Medicaid Estate Recovery in Washington
Apple Health (Washington Medicaid) is run by the Health Care Authority, and estate recovery is collected by the DSHS Office of Financial Recovery. For services received on or after January 1, 2014, recovery is limited to long-term services and supports — nursing facility care, home and community-based services, and related hospital and prescription drug costs — provided to a recipient aged 55 or older.
Administering agency
DSHS Office of Financial Recovery (OFR) — Estate Recovery Unit
Authority
RCW 41.05A.090; RCW 43.20B.080; WAC 182-527-2738 (recovery bar); WAC 182-527-2740 (age); WAC 182-527-2742 (services); WAC 182-527-2750 (undue hardship)
Medicaid Estate Recovery in Washington: key facts
- Recovery scope (services received on or after Jan 1, 2014)
- Nursing facility services, home and community-based services (including COPES, CFC, IFS, PACE, and Medicaid Personal Care), and related hospital and prescription drug costs paid for a client age 55 or older.
- State-funded long-term care
- State-only funded long-term care services and related charges are recoverable from estates of recipients of any age. Adult protective services, offender reentry community safety program services, supplemental security payments authorized by developmental disabilities community services, volunteer chore services, and guardianship and conservatorship assistance program services are excepted (WAC 182-527-2742(1)).
- Recovery barred
- The state cannot recover from the estate so long as there is a surviving spouse, or a surviving child who is age 20 or younger or who is blind or disabled (WAC 182-527-2738(3)).
- Medicaid transformation services exempt
- For dates of service beginning July 1, 2017, long-term services and supports authorized under the medicaid transformation project — including medicaid alternative care and tailored supports for older adults — are exempt from estate recovery.
- Hardship deferral
- An heir may ask the state to delay recovery for undue hardship. Undue hardship exists only when the property subject to recovery is an heir's sole income-producing asset, when recovery would deprive an heir of shelter and the heir cannot afford alternative shelter, or when the client is survived by a state-registered domestic partner (WAC 182-527-2750).
- Conditions on a granted deferral
- An heir granted a delay must reside on the property, not sell, transfer, or encumber it, keep property taxes and utilities current, and insure it with the state of Washington named as primary payee (WAC 182-527-2750(4)).
Governing law: RCW 41.05A.090; RCW 43.20B.080; WAC 182-527-2738 (recovery bar); WAC 182-527-2740 (age); WAC 182-527-2742 (services); WAC 182-527-2750 (undue hardship)
Steps to take when someone dies
- Confirm whether the deceased received Apple Health long-term services and supports at age 55 or older, or any state-funded long-term care.
- Report the death to the OFR Estate Recovery Unit at 1-800-562-6114 and ask whether a claim or lien will be filed.
- Treat the OFR claim as a debt of the estate before distributing assets to heirs.
- If recovery would create undue hardship, request a hardship deferral from OFR at 1-800-562-6114. You may request one if you are:
- The state-registered domestic partner of the deceased
- An heir for whom recovery would deprive you of a place to live and you have no money to live somewhere else
- An heir with limited income for whom the property is your only source of income
- If you are a surviving spouse or a minor, blind, or disabled child, you may live in, rent out, sell, borrow against, or refinance the property. Call the Estate Recovery Unit at 1-800-562-6114 to request lien removal; the state must remove the lien on proof that a bona fide sale or transfer is complete.
DSHS Office of Financial Recovery (OFR) — Estate Recovery Unit
Phone: 1-800-562-6114
Visit the agency website →Frequently asked questions
For services received on or after January 1, 2014, Washington recovers only long-term services and supports — nursing facility care, home and community-based services, and related hospital and prescription drug costs — provided to a client age 55 or older. For dates of service beginning January 1, 2010, a client who was eligible for both Medicaid and a Medicare savings program leaves no estate liability for any sum paid to cover medical assistance cost-sharing benefits (WAC 182-527-2742(9)).
The state cannot recover from the estate so long as there is a surviving spouse, or a surviving child who is age 20 or younger or who is blind or disabled (WAC 182-527-2738(3)). A surviving spouse or a minor, blind, or disabled child may continue to live in or rent out the home, and may sell, borrow against, or refinance it; the state must remove its lien on proof that a bona fide sale or transfer is complete.
Yes. Under WAC 182-527-2750, an heir may ask the state to delay recovery for undue hardship. Undue hardship exists only when the property is the heir's sole income-producing asset, when recovery would deprive an heir of shelter they cannot afford to replace, or when the client is survived by a state-registered domestic partner. Request a deferral from the DSHS Office of Financial Recovery at 1-800-562-6114. An heir granted a delay must live on the property, keep it insured with the state named as primary payee, and may not sell, transfer, or encumber it.
Sources
Data sourced from Medicaid Estate Recovery in Washington primary sources (8 pages reviewed). How we research.
Administering agency
DSHS Office of Financial Recovery (OFR) — Estate Recovery Unit
Authority
RCW 41.05A.090; RCW 43.20B.080; WAC 182-527-2738 (recovery bar); WAC 182-527-2740 (age); WAC 182-527-2742 (services); WAC 182-527-2750 (undue hardship)