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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

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Citation(s)

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42CFR 433.36(c) & 4.17. Liens, Adjustments and Recoveries

1902(a)(18)&

1917(a) & (b) of the Act A. Liens

____ The State imposes liens against an individual’s real property on account of medical assistance paid or to be paid.

The State complies with the requirements of section 1917(a) of the Act and regulations at 42 CFR 433.36(c)-(g) with respect to any lien imposed against the property of any individual prior to his or her death on account of medical assistance paid or to be paid on his or her behalf.

____ The State imposes liens on real property on account of benefits incorrectly paid.

____ The State imposes TEFRA liens under 1917(a)(1)(B) on real property of an individual who is an inpatient of a nursing facility, ICF/MR or other medical institution where the individual is required to contribute to the cost of institutional care all but a minimal amount of income required for personal needs. If the State is imposing TEFRA liens the State is required to determine whether an institutionalized individual is permanently institutionalized and specify its procedures for this determination in 4.17D(1) of this plan. The State must also provide the individuals with notice, hearing procedures and due process requirements.

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

______________________________________________________________________________

Citation(s)

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4.17 A. Liens (continued)

____ The State imposes liens on both real and personal property of an individual after the individual’s death.

2. Adjustments or Recoveries

The State complies with the requirements of section 1917 (b) of the Act and regulations at 42 CFR 433.36 (h)-(i).

Adjustments or recoveries for Medicaid claims correctly paid are as follows:

1. For permanently institutionalized individuals, adjustments or recoveries are made from the individual’s estate or upon sale of the property subject to a lien imposed because of medical assistance paid on behalf of the individual for services provided in a nursing facility, ICF/MR or other medical institution.

2. ____The State determines permanent institutional status of individuals under the age of 55 other than those with respect to whom it imposes liens on real property under 1917(a)(1)(B) (even if it does not impose those liens).

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

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Citation(s)

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4.17 B. Adjustments and Recoveries (continued)

3. For any individual who received medical assistance at age 55 or older adjustments or recoveries of the payments are made from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services.

_____ In addition to adjustment or recovery of payments for services listed above, payments are adjusted or recovered for other services under the State plan as listed below:

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

______________________________________________________________________________

Citation(s)

______________________________________________________________________________

4.17 B. Adjustments and Recoveries (continued)

1917(b)(1)(C)(4)(A) 4. _____(Only California, Connecticut, Indiana, Iowa and New York may check this entry.) The State disregards assets or resources for individuals who receive or are entitled to receive benefits under a long term care insurance policy as provided for in Attachment 2.6-A, Supplement 8b. (Check one of the following entries.)

______The State adjusts or recovers from the individual’s estate on account of all medical assistance paid for nursing facility and other long term care services provided on behalf of the individual.

______The State does not adjust or recover from the individual’s estate on account of any medical assistance paid for nursing facility or other long term care services provided on behalf of the individual.

______The State adjusts or recovers from the assets or resources on account of medical assistance paid for nursing facility or other long term care services provided on behalf of the individual to the extent described below:

4._____ (States other than California, Connecticut, Indiana, Iowa and New York may check this entry.) If an individual covered under a long-term care insurance policy received benefits for which assets or resources were disregarded as provided for in Attachment 2.6-A, Supplement 8c (State Long-Term Care Insurance Partnership), the State does not seek adjustment or recovery from the individual’s estate for the amount of assets or resources disregarded.

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TN: ______ Approval Date ___ Effective Date ______

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

______________________________________________________________________________

Citation(s)

______________________________________________________________________________

2. Adjustments or Recoveries: Limitations

The State complies with the requirements of section 1917(b)(2) of the Act and regulations at 42 CFR 433.36(h)-(i).

1. Adjustment or recovery of medical assistance correctly paid will be made only after the death of the individual’s surviving spouse, and only when the individual has no surviving child who is either under age 21 or blind or disabled.

2. With respect to liens on the home of any individual who the State determines is permanently institutionalized and who must, as a condition of receiving services in the institution apply their income to the cost of care, the state will not seek adjustment or recovery of medical assistance correctly paid until such time as none of the following individuals are residing in the individual’s home:

• A sibling of the individual who was residing in the individual’s home for at least one year immediately before the date that the individual was institutionalized, or

• A child of the individual who was residing in the home for at least two years immediately before the date the individual was institutionalized who establishes to the satisfaction of the State that the care the child provided permitted the individual to reside at home rather than become institutionalized.

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

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Citation(s)

______________________________________________________________________________ 4.17 C. Adjustments or Recoveries: Limitations (continued)

3. No money payments under another program are reduced as a means of adjusting or recovering Medicaid claims incorrectly paid.

D. State Procedures

Section 1917(a)(1)(B)(ii) 1. The State uses the following procedure for determining

the Act that an institutionalized individual cannot reasonably

42 CFR 433.36(d) be expected to be discharged from the medical institution and return home:

Section 1917(b)(2)(B)(ii) 2. The following criteria are used for establishing that a

of the Act permanently institutionalized individual's son or daughter 42 CFR 433.36(f) provided care that permitted the individual to reside at home rather than become institutionalized:

3. The State uses the following standards and procedures to waive estate recovery due to undue hardship:

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

______________________________________________________________________________

Citation(s)

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4.17 D. State Procedures (continued)

4. The State defines cost-effective as follows and uses the following methodology and thresholds to determine when adjustment or recovery is not cost-effective:

42 CFR 433.36(d) &

(g)(2)(ii) 5. The State’s collection procedures are described below. This description includes specific elements of the advance notice, specifies the method for applying for a waiver, the procedures for hearings and appeals and the pertinent time frames for these activities.

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

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Citation(s)

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4.17 (continued)

E. The State defines the terms below as follows:

Section 1917(b)(4)(B) of the Act

1. ESTATE: (At a minimum, this must include estate as defined under State probate law). The definition of estate must include all real and personal property and assets of an individual, including any property in which the individual had any legal title or interest at the time of death to the extent of the interest and also including the assets conveyed through devices such as joint tenancy, life estate, living trust, or other arrangement.

42 CFR §433.36(e)

2. INDIVIDUAL'S HOME:

3. EQUITY INTEREST IN THE HOME:

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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: __________________

LIENS, ADJUSTMENTS AND RECOVERIES

______________________________________________________________________________

Citation(s)

______________________________________________________________________________

4.17 E. Definitions (continued)

4. RESIDING IN THE HOME FOR AT LEAST ONE OR TWO YEARS ON A CONTINUOUS BASIS:

5. DISCHARGE FROM THE MEDICAL INSTITUTION AND RETURN HOME:

6. LAWFULLY RESIDING:

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