As part of the Medicaid program, federal law dictates that a State Medicaid plan is required to seek “adjustment or recovery from the individual’s estate” if that individual is 55 years or older. 42 U.S.C.A. § 1396p (b) (1) (B). The definition of the word “estate” is broad, covering most of the property a Medicaid beneficiary owned at death or comes into his/her estate. As the resource threshold to qualify for Medicaid is $2,000.00, there is not much Medicaid can go after. But if a beneficiary owns a vehicle or a house which was exempt during the application process, upon death, those assets can be sold and the proceeds paid to the Division of Medical Assistance and Health Services. If one disagrees with the lien amount or basis of the lien, they have two methods to appeal.
The first method is to file for a waiver or compromise of the lien within 20 days of being notified of the lien (which occurs when the representative of the estate informs Medicaid of the beneficiary’s passing). Under this procedure, as outlined in N.J.A.C. § 10:49-14.1 (h) (3), the Division has 45 days to make a decision on the waiver. If the estate still disagrees, the representative of the estate must file a fair hearing appeal before an administrative law judge, who will determine the claim.
The second appeal method is filing a complaint in Superior Court challenging the facts and circumstances surrounding the entry of the lien naming DMAHS as a defendant under N.J.S.A. § 30:4D-7.8. This option is available to the estate when the 20-day time limit to appeal has passed, as there is no time limit in the statute to file. This also gives the estate the opportunity to appeal in a courtroom setting versus at an administrative hearing. Which direction you should go depends on the lien amount and likelihood of success.
If you are looking for additional information on this topic or require advice about your situation, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at firstname.lastname@example.org. Please ask us about our video conferencing or telephone consultations if you are unable to come to our office.
Written by Stephen W. Kornas, Esq. of Hanlon Niemann & Wright