Medicaid Estate Recovery

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Medicaid Estate Recovery

• Medicare Improvements for Patients and Providers
  Act of 2008 (MIPPA)
• Section 115 Elimination of Estate Recovery
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• COB/TPL Technical Advisory Group Webinar
• October 2009

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What Does Section 115 of MIPPA Require? 

• Section 115 of MIPPA requires States to exempt
  Medicare cost-sharing benefits (i.e., Part A and
  Part B premiums, deductibles, coinsurance, and
  co-payments) paid under the Medicare Savings
  Programs (MSP) from estate recovery under section
  1917(b)(1) of the Social Security Act.
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• When is Section 115 Effective?
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• This provision is effective January 1, 2010.
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Which Dual Eligibles Are Affected by Section
115?

• The exemption in section 115 of MIPPA applies to
  the following groups of dual eligibles
• Qualified Medicare Beneficiary (QMB),
• Specified Low-Income Medicare Beneficiary (SLMB),
  
• Qualifying Individual (QI),
• Qualified Disabled and Working Individual (QDWI),
  
• QMB Plus (QMB with full Medicaid benefits), and
• SLMB Plus (SLMB with full Medicaid benefits).

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Which Medicaid Benefits Are Affected by Section
115?

• The provision applies to Medicare cost-sharing
  benefits (i.e., Part A and Part B premiums,
  deductibles, coinsurance, and co-payments) paid
  under the MSP with a date of service that is on
  or after January 1, 2010.

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Which Medicaid Benefits Are Not Affected by
Section 115?

• The provision does not apply to
• MSP cost-sharing benefits with a date of service
  that is before January 1, 2010 and
• Benefits not related to MSP cost-sharing.
• Also, this MIPPA exclusion does not affect
  inclusion of MSP cost-sharing benefits received
  before January 1, 2010, in the Medicaid costs
  that are included in a lien that was in effect at
  the time of the recipients death, regardless of
  the date the lien was initiated or the date of
  the recipients death.

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Which MSP Cost-Sharing Benefits Should Be
Included in the Medicaid Estate Claim?

• Three factors govern inclusion of MSP
  cost-sharing benefits in
• the Medicaid claim against the estate of a
  deceased recipient
• type of dual eligibility, date of service, and
  date of death.
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• Type of dual eligibility Only those dual
  eligibles listed above are protected from estate
  recovery for MSP cost-sharing benefits.

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• Date of service The Medicaid service for the
  listed dual
• eligibles is the MSP cost-sharing benefit.
• The date of service for MSP deductibles,
  coinsurance, and co-payments is the date the
  request for payment is received by the State
  Medicaid agency.
• For premium payments, the date of service is the
  date the State Medicaid agency paid the premium.
  
• Exemption of MSP cost-sharing benefits from
  estate recovery extends only to benefits with
  dates of service on or after January 1, 2010.
  MSP cost-sharing benefits with dates of service
  before January 1, 2010, may be included in the
  Medicaid claim against the

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• estate of a dual eligible whose date of death is
  on or after January 1, 2010.
• Date of death The new MIPPA exclusion does not
  apply to estate recovery for dual eligibles who
  die before January 1, 2010.

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What Do States Need to Do to Implement Section
115?

• CMS will require States to modify their State
  plans to reflect the changes brought about by
  Section 115.
• However, to reduce State reporting burden, CMS
  will allow States to note changes solely on the
  appropriate SPA preprint page, as a check-off
  technical amendment.
• For additional flexibility, States will be
  granted up to six months from date of
  implementation to forward SPAs to their CMS
  Regional Office.

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• As budgets permit, States are requested to
  revise all affected public information services
  (e.g., website, program brochures, flyers, etc.)
  to clearly notify affected dual eligibles, of the
  expanded protection of their estate from Medicaid
  recovery (for the value of Medicare cost-sharing
  benefits).

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For Additional Information, Contact 

• Centers for Medicare Medicaid Services
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• Barry Levin [phone] Barry.Levin_at_cms.hhs.
  gov
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• Nancy Dieter [phone] Nancy.Dieter_at_cms.hhs
  .gov