Some important changes are taking place in the Estate Recovery Program as a result of the 2013-2015 biennial budget that was passed by the Wisconsin State Legislature in 2013. These changes will begin August 1, 2014.
Background
Through the Estate Recovery Program, the state seeks repayment for the cost of certain long term care services paid for by Medicaid and BadgerCare Plus, and all services paid for by the Wisconsin Chronic Disease Program (WCDP). Repayment is made from the member’s property after they pass away or from liens placed on their homes. The money recovered from the member’s estate is returned to the program and used to pay for care for other members. It is important to remember that the state does not seek repayment from a member’s property while the member is survived by a:
- Spouse
- Child under age 21
- Disabled or blind child of any age.
Repayment is made only after the member or the surviving spouse passes away or, in some situations, from a lien on the member’s home. Liens are not filed against homes of members while they are living in the community. The Estate Recovery Program is paid after certain other expenses are paid according to standard probate procedures. Costs paid prior to the Estate Recovery Program include:
• The costs of administering the estate, including attorney fees.
• Reasonable funeral costs.
• The costs of the last illness, if any, that were not paid by Medicaid, BadgerCare Plus, or WCDP.
Policy Changes
Beginning August 1, 2014, certain new assets and services will now be part of the Estate Recovery Program.
The assets below will now be part of the Estate Recovery Program:
• Joint Tenancy Property
Repayment will be made after the member passes away from joint tenancies created on and after August 1, 2014. Repayment will be made from the interest in the property that the member has at the time the member passes away. Tax Equity and Fiscal Responsibility Act of
1982 (TEFRA) liens will continue to be filed on joint tenancy homes and repayment will be made from joint accounts at financial institutions, no matter when the joint tenancy was created.
• Life Estates
Repayment will be made from a life tenant’s interest in life estates that are created on and after August 1, 2014.
• Life Insurance Policies
Repayment will be made from a member’s life insurance policy, no matter who is named as the beneficiary, for life insurance policies created on and after August 1, 2014.
• Marital Property
Repayment will be made from 50 percent of the surviving spouse’s estate.
• Revocable Trusts
Repayment will be made after the member passes away from revocable trusts created on and after August 1, 2014. A TEFRA lien will continue to be filed on a home in revocable trust regardless of when the trust was created.
• Tax Equity and Fiscal Responsibility Act of 1982 Liens
Repayment will be made through TEFRA liens placed on life estates that are created on and after August 1, 2014.
• Other Non-probate Property
Repayment will be made from non-probate property not listed above for any member who passes away on or after August 1, 2014. These assets will be used as repayment for members who pass away on and after August 1, 2014.
Services
The cost of the services below will now be included in the amount that the Estate Recovery Program will seek repayment for:
• All services received while participating in a long term care program
Repayment will be made for all services received on and after August 1, 2014, by a member age 55 years and older participating in a long term care program. This
includes members participating in home and community-based waiver programs, and the Program of All-Inclusive Care for the Elderly (PACE).
• Capitation payments
Repayment will be made for the entire capitation payment made to a managed care organization (MCO) beginning August 1, 2014, for a member participating in a long term care program. Repayment of these services applies to services received and capitation payments made on and after August 1, 2014, for any member age 55 and older participating in a long term care program. Long term care programs include all home and community-based programs and PACE.
Program Dis-enrollment
Members should contact the source listed below for their program before July 18, 2014, for benefit counseling if they do not want the new services recovered and will need to dis-enroll from their program. This will allow for case closure and dis-enrollment from Wisconsin Medicaid, BadgerCarePlus, or WCDP prior to the new rules taking effect:
• Medicaid — Contact your local Aging and Disability
Resource Center (ADRC).
• BadgerCare Plus — Contact your agency.
• WCDP — Contact Member Services at 1-800-362-3002.
For More Information
http://www.dhs.wisconsin.gov/publications/p1/p13032-C.pdf
