Estate Recovery Program
What is Estate Recovery?
The Medi-Cal program must seek repayment from the estates of certain deceased Medi-Cal beneficiaries. Repayment only applies to benefits received by these beneficiaries on or after their 55th birthday and who own assets at the time of death. If a deceased beneficiary owns nothing when they die, nothing will be owed.
For Medi-Cal members who died
on or after January 1, 2017: (See
Changes to Estate Recovery effective January 1, 2017
due to Legislation SB 833)
Repayment will be limited only to estate assets subject to probate that were owned by the deceased beneficiary at the time of death.
Repayment will be limited to payments made, including managed care premiums paid, for nursing facility services, home and community based services, and related hospital and prescription drug services received when the beneficiary was an inpatient in a nursing facility or received home and community based services.
For Medi-Cal beneficiaries who died
prior to January 1, 2017:
Repayment will be sought from all assets owned by the deceased beneficiary at the time of death.
Repayment will be owed for payments made for most services received and/or monthly managed care premiums paid on behalf of the Medi-Cal beneficiary.
Submitting Notice of Death
If you are the person handling the affairs of the deceased Medi-Cal beneficiary, you must provide “Notice of Death” to the Director of DHCS within 90 days of the date of death with a copy of the death certificate. To satisfy the
“Notice of Death” requirement and for fastest processing, complete and submit online the “Notice of Death” form with a copy of the death certificate. You may also mail
“Notice of Death” with a copy of the death certificate to DHCS at: Department of Health Care Services, Estate Recovery Section, MS 4720, P.O. Box 997425, Sacramento, CA 95899-7425.
Exemptions/Waivers
Specific limitations or
exemptions may apply. The Department of Health Care Services (DHCS) may waive its claim if payment of the claim would cause a substantial hardship. Any request for a substantial
hardship waiver must be submitted to DHCS within 60 days of the date on the DHCS Estate Recovery claim letter.
Certain income and resources of American Indians and Alaska Natives are exempt from Estate Recovery. Please be sure to inform DHCS if the decedent’s property is on or near a federally recognized reservation, Pueblo, or Colony. A collection representative will contact you to clarify if DHCS can or cannot collect against these assets. For specific details on what assets are exempt from Estate Recovery please see the State Medicaid Manual, Section 3810 (7) and (8).
Pay a Claim
When you receive our claim amount and are ready to submit payment, we accept
Electronic Fund Transfers (EFT) and checks. Regardless of which method you use to pay, you will need your DHCS Account Number to ensure payment is posted to the correct account.
Contact Information
Department of Health Care Services
Third Party Liability and Recovery Division
Estate Recovery Section - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
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Mailing address for payments:
Department of Health Care Services
Third Party Liability and Recovery Division
Estate Recovery Section - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Request for Medi-Cal Expenses Subject to Estate Recovery
Medi-Cal members or their authorized representative may submit a
Request for Medi-Cal Expenses Subject to Estate Recovery, form DHCS 4017, once per calendar year for a five dollar ($5) processing fee if the current or former member meets either of the following descriptions:
a.
An individual who is 55 years of age or older when the individual received health care services.
b.
A permanently institutionalized individual who is an inpatient in a nursing facility, intermediate care facility of the intellectually disabled, or other medical institution.