Estate recovery only affects Medi-Cal members who are 55 and older or Medi-Cal members of any age who have been determined "permanently institutionalized." An individual is determined to be “permanently institutionalized” when they are an inpatient in a nursing facility, are not expected to return home, and have had the opportunity for a hearing regarding their “permanently institutionalized” status. For members who die on or after January 1, 2017, repayment will be limited to payments made, including managed care premiums paid, for nursing facility services, home- and community-based services (HCBS), and related hospital or prescription drug services received while the member was an inpatient in a nursing facility or was receiving HCBS.
When notification of a Medi-Cal recipient’s death is received, the Department of Health Services will determine whether or not the cost of services must be repaid. Regardless of what is owed, the Department will never collect more that the value of the assets owned by the person who received Medi-Cal at the time of his/her death.
The Department of Health Services cannot require reimbursement under the following circumstances:
- During the lifetime of a surviving spouse or registered domestic partner.
- For Medi-Cal services provided before the beneficiary’s 55th birthday, unless determined "permanently institutionalized".
- If the Medi-Cal beneficiary is survived by a child under 21 years old.
- If the Medi-Cal beneficiary is survived by a child who is blind or disabled (as defined by the Federal Social Security Act).
- Beneficiaries only receiving assistance through a Medicare Savings Program.
In some cases, exemptions or waiver to repayment may apply. Different laws apply to Medi-Cal members who died prior to January 1, 2017. For more information regarding Estate Recovery please click here.
