RD552 - Findings and Recommendations for Developing an Improved Estate Recovery Program – December 1, 2016

Executive Summary:
Federal law requires state Medicaid programs to operate estate recovery programs for individuals age 55 or older. The programs must seek to recover payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States have the option, an option which Virginia exercises, to recover payments for all other Medicaid services provided to individuals 55 or older. In 2015, the Joint Legislature Audit and Review Commission (JLARC) issued a study which contained several findings and recommendations related to the estate recovery program at the Department of Medical Assistance Services (DMAS). The study found that the program does not proactively identify assets that may be recoverable from the estates of deceased Medicaid beneficiaries, which limits the state's ability to seek reimbursement for the cost of Medicaid expenditures. That JLARC finding resulted in language in the 2016 Appropriations Act directing DMAS to require eligibility workers to search for unreported assets at the time of initial eligibility determination and to develop a plan to improve the estate recovery program.