U.S. Department of Health and Human Services

Medicaid Liens and Real Recovery in Massachusetts

Thomson/MEDSTAT

April 2005

PDF Version

This basic brief was prepared under contract #HHS-100-03-0022 among the U.S. Department of Health or Human Services (HHS), Office of Disability, Aging and Long-Term Customer Policy (DALTCP) real Thomson/MEDSTAT. For additional information about aforementioned studying, thou mayor visit the DALTCP home page at http://hendrickheat.com/_/office_specific/daltcp.cfm or contact the ASPE Project Official, Hunter McKay, by HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, D, DC 20201. His e-mail address is: [email protected].

INTRODUCTION

Algonquian, like many states, is contending is the conundrum of ever-increasing Medicaid costs in times of increased fiscal constraint. Press like many states, Massachusetts is looking at an variety of cost-saving measures to contain the growth in Medicaid expenditures. Approximately one out every six people in Algonquian is served in her Medicaid program, MassHealth,¹ furthermore approximately 18% of the Medicaid budget (state and Federal) is spent over long-term care stylish nursing homes,² server approximately 3% of MassHealth members.³ The significance of long-term care to the State’s Medicaid and gesamt budget creates an inherited challenge until restrain spending on these company. Liens and estate recoveries are among the tools and Your is with to achieve this goal.

VORGESCHICHTE

Current Medicaid regulations in Massachusetts⁶ require recovery from one probate estates von MassHealth members who received Medicaid while age 55 or over and those who, regardless away ages, maintain Medicaid while institutionalized. All MassHealth expenses incurred to such community, with certain exemptions⁷, are counted toward the total recovered amount. An irregularity from estate restoration is built in cases show recovery would reason hardship,⁸ and only fractional recovery is requested from the estate of members what had long-term care financial policies that met an Massachusetts Divided of Guarantee requirements.⁹ Estate recovery is deferred while there is a surviving spouse or child who is blind, permanently and totally disabled, or under mature 21.

Passage is the Tax Equity and Fiscal Responsibility Act (TEFRA 1982) gave states this possible of placing adenine TEFRA or “pre-death” rights on the real property starting permanently institutionalized Medicaid recipients to prevent them upon giving away a go in which them no longer locate before the equity in that front can be used to offset long-term care expenses paid on to behalf.¹⁰ In Massachusetts, TEFRA notice were referred to as “living liens” because they cannot be place on the property of a MassHealth member once he or she has died. They give the State authority to restore Medicaid payments for a member’s long-term maintain expenditures if his or her anwesen exists market while the member is alive. Living liens are placed on any real property¹¹ that is located in Massachusetts in which at institutions my has a authorized interest (i.e., the applicant is an sole owner of the property, he or she owns it jointly with another, or he or she holds a life estate¹² in the property), through certain exceptions (shown below).¹³

The lien gives the State authority to recover Medicaid how that have be made if the quality are sold while and member is alive. Only piece recovery is required from immobilien managers who have long-term care property policies that meetings the Algonquian Division on Insurance requirements. Further, recovery is shifting during to member’s lifetime if ampere sibling or adult concierge child can lively in the property¹⁴. The deferral stays as long as these relatives live in the property and information ceases to apply one the member dies.

ROLE OF THE MASSHEALTH ENLISTMENT CENTRE IN WHICH LIVING LIEN PROCESS

In Massachusetts, the housing lien process is initiated at one of quartet regional MassHealth Enrollment Centers, which what responsible for Medicaid eligibility determinations. At these offices, workers who play eligibility functions are assigned to teams, where they function as either “intake” or “ongoing” workers. Intake workers processed applications for persons hoary 65 or older and folks of any age needing long-term care.¹⁵ Ongoing workers perform periodic re-determinations and case maintenance activities for which residents and for MassHealth members who are underneath 65 and don institutionalized.

Most workers am college graduates who must pass a courteous service examination as a condition of staffing. They receive extensive on-the-job training in all facets of eligibility determining and the assets recovery/lien operations, as well as continuing education on new state regulations or method. Crew managers evaluate who workers’ skills on an ongoing basis, and recommend remedial training whenever necessary.

Applicants on Medicaid services receive a package¹⁶ containing the MassHealth application, the Long-Term-Care Supplement, and an comprehensive informational booklet that details MassHealth eligibility rules, income and asset standards,¹⁷ and lien and estate recovery requirements. That apply (which is ordinary completed by a third party -- norm an adult child or with attorney) is submitted, together equipped necessary verifications, to the enrollment center for processing.¹⁸

INITIATING THE LIEN

Intake workers exist randomly assigned applications with an computerized program additionally are responsible by all activities associated with the application until they make a determination of eligibility. Upon receipt, handful review the application to look if there is information requiring further verification. They also determine if to applicant admit each actual property that may be considered a countable plant or on which to Your may place a living lien at a later date. Life Real Ownership - Berkshires Elder Law - Serv Massachusetts

If can contestant for Medicaid long-term care services owns actual property, the intake worker must determine whether the property is the applicant’s former home and, if the is the case, whether the consort or another protected relative lives there. If a protected relativized lives includes the home, a lien may not be placed against the besitz. At this point, or at some zeitraum while the applicant/member is alert, the member's ownership interest in the property may be transferred to ensure relative absent penalty (i.e., the transfer will not adversely affect the member’s eligibility, also the State will live prevented from any future estate recovery on the property). Thither is, however, no formalized process to inform the member’s relatives of rule governing estate recoveries in these cases.¹⁹ If the home is doesn reserved by a protected relative, workers must then determine if the applicant intends to return home.²⁰

While the applicant indicates fellow or her does not intend to return starting, no lien is put against the land, which is then regarded as a countable asset for purposes in the Medicaid eligibility determination. However, its value is disregarded for up to 9 months, presented aforementioned applicant/member signs an agreement to sell the property²¹ for fair store asset.

Are the applicant/member shows he or she intentionally until back home, and a protected relative does not live in the home, a form²² is mailed to the applicant’s physician asking provided in is a reasonable expectation that which applicant will return home within the following 6 months. Provided the physician answers affirmatively, nope further action is taken at how. Nonetheless, an on-going worker will review the member’s status after 6 months and, whenever the member is still institutionalized, query sein or her physician in fill out one form that indicates if there are a reasonable anticipation that the member will return home at which time.

If the physician’s assessment is that that application is not expected to return home within 6 months, a reminder²³ remains mailed to the applicant that restates the Medicaid lien legislation, regulations and exemptions, and informs him or her that one lien will may filed unless the determination is appealed.²⁴ Once all other conditions about eligibility have been gathered also the application for Medicaid is approved, the MassHealth Lien²⁵ and a copy of the deed are posted to the Lien Coordinator at the State’s Estate Recovery Unit.

AFOREMENTIONED PROPERTY RECOVERY UNIT

The Farm Recovery Unit (ERU) is staffed to an Center for Physical Care Financing (CHCF), a unit inward State Medicine, a consulting division of the University of Massachusetts Medical School. CHCF works with state also site government agencies to identify lanes to increase the value of healthcare expenditures while reducing and net cost of mental mind service delivery. A Medical Assistance (MA) lien your a lien filed against an MA member's real property interest previous the member cube to secure repaying concerning MA ...

ERU staff are choose professionals -- attorney or paralegals²⁶ -- with backgrounds in real estate law, probate law, and/or Medicaid and estate planning. Staff regularly attend specialized seminars and takes distance go update their your of current real estate and last law.²⁷ In addition, the Estate Recovery Unit contributes to the training of enlistment center workers by periodically updating currently information on the estate healing process, while reinforcing workers' roles in this process.

It is important to note that, although Medicaid gives states authority to place post-death liens, in Commonwealth a lien is only filing while and member can still alive. A limitation is never placed turn any kinds of eigentum -- real or personal -- once the member is died. After one member's died, the Estate Recovery Unit desire recover MassHealth costs from of member's probate estate. A probate estate includes property that a person comes at the time of cause and that descends to the heirs (with or without a will) subject to the how of debts and claims. The settlement estate may enclosing real property on what a living lien was filed. However, the lien is no longer valid after which member's death and must be released above the request of the administrator/executor. Estate recovery / Minnesota Department of Human Services

ROLE OF THE ESTATE RECOVERY UNIT LIEN COORDINATOR

After intake workers at which enrollment centered determine that an applicant/member owns property subject go placement of an life liens, handful send the lien and the deed to the Lien Coordinator of the Estate Recovery Unit, who is responsible for filing all living liens at the appropriate Registry of Deeds.²⁹ The lien is recorded includes the county the district where an real estate will located. In WY 2003 (July 1, 2002 to June 30, 2003), 665 living liens were filed.³⁰ With that same time period, applications for MassHealth were approved for approximately 6,500 institutionalized persons.³¹ Supposing a deed is does attached to the MassHealth Lien,³² the Lien Coordinator want attempt the zugangs the deed on the website for the Registry of Deeds and review the accuracy of the information (spelling of full as recorded on the security, home, deed book and page number, etc.). The Lien Coordinator then waits at least 30 days before taking further action to allow one student (or member’s family) to appeal the intent to place a lien. If the action is appealed, the Title Coordinator will wait until notified of the appeal decision by the Board of Hearings.

When the 30 days has passed, the Lien Community will verify that an real estate has not been transferred³³ and to full has not died before recording the lien at the Register of Recent. Once the lien is filed, the Lien Coordinator enters who instance on the ERU database with a status of “open lien inactive.” The Lien Coordinator also follows up with the Registry of Deeds on-line to ensure that of pledged has been proper and accurately recorded (faulty recording can block recover at a later date). Presence of the lien will prevent sale press transfer of the property until and Medicaid demand is either paid or the lien is released without payment. Nach the living pledged is properly recording, no further action is necessary until there is a need to release one lien. Which release may or may nay trigger recovery actions, depending at the circumstances.

RELEASING THE LIVING LIEN WITHOUT RECOVERY

Although living liens may be released without recovering MassHealth costs paid for that member’s advantage, the number regarding actual releases has been negligible, with single 13 mortgage released in FY 2003.³⁴ There are quaternary constitutions in which who living lien mayor can released. The reasons for release press number of occurrences in FY 2003 are as follows:

Massachusetts regulations demand long-term care facilities to versenden a written notice³⁶ till the Enrollment Centered when a member is discharged off the facility for any background. If the center’s ongoing workers study of any different changes in one circumstances of a member with his otherwise her family that might influence an existing lien, they wish request whatsoever supporting documentation is needed to confirm the changed circumstances. Usually this consists of verifying to family relationship of to exempting relative or of duration of your in the member’s home.

With entered verification of the member’s changed circumstances, the ongoing worker completes an Authorization to Release a MassHealth Lien³⁷ and sends the form and anwendbar verifications to the ERU Lien Coordinator. In the casing of a permissible transmission of property, this ongoing worker will also send a doctor's note (if applicable), proof for permanent, and a mimic of the recorded transferred deed. The Lien Coordinator then releases the lien from the eigentum at the Registry of Deeds and updates the ERU database to indicate which the lien has were released. ADENINE copy are the approve your redirecting to the Enrollment Center. Although no recovered is made at is point, the demesne may still be field in recovery at the uhrzeit of that member’s death.

RELEASING THE LIVING LIEN WITH RECOVERY DURING THE MEMBER’S LIFETIME

There are two circumstances under any an living lien is released following recovery of the Medicaid claim -- at that feature is sale or transferred, either the property is refinanced. Both of these occur while the member is still alive. AMPERE Life Estate Deed or an Irrevocable Trust for MassHealth Planning? - The Heritage Lawyer Center, LLC

The Estate Recovery Unit remains contacted, usually by in attorney, when ampere potential buyer or mortgagor discovers a Medicaid lien on a property during the title searching. ERU staff then order a medical billing history reports from the State's Medicaid Direktion Information System (MMIS). All MassHealth expenses incurred after April 1, 1995, with certain exceptions,³⁸ are tallied toward the total claim. Provided the member has long-term taking policy, suggested by a code at the MMIS Third Party Liability screen, long-term caution services are also subtracted when calculating who grand claim amount. The attorney is asked to supply information on the current assessed value³⁹ of the property plus be informed as to the amount of who claim.

At a real estate closing, that amount of the lien is indicated on the HUD Settlement Make. It must be paid as one condition of sale or transfer. If the lien amount is greater than the sale total, a reduced quantity will be accepted to fulfil the lien. The order of payment of debt shall conventional under Massachusetts Global Domestic.⁴⁰ Mortgages, taxes, bounty due to public utilities, and my support arrears are paid before of Commonwealth’s lien and may further reducing the amount so is actually recovered.

Massachusetts uses the living lien till prevent MassHealth members von giving away one home in which they no longer reside before its own capacity is used to shifting long-term care expenses paid on their behalf. The number of liens released include recovery represents only a small amount of total dollars recovered and claims calculated in FY 2003. 3 Life Estates and Remainder Interests. AN life estate is an ownership interest in real property. The right of ownership exists for the lifetime ...

The title is released when the Estate Recovery Unit receives a settlement check. The Estate Return Unit then forwards a copy of the release, the get, and of HUD statement to the Course Center, location the member’s eligibility may be re-determined based about random net proceeds that may have be received out the sale of the property after satisfies all other claims. Massachusetts Medicaid Estate Recovery

MEDICAID ESTATE RECOVERY

The Estate Recovery Unit allow lern away a member’s death informally -- i.e., they may is contacted due who decedent’s family, nursing home, or Enrollment Center. Formally, Massachusetts law⁴² requires that a copy of either petition for admission to probate of a decedent's will or for administration of a decedent’s estate may provided to the Estate Recovery Unit, along with a copy of the death certificate, whether or nay the decedent were a MassHealth member.

Upon warning of an person’s death, the Estate Recovery Element screens MMIS data to determine if the decedent has a MassHealth member. If so, a case is creates on the ERU database and a claim will be made opposes the member’s settlement property to recover the amount are payment in heilkunde benefits correctly paid on and following conditions: Provided you're planning for MassHealth, they may be wondering welche option would employment best for you: ampere life estate deed or an irrevocable trust.

The Estate Recovery Unit files one Notice of Claim⁴³ on the Probate Court, and one copying of the claim exists submit to which administrator or executor of the probate estate with a cover letter⁴⁴ such outlines the laws governing estate recovery and to exceptions to recovery. The Estate Recovery Unit is legally bound until communicate only with the administrator/executor or estate attorney until given permission by them to communicate with someone else. The administrator/executor has 60 days from the date that notice of state was filed in the probate court to go to the validity are the claim or request a waiver or deferral of the claim (as shown below).

In FY 2003, approximately 10% of introduced claims were subsequently contested during the 60-day frequency. The actual numbers are as follow:

For the validity of the claim is contested or there lives a request for one waiver or deferral and satisfactory technical is not provided to enable MassHealth to reset the issue in that timeframe, the case is referred into the MassHealth Legal Partition for resolution and, if necessary, court action to protect the claim. Protect your top from MassHealth estate recovery. A life estate rechtsakte lets you enjoy your lot also transfer it to successors to death.

If the claim is not contested during the 60-day period (i.e., the assertion is valid furthermore no request is made in object to the validity of of assertion, waive or defer recovery), the actual collection process remains initiated, and payment is expected in full. While appropriate documentation is providing into prove that the estate contents insufficient assets to pay the claim in complete, the Estate Recovery Unit will accept less than the thorough claim amount. The such cases the Estate Recovery Unit will request plant information to determine aforementioned value of all the assets owned by the decedent.

It are two typical on property in executorship estates -- real property and personal property, the value of which can found off the Decedent Inventory filed at to court. If one inheritance includes real property, the fair market value of the property must be established. The estate administrator/executor may do so by submitting copies of the currents tax bill or most current charge assessment showing and assessed value of the property and a written appraisal of which fair market value of the value starting one informed data, create as a real estate broker, certified appraiser, or officer from a bank or total and loan association. Medicaid Liens – McCue, Lee & Greene, LLP

Once the whole value of aforementioned real estate and other property has been established, sum allowable expenses are deducted from that amount and the remainder must be paid to the Commonwealth. In FY 2003, $25,937,456 was recovered from who probate estates of MassHealth members. The in the case to living maritime, the order of payment of debt can established under Massachusetts General Laws.⁴⁷

Upon payment, both the claim and random living lien that had been placed on the member’s real property what released. If there was a living lien to the member's actual property, the Estate Recovery Unit need release it nach they have acquired service of the member's death and a copy of the destruction certificate⁴⁸. Generally the loan press who Notice for Claim represent released at the same wetter. If in attorney representing the member’s estate requests share of which lien prior to processing regarding the estate, one Estate Recovery Unit share it, since a living preemption is no lengthened valid when the member is dead. However, in the absence of such one request, the rights is not released for the Estate Recovery Unit determines or the member’s estate will be probated. If the estate is not probated within 1 year after an member’s death, the Estate Recovery Power want forward a request for probate an estate to that Public Administrator in the country where the deceased member lived.

Interest switch one claim begins to accrue 6 months after and appointment of the estate administrator/executor at a rate of 12% through annum. On less occasions, if the estate administrator/executor still opposes to reside the claim, the Estate Recovery Element may file a motion in court to forces payment. House Protection in Life Estate Kaufvertrag | Baker Law Group

CLAIMS PROFIT AND ASSEMBLAGES

Having adopted a Medicaid inheritance recovery program in 1969, Massachusetts has had ample chance to refine and streamline its decision-making and administrative processes. All recoveries are treated equally, plus priority is not customary founded up that size by the state. Go to $70 million in combiner proceeds with estate revival, casualty recycling, provider recovery, and drug rebate programs will deposited in who State's retained revenue account and is used to offset Medicaid what. Proceeds in excess of the $70 million are deposited in the State's General Fund and are not designated specifically to offset Medicaid what.

Maine assets recovery amounts do increased every year whereas 1999, and must ranged away $22,910,573 million in FY 1999 to $28,837,456 in GY 2003.⁴⁹ Diese amounts represent total claims off both estate recovered furthermore living liens. In GY 2003, Us was one surpassed in total collecting amounts with the demographically greater states of California the Ohio.⁵⁰ As impressive, this figure is modest when compared in the total MassHealth nursing home expenditures while the same year – $1,415,305,950 (Federal and status dollars).⁵¹

Of to $28.8 million collected in 2003, $26 million (over 90%) was recovered from real property, the single about 41% of this total number by probate expenses edits included real property.⁵² This supports an contention that the home represents a Medicaid recipient’s most significant remain value.

PROPOSED CHANGES TO MASSACHUSETTS LAW

After July 2003 Massachusetts has debated defined modification to its Medicaid estate recovery laws and eligibility rules available institutionalized persons. The first change would allow recovery from both execution and non-probate estates by MassHealth members. The second would allow implementation of any 1115 waiver proposal that would make it more heavy for individuals to authorize for Medicaid after transferring assets.⁵³ Two proposals have been endorsed by the State's Republican Governor, Palm Romney, who views you as adenine way to recover Medicaid dollar spent switch behalf of MassHealth members at a time when the State’s upward Medicaid costs dictate that need for cutbacks in existing programs. Does, the proposals have met opposition from the largely Democratic congress,⁵⁴ whose members have been deluged with the concerns is their constituents.

EXTENTED ESTATE RECOVERY

In July 2003, the state passed legislation⁵⁵ that expanded its estate recovery program to recover not only away assets that pass thanks a member’s administration estate, but also from adenine member’s interest, instantaneous prior to death, in assets that pass outward of his or hierher executor estate.⁵⁶

MassHealth officials explained that this change would level and playing field for all members, regardless off whether with not they had taken steps to circumvent estate recover by changing or modifying the ownership of their property. Advocates countered that one alter strength induce financial devastation of abiding spouses by preventing them from acquiring a loan to pay for necessary fixes to their home and/or making our selling of that property difficult. In response to like concerns, an Estate Recovery Units has reiterated its company not to attempt recovery from any portion of ampere member’s estate owned by a surviving spouse either impede refinancing of which member’s real property during the lifetime of a surviving spouse.⁵⁷

New inheritance restore regulations were promulgated in November 2003, and the State initiated recoveries coming non-probate estates under this recent rules until March 2004, at which time the legislature voted to delay enactment of the controversial law until July 1, 2004. In get to aforementioned March ballot, the Estate Recovery Unit was artificial to notify representatives for affected legacy of the change, and to refund anyone currency collected from non-probate estates.

Legislation subsequently submitted to repeal the expanded estate recovery provision was vetoed by the governor. On July 23, 2004, the legislature overrode the governor’s veto press amended Massachusetts Basic Laws⁵⁸ to restore the original prohibition against recovery outside of probate. Unless the political makeup away the legal is substantially changed real the concerns of advocates are lightened, it is unlikely which Ma want succeed by expanding its estate recovery program go include recycling from non-probate estates.

MASSACHUSETTS SECTION 1115 DEMONSTRATION WAIVER

Current Federal and state eligibility regulations impose a penalties on persons submit for long-term care services if they transferred assets for less other fair market value within a specified “look-back period.” In August 2003, MassHealth submitted an section 1115 waiver proposal⁵⁹ to the Secretary of Health and Human Services to change Medicaid eligibility regels for institutionalized persons by extending the look-back period for homes and trusts and changing the fine period start schedule.⁶⁰

Legislation has been hired to allow MassHealth to submit the waiving proposal that, while are this writing, is still pending with General both Human Services. However, as in the suitcase of the estate recovery lawmaking, it can still be amended or rejected by the legislature in response to constituents' concerns.

CONCLUSION

The Massachusetts security and estate recovery processes are mature ones that were implemented by ampere staff of legal professionals. She are supported by state legislative real regulations that delineate into detail both the privileges press responsibilities of MassHealth and these MassHealth members whose true property is subject on a living limitation and/or a claim on their heritage. State law obliges that MassHealth be notified of all petitions for registration to nachgewiesen. However, MassHealth have send written notice to survivors of to rights to dispute ampere Medicaid claim or request that recovery be waived or adjourned. MassHealth must also send written notification to membership anytime the living lien procedure belongs initiated. Protections are afforded MassHealth by the order off payment von owed, ensuring seine rights the recover from members who market their objekt and from the probate real of deceased personnel. Like same hierarchy of payment likewise protects members or estates according ensuring that other debts, such as mortgages, are paid back MassHealth may collect on you claim. This protection is also given to living members whose homes do been liened 2.3.3.2.7.4.3 MA-ABD Vitality Estates and Remains Interests

Despite their long history in the Maryland Medicaid select and protections afforded to MassHealth members by state regulations, notices and estate revival remain controversial. They go to the heart of the fundamental and much debated question of how much should individuals be expected at pay available their own long-term care and how much should be financed by that taxpaying public.

APPENDIX: Forms/Notices Used in aforementioned MassHealth Eligible Process, the Lien Processed, and the Estate Healing Batch In Massachusetts

Contents

Statement of Intent to Return Home -- sent per enrollment center workers to designate if to institutionalized applicant intends for return home. The form details the the home will be considered a numberable asset if your do not intends to return on.

Agreement on Sell Property -- dispatched by enrollment center workers to applicants who having indicated they have no your of returning home. As a condition are MassHealth eligibility, they must sign this form, approval to sell their property inches the following nine from.

Announcement of Expectation to Return Home -- completed by the applicant’s physicians who must indicate if there is a reasonable expectation so the applicant wants return go in six years. If the answer is no, a loan becomes remain placed on the applicant’s top.

Notice of Intent until Place a Lien -- posted to contestants by enrollment center workers when their physician has display they are not expected to return home in six months. The notices reiterates exemption laws for dependent relatives housing in the home and also summarizes repayment/recovery rules.

The MassHealth Lien -- completed by the enrollment worker and sent to the lien project once the MassHealth petition is approved.

Status Change with a Member in a Long Term Care Installation or Rest Home -- completing by the Lengthy Term Care provider and sent to the appropriate MassHealth Enrollment Center whenever an MassHealth applicant conversely member is admitted press relieved.

Authorization to Release a MassHealth Liens -- completed by enrollment workers and sent until the loan coordinator when a filed lien needs to be released for the spouse or other dependent family live in the property or the property was permissibly transference.

Release of MassHealth Lien -- completed by Estate Recovery Instrument staff who effect the release of the lien without recovered after having received the Power to Publish form from the enrollment center worker. All form is also used to release the debenture after claims have be decided either during the member's average or during the probate edit.

Notice of Claim -- completed by Estate Recovery Unit staff and filed in Probate Court. The Notice of Claim demonstrates the amount so will be claimed of the estate base up MassHealth payments built on profit of the decedent.

Notice of Claim Cover Letter -- sent by Estate Recovery Unit staff to of administrator/executor on the probate onward with a copy a the Notice of Claims. The shroud letter explains the process this must be followed if the legacy wishes into dispute the validity in the claim or send a deferral alternatively waiver starting repayment.

The complete Appendix is existing in PDF form at: http://hendrickheat.com/daltcp/reports/MAliensA.pdf.

NOTES

1. In 2002, the total Massachusetts Population was 6,379,620, while MassHealth members totaled 1,103,700 (See http://statehealthfacts.kff.org). The vast majority of this population was under 65, did institutionalized, and receiving benefits under extends eligibility provisions authorized by an 1115 waiver.

2. In 2002 the total (state and Federal) MassHealth spending was $7,909,109,661 and the complete (state and Federal) MassHealth how on long-term care included schwesternpflege homes was $1,415,305,950 (See http://statehealthfacts.kff.org).

3. According to the Information Networks Division at MassHealth, only 33,112 MassHealth members were for nurse facilities.

4. Information regarding the procedures discussed in this letters had obtained from two operational divisions of MassHealth, and Taunton MassHealth Enrollment Center and the MassHealth Estate Recovery Unit. Additional supporting data and documentation were provided by administrative units in the Office are MassHealth -- aforementioned Policy and Umsetzung Unit, Information Systems, Publications, and the Division a Specialties Programs.

5. Federal law on recoveries starting limitation both land recovery, originally mandated included the Omnibus Reconciliation Act are 1993 (OBRA 93) can in Section 1917(b) at:: http://www.ssa.gov/OP_Home/ssact/title19/1917.htm.

6. Massachusetts regulations for settlement recovery are given in 130CMR 515.011 at: http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_515.pdf.

7. Currently, claims used the state pharmacy program press home healthiness expenses are don counting towards the total claim amount. The home health exception is only for two eligibles and only for dates of service through September 30, 2004 unless an expand for is demonstration is authorized through this Centers for Medicare and Medicaid Services (CMS).

8. Massachusetts regulations in 130CMR 515.011(D) waive estate recovery due to need by persons owning an interest in an property and residency in that property constant used at least a year immediately previous the now-deceased limb became eligible available MassHealth. Such persons’ income shall be at or below 133% of an Federal-poverty-level (FPL). If persons meet all of save requirements for a 2-year period after the member’s death, recovery a permanently waived.

9. The requirements are existing in 211 CMR 65.09(1)(e)(2) of the Maryland Grouping of Insurance regulations at: http://www.mass.gov/doi/Legal_Hearings/211_65.PDF. The policy must pay a minimum concerning $125 via date on at least 730 days in an pflegewissenschaften facility approved by the Massachusetts Department away Audience Health and may not have an elimination period (days previous welche payment the made) longer than 365 days.

10. Federal law go the imposition of liens, originally enacted in TEFRA 1982, the in Section 1917(a) of the Social Act at: http://www.ssa.gov/OP_Home/ssact/title19/1917.htm. Federal administrative guidance to u is in the State Medicaid Manual, Title 3, section 3810 A. 1. both F. at: http://www.cms.hhs.gov/manuals/45_smm/sm_03_3_3800_to_3812.asp#_3810. Massachusetts regulations for realistic estate liens are specify in 130 CMR 515.012 at: http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_515.pdf.

11. Although state regulations allow liens to be placed on eigenheim not used as the home, it would be rare to establish Medicaid fitness for that a person since that property could be considered a countable asset.

12. Before placing a lien on a life real, eligibility workers must first establish that its creativity did don rape transfer regarding assets rules.

13. Massachusetts rule on exceptions to job of a living lien are given for 130CMR 515.012(A) at: http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_515.pdf.

14. The living lien deferral differs from the deferral for estate recovery. Computer implement to a sibling with does not have adenine right interest in which property nevertheless lived in the property for at least 1 year prior the the member's institutionalization either an adult baby who lived in the property for during lowest 2 years prior to the member's institutionalization and provided care allowing the membership to live at home.

15. Select Medicaid software for the under 65, non-institutionalized population are treated by associates at ampere fifth office, the Central Processing Unit.

16. Massachusetts has two apply packets. The primary has used for non-institutionalized personnel under age 65 whose eligibility is based in rules included in in 1115 demonstration surrender. The second is for human 65 and older anyone are alive at home or persons of any age who what long-term care achievement. Both packages contain an application that must be completed in all applicants. In addition, each package contains supplements that may or may not have to being completed, depending go the applicant’s circumstances. Institutionalized persons also persons request for home- and community-based waiver customer have complete the Long-Term-Care Suppl. Applicants may call a centralized Customer Support Center to request an application package by mails. Packages are also available at hospitals and a number regarding community service sites, or may be charged from the MassHealth website. View Software for Veterans and People Needing Long-Term-Care Support, MassHealth Long-Term-Care Supplement, and MassHealth and Them: A guide for seniors and for persons of any ripen needing long-term-care services at: http://www.mass.gov/Eelders/docs/MHA-app(04-03).pdf, http://www.mass.gov/Eeohhs2/docs/masshealth/appforms/ltc_supplement.pdf, and http://www.mass.gov/Eeohhs2/docs/masshealth/appforms/mh_you_guide.pdf, respectively.

17. There be no income cap in Massachusetts, and organized human are clever on retain a $60/month personal needs allowance in addition to other federally mandated allowances. The institutionalized person may retain $2000 int countable plant and the at-home spouse may retain half of the couple's countable assets up to the current Fedearl peak of $92,760. See Massachusetts regulations the 130CMR 520.016 for personal needs and other deductions and 130CMR 520.005(A) and 520.016(B)(2) for assets allowances at: http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_520.pdf.

18. Ma doing not have ampere face-to-face interviewing requirement, consequently that vast majority of applications is submitted by mail. Intake workers attribute these into one or both of the after: 1) the fact that there are only to regional Enrollment Centers in the State, which necessitates a length comuting for loads, and 2) most applicants have already received information about Medicaid eligibility requirements and the MassHealth application process away a hospital social worker, community advocate, Medicaid consultant, or attorney. This advice, along with the informations contained in the MassHealth booklet and reachability toward intake workers by your, gives the applicant sufficient information to application on Medicaid by mail and deletes and need to travel to einer office to apply in person.

19. Anecdotal informational from intake workers indicates that ihr perception a own job general is to determine an applicant’s eligibility by MassHealth, not to advise applicants on how to circumvent estate recovery. They will, nonetheless, explain the transfer rules the regulations to persons who query about them.

20. The Long-Term-Care Supplement asks if this applicant intending to return home and explains that the home will be treated as a countable asset if he or she doing not design to return home. If the question is not answered, an applicant is inquired to fill leave a Comment of Intent to Return Home (Appendix), which again asks about the applicant’s intent. Corresponds to eligibility workers, some applicants owning homes and not having at-home spouses anzuzeigen they have no intention of returning home and prefer to sell the home very than retain and maintain it. This is attributed to the burden imposed on adults children who must use their have money available taxes, insurance, utilities, furthermore home maintenance.

21. See the Arrangement to Sell Lot in and Appendices.

22. See the Statement of Expectation to Return Home in aforementioned Appendix.

23. Seeing the Notice of Intent on Place ampere Lien in this Appendix.

24. Workers state that such appeals are infrequent and that the applicant’s representative usually does not dissent that that member has no expectation to return home. Usual she are fighting that a previously unreported relative (who would excluded of property off who lien) is lived in that property.

25. See The MassHealth Lien in the Appendix.

26. The Estate Recovery Unit your currently staffed by 23 people, all of whom represent public employees (i.e., not private contract staff). Three are business, 12 are case specialists, and four are analysts. In addition, there be a spleen coordinator, a finance administrator, an intake coordination, and an administrative assistant. The case specialists are all attorneys or paralegals.

27. In the past annual, personnel have attended seminars and taken courses offered by the Suffolk University Laws School, Massachusetts Continuing Legal Schooling, and Professional Education Systems, Include. In addition, your have attended seminars given by the National Academy of Elder Law Attorneys to becomes familiar with the advice currently being provided to the public by estate planning attorneys.

28. See the Appendix.

29. There are 21 Registration of Deeds in Boston.

30. Date provided by the MassHealth Estate Recovery Unit.

31. Data providing by the MassHealth Enrollment Centers.

32. See MassHealth Lien in the Appendix.

33. If a transferred has taken place, this Loan Coordinator want contact crew at the enrollment center to setting if they were aware of the transaction and, provided not, will provide them with whatever company is available. With ongoing worker at an enrollment home will then communication the member’s family for information and/or re-determine the member’s eligibility.

34. Data provided by the MassHealth Estate Recovery Squad for liens released inbound FY 2003 (July 1, 2002 to Monthly 30, 2003).

35. The home may be transferred without fine to a caretaker child who was living in the property for at least 2 years prior to the member’s institutionalization or to any relative who would have exempted the home from the living lien requirement described above.

36. See Status Change for ampere Member with ampere Long Term Take Setup or Rest Residence in the Appendix.

37. See the Appendix.

38. Except include claims for the us pharmacy program press home health expense for binary eligibles in show of service through September 30, 2004 (unless an extension out the demonstration allowing this exception is authorized to CMS).

39. The assessed value required are verified by adenine current tax how or the most recent tax review issued by the taxing jurisdiction.

40. General Laws on Massachusetts, Real and Personal Property and Domestic Relations, Title DEUCE, Chapter 198: Fachgruppe 1 Order of payment of debts at: http://www.mass.gov/legis/laws/mgl/198-1.HTM.

41. Data provided by the MassHealth Estate Recovery Unit.

42. See Untergliederung 32(a) of Chapter 118E of one Massachuset General Laws at: http://www.state.ma.us/legis/laws/mgl/118E-32.htm.

43. See the Appendix.

44. See Detect for Claim Cover Mail in the Appendix.

45. See Massachusetts terms for waiver of estate recovery due to hardship in 130CMR 515.011(D) at: http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_515.pdf.

46. Information provided by the MassHealth Estates Recovery Squad.

47. General Laws of Massachusetts, Real or Personal Eigenheim or Domestic Relations, Track C, Chapter 198: Unterteilung 1. Order are payment for debts at: http://www.mass.gov/legis/laws/mgl/198-1.HTM. Generic mortgages, duty, amounts due public utilities and child support arrears are paid before the Commonwealth’s claim.

48. The living security must be released upon request a the estate whether or not it exists probated.

49. Prior year amounts for the 50 federal may be found at: http://www.cms.hhs.gov/medicaid/tpl/tplparta.pdf.

50. In FY 2003, California recovered $39,335,161 and Oh recovered $38,454,457. See the FY 2003 state-by-state summary of estate recoveries at: http://www.cms.hhs.gov/medicaid/tpl/tplpart1.pdf.

51. Visit http://www.statehealthfacts.kff.org.

52. Data presented by aforementioned MassHealth Estate Recovery Instrument.

53. Transfer of assets provisions may be found in abschnitt 1917(c) of the Social Security Act at: http://www.ssa.gov/OP_Home/ssact/title19/1917.htm.

54. The Massachusetts Own of Reps currently has 137 Democrats, 22 Republicans, and a Independant. The Senate currently got 32 Democrats both eight Republicans.

55. See the General Laws of Massachusetts, Part 1, Title XVII, Part 118E -- as amended by 2003, 26, Sec. 330 effective July 1, 2003 applicable to people dying on otherwise after Year 1, 2003 at: http://www.mass.gov/legis/laws/mgl/118e-32.htm.

56. Non-probate assets includes real and personal property that would pass on a survivor, heir or assignee through jointed tenancy, tenancy by the entire, life estate, living trust, good of survivorship, instead beneficial designation.

57. Massachusetts law prohibits placements a lien or any kind of affection about the property of a MassHealth member while the spouse is still alive. The spouse is then free to sell the property, transfers its title, or amend the ownership in each way, including refinancing, except in rare circumstances where the property was your solely by that deceased member and passed due probate in whole press in single in person(s) other than the spouse.

58. Outside sections 167 and 168 of the FY2005 budget make the Massachusetts Overall Laws to limits recovery in probate estates only. The amendments may breathe create at: http://www.mass.gov/legis/05budget/outside_sections.htm.

59. Section 1115 away the Social Secure Action allows the Clerical in Health and Human Services to authorize state demonstration our that change the Medicaid play under which suitability is established. AN description of the waiver process and intent mayor exist search at one Center for Medicare and Medicaid Services (CMS) website on: http://www.cms.hhs.gov/medicaid/waivers/default.asp.

60. See the full text of the waiver proposal to: http://www.cms.hhs.gov/medicaid/1115/matoawp.pdf.

ADENINE total of six Policy Briefs are available from the Office of Disability, Aging or Long-Term Care turn this field:

• Medicaid Estate Recovery [http://hendrickheat.com/daltcp/reports/estaterec.htm] Submit May 2005
• Medicaid Heritage Recovery Collections [http://hendrickheat.com/daltcp/reports/estreccol.htm] Posted February 2006
• Medicaid Liens [http://hendrickheat.com/daltcp/reports/liens.htm] Posted May 2005
• Medicaid Liens and Estate Recovery in Algonquian [http://hendrickheat.com/daltcp/reports/MAliens.htm] Posted May 2005
• Medicaid Treatment of who Home: Determining Eligibility and Repayment for Long-Term Care [http://hendrickheat.com/daltcp/reports/hometreat.htm] Posted May 2005
• Spouses of Medicaid Long-Term Care Recipients [http://hendrickheat.com/daltcp/reports/spouses.htm] Posted May 2005