not pursue recovery where the home is the sole income-producing asset of a family business that operated there for at least 12 months before the death and provides 100% of an heir's livelihood, and recovery would cost the heir that livelihood.²

The District also will not pursue recovery where it would leave the person without shelter they cannot otherwise afford, or where the estate proceeds would make the difference in that person's eligibility for assistance payments.¹

Hardship does not exist where recovery merely inconveniences the heirs, restricts their lifestyle, or prevents an anticipated inheritance.¹

Under 29 DCMR 6703.4 a waiver applies only to the proportionate share of the estate passing to the person who qualifies.²

Governing law: 29 DCMR 6700-6799 (ch. 67); 42 U.S.C. 1396p(b); DC Medicaid State Plan Attachment 4.17-A; D.C. Code 4-214.01 (a separate claim)

Request for the Undue Hardship Waiver Application, by the personal representative or attorney of record

within 15 business days of the date of the Notice of Proposed Recovery²

Return of the completed application with supporting documents

within 30 calendar days of receipt of the application; A late or still-incomplete application means the District seeks the full amount of the claim.²

Completing an application denied as incomplete

within 5 additional working days of the date of the denial notice; A still-incomplete application means the District seeks the full amount of the claim.²

DHCF's answer to a completed application

within 30 calendar days of receipt of the completed application²

Appeal of a denial to the DC Office of Administrative Hearings

within 30 days of the decision letter²

DC Office of Administrative Hearings

Appeals of DHCF undue-hardship waiver decisions²

1. 1.DHCF Medicaid Estate Recovery Fact Sheet (version Aug. 19, 2015)
2. 2.29 DCMR ch. 67, "Medicaid Program - Liens and Adjustments or Estate Recovery," 29 DCMR 6700-6799 (Final Rulemaking, 53 DCR 6353, Aug. 4, 2006)
3. 3.D.C. Code 4-214.01
4. 4.DC Medicaid State Plan Attachment 4.17-A (estate defined by D.C. Official Code 20-101(1))