Medicaid Fee-For-Service Program – Long Term Care – Liens

The Department is required to place liens on the home property of Medicaid recipients who receive long term care services in a nursing home or a medical institution. Recovery will be for the amount of Medicaid payments made on behalf of the recipient.

Placement of Lien Process

The Department will use the following process to place a lien:

  • The Department shall determine if the recipient is likely to be a permanent resident of a medical institution. The determination will be based on whether the recipient can reasonably be expected to be discharged from the medical institution and return home.
  • The Department shall send a notice to inform affected recipients that a lien may be placed on the home.
  • The recipient or the recipient’s authorized representative shall have the opportunity to request a hearing if they disagree with the determination to file a lien.
  • After the notice and the opportunity for a hearing, a lien will be filed on the home property if there is no request for a hearing or if the outcome of requested hearing is in the Department’s favor.

Lien Exemptions

A lien will not be placed if the recipient is expected to be discharged from the medical institution and returned home. Liens will not be placed if the following relatives of the recipient are lawfully residing in the home:

  • Spouse
  • Minor child
  • Adult child who is blind or disabled
  • Sibling who has an equity interest in the home and had lived in the home at least one year prior to the recipient’s admission to the medical institution.

Recovery

Recovery from the lien will take place after the death of the recipient or when the home is sold or transferred while the recipient is living. After the death of the recipient, recovery from the lien will not be made while the surviving spouse is living or if there is a minor child or an adult child who is blind or disabled. Recovery from the lien will not be made while the following individuals are lawfully residing in the home:

  • A sibling who resided in the home for one year immediately before the recipient’s admission to the medical institution;
  • An adult child who resided in the home two years immediately before the recipient’s admission to the medical institution and provided care to the recipient that delayed the need for long term care.

These individuals must have continuously lived in the home since the recipient’s admission to the medical institution.

Waiver of Recovery Due to Hardship

Recovery may be waived for the period the following conditions exist:

  • The real property is the sole income-producing asset such as a family farm or other family business; and
  • The income from the property is not over 100% of the federal poverty guidelines for the number of family members solely dependent on the real property; or
  • The real property is a home of modest value and the family members have lawfully resided in the home for a continuous period that started three months immediately before the recipient’s admission to the medical institution and provided care that delayed the admission; and
  • These family members do not own other real property and have income not greater than 100% of the federal poverty limit.