Will Medicaid Costs I Incurred Before 55 Be Part of My Lien?

No, those years would generally not be part of a Medicaid lien.

For people under 55, estate recovery only applies if they were permanently institutionalized in a nursing home or other medical facility.

What Happens When You Pass Away

When a person who received Medicaid benefits passes away, the state Medicaid agency will look to see if they are subject to estate recovery.

Important Things to Remember

• State variations: While federal law sets the rules, each state has its own specific Medicaid Estate Recovery Program (MERP). The rules can vary slightly, so it’s always a good idea to check with your state’s Medicaid office or an elder law attorney for the most precise information.
• Preventing a lien: Even if you received Medicaid after age 55, there are certain situations where the state cannot pursue a lien, such as if you have a surviving spouse, a child under 21, or a blind or disabled child of any age.
• Hardship waivers: Your heirs may also be able to apply for a hardship waiver if a lien would cause them significant financial distress.
• Recoverability of a (d)(4)(A) trust: Funds in a (d)(4)(A) trust are recoverable by the state and are not limited by age. If you are a beneficiary of a (d)(4)(A) trust and funds remain in the trust when you pass away, those funds are subject to payback.

In your case, because the years you used Medicaid were well before the age of 55, you can be confident that those costs will not be part of any future Medicaid lien on your estate.

The “55 and Older” Rule

Note that Medicaid estate recovery is a federally mandated program that allows states to get money back for certain Medicaid costs after a person passes away, but the key factor is age.

• Medicaid estate recovery generally only applies to benefits received when the person was age 55 or older.
• This means that any Medicaid costs incurred while you were between the ages of 21 and 40 would not be subject to a lien on your estate.

What Costs Are Subject to Recovery?

Even for those over age 55, a lien is typically only placed for specific types of care. The program is designed to recover costs for long-term care, which includes things like:

• Nursing facility services
• Home and community-based services
• Related hospital and prescription drug services