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. The regulation reaches all services and health premiums paid under the District's State Plan, including nursing facility services, home and community-based services, and related hospital and prescription drug services. 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. 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. 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 impose the lien if any of these people is lawfully residing in the home: the surviving spouse; the beneficiary's child who is under age 21 or is blind or disabled; or a sibling of the beneficiary who has an equity interest in the home and lived there for at least one year immediately before the beneficiary entered the medical institution. The DHCF fact sheet lists only the spouse and child exemptions; the sibling exemption comes from the regulation itself.

Small-claim floor

Recovery is not cost-effective, and may be waived, when the amount of the claim is less than $100.

Undue hardship

The District will not pursue recovery where it would cause undue hardship — where the home is the sole income-producing asset of a family business and recovery would cost the heir their livelihood (the business must have operated at the property for at least 12 months before the death and provide 100% of that person's livelihood), where recovery 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. Hardship does not exist where recovery merely inconveniences the heirs, restricts their lifestyle, or prevents an anticipated inheritance. A waiver applies only to the proportionate share of the estate passing to the person who qualifies.

Hardship and exemption deadlines

The personal representative or attorney of record must request the Undue Hardship Waiver Application within 15 business days of the date of the Notice of Proposed Recovery, then return the completed application with supporting documents within 30 calendar days of receiving it. An incomplete application is denied, with 5 additional working days to complete it; a late or still-incomplete application means the District seeks the full claim. DHCF answers a completed application within 30 calendar days. A denial can be appealed to the DC Office of Administrative Hearings within 30 days of the decision letter, though an appeal does not stop the District from filing its claim against the estate.

Governing law: 29 DCMR ch. 67, "Medicaid Program - Liens and Adjustments or Estate Recovery," 29 DCMR 6700-6799 (Final Rulemaking published at 53 DCR 6353, Aug. 4, 2006); 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.

Steps to take when someone dies

1. Determine whether the deceased received DC Medicaid coverage at age 55 or older.
2. Contact the DHCF Third Party Liability Division at 202-698-2000 to ask whether an estate-recovery claim applies and to request the claim amount in writing.
3. Watch for a Notice of Proposed Recovery. It carries the District's lien on the estate, itemizes what Medicaid paid, and states the exemptions and the undue-hardship procedure.
4. If an exemption or hardship applies, request the Undue Hardship Waiver Application within 15 business days of the date of the Notice, then return it completed, with supporting documents, within 30 calendar days of receiving it. A late or incomplete application means the District pursues the full claim.
5. If DHCF denies the application, note the 5 working days to cure an incomplete filing and the 30 days to appeal to the DC Office of Administrative Hearings. An appeal does not stop the District from filing its claim.
6. Treat any confirmed claim as a debt of the estate and address it before distributing assets to heirs.

Frequently asked questions