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www.dads.state.tx.us/services/estate_recovery/index.html
On March 1, 2005, Texas implemented the Medicaid Estate Recovery Program in compliance with federal Medicaid laws. The program is managed by the Texas Department of Aging and Disability Services.
Under this program, the state may file a claim against the estate of a deceased Medicaid recipient, age 55 and older, who applied for certain long-term care services on or after March 1, 2005. Claims include the cost of services, hospital care, and prescription drugs supported by Medicaid under the following programs:
- Nursing facility
- Intermediate Care Facility for Persons with Mental Retardation (ICF/MR), which includes state schools
- Medicaid Waiver Programs including
- Community Living Assistance and Support Services
- Deaf-Blind with Multiple Disabilities Waiver
- Home and Community-based Services
- Texas Home Living Program
- Consolidated Waiver Programs
- Community Based Alternatives, which includes Star Plus services
- Community Attendant Services
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EXCEPTIONS TO FILING CLAIMS
Medicaid Estate Recovery Program claims will only be filed when it is cost-effective. Claims that are considered not cost-effective are those where:
- The value of the estate is $10,000 or less.
- The recoverable amount of Medicaid costs is $3,000 or less.
- The cost of the sale of the property would be equal to or greater than the value of the property.
In addition, a claim may not be filed should one or more of the following conditions exist:
- There is a surviving spouse.
- There is a surviving child or children under 21 years of age.
- There is a surviving child or children of any age who are blind or permanently and totally disabled under Social Security requirements.
- There is an unmarried adult child residing continuously in the Medicaid recipientŐs homestead for at least one year before the time of the Medicaid recipientŐs death.
An undue hardship waiver may be filed when:
- The estate property is: a family business, farm, or ranch; is the primary income producing asset of the heirs; produces at least 50 percent of the livelihood for heirs for at least 12 months prior to the death of the Medicaid recipient; and recovery by the state would affect the property and result in heirs losing their primary source of income.
- Beneficiaries of the estate will be eligible for public or medical assistance if recovery claim is collected.
- Allowing one or more heirs to receive the estate enables them to discontinue eligibility for public or medical assistance.
- The Medicaid recipient received medical assistance as the result of being a crime victim.
- The value assessed by the tax appraisal district is less than $100,000 and the heirs have gross family incomes below 300 percent of the Federal poverty level.
- Other compelling reasons exist.
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ADDITIONAL INFORMATION
- Information about the filing process, allowable deductions, and asset transfers can be found in the Texas Medicaid Estate Recovery Program Receipt Acknowledgement Form, which is in PDF format.
- You also may call DADS at 1-800-458-9858. This line is answered by in-office staff from 8 a.m. to 5 p.m. Monday through Friday. Voice mail is available 24 hours a day, seven days a week, with a message that states the call will be returned the next day. Voice mail is monitored by in-office staff from 8 a.m. to 5 p.m. on Saturday, Sunday, and holidays. You can also send e-mail to charline.stowers@dads.state.tx.us.
- Contact an attorney for legal advice.
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