On March 1, 2005, Texas implemented the Medicaid Estate Recovery Program in compliance with federal Medicaid laws. The Texas Department of Aging and Disability Services (DADS) manages the program.
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,
- Home and Community-based Services,
- Texas Home Living Program,
- Consolidated Waiver Programs,
- Community Based Alternatives,
- STAR+PLUS and Integrated Care Management (ICM) waiver services; and
- Community Attendant Services.
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; or
- the cost of selling the property would be equal to or greater than the property's value.
In addition, a claim will 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; or
- there is an unmarried adult child residing continuously in the Medicaid recipient's homestead for at least one year before the time of the Medicaid recipient's death.
An undue hardship waiver may be filed when:
- The estate property
- has been the site of a family business, farm, or ranch for at least 12 months prior to the death of the Medicaid recipient;
- is the primary income producing asset of the heirs;
- produces at least 50 percent of their livelihood; and
- recovery by the state would affect the property and result in heirs losing their primary source of income.
- The estate's beneficiaries would be eligible for public or medical assistance if a 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.
- Other compelling reasons exist.
A hardship waiver specific to the homestead may be filed when:
- One or more heirs have gross family income below 300 percent of the federal poverty level.