The Georgia Department of Community Health announced that it would begin implementing the Medicaid Estate Recovery Program in May 2006. Under this program, funds are recovered from the estate of the individual who received services, after the member’s death, for the cost of Medicaid services received.

According to the Department, estate recovery applies to those who reside in a nursing facility or other long term care facility paid for by Medicaid. Additionally, it applies to those who are 55 years of age or older and are receiving services through Medicaid waiver programs including home-based and community-based services. Covered services include personal care services, hospital services, prescription drug services, nursing facility services, personal care services, and home and community-based services.

There are special circumstances where the state will not seek recovery of assets or take action to recover monies spent on medical care. Examples given by the Department of Community Health are estates that are valued at less than $25,000 or if other specific hardships exist. The state may delay recovery action if the individual who received services has a spouse, child under 21 or blind or permanently disabled child living in the home.

The Georgia Administrative Code, Chapter 111-3 Medical Assistance, requires both the administrator of the nursing facility or intermediate care facility and the personal representative of the estate to report the death of a member to the Department of Community Health within 30 days of the death of the individual receiving Medicaid services. This means if you are appointed the Administrator or Executor of an estate of an individual who was receiving Medicaid services, you most likely have a reporting obligation.

Importantly, the Code states that if a personal representative of an estate makes a distribution of estate assets to the heirs or others without having met the obligations of this Code section, the personal representative may be held personally liable for the amount of medical assistance paid on behalf of the member, up to the full value of the property belonging to the estate that was in the custody or control of the personal representative.

For more information or to discuss your specific situation, contact Hindson & Melton LLC. Karen Hindson (770) 939-3936 or Joy Melton (770) 512-8383