Pennsylvania’s MA Estate Recovery Program became effective on August 15, 1994. The program was generated by the passage of Federal Public Law 103-66, which directs states to recover certain MA LTC costs by submitting a claim against the probate estates of specific MA LTC recipients who have died. These individuals are defined as those who:
Received MA for LTC services (including hospital and prescription drug services), cost-sharing and premium payments for QMB’S, and/or Home and Community-Based Services (HCBS) (including hospital and prescription drug services).
Received MA LTC on or after August 15, 1994.
Were 55 years of age or older at the time that MA LTC was received.
Died on or after August 15, 1994 (effective date of the Estate Recovery Program).
Example 1: Mrs. X, age 71, entered an LTC facility in January 1995. She was eligible for MA LTC, and remained in the LTC facility until her death at age 73. Her estate is subject to estate recovery by the Department of Human Services (DHS) for all of the MA LTC payments made on her behalf during that time.
Example 2: Mr. G. began receiving MA LTC in 1991. He was 46 at that time, and remained in an LTC facility until his death at age 56. His estate would be subject to estate recovery only for the MA LTC he received from age 55 through age 56.
NOTE: Estate recovery does not apply to estates of individuals who received MA LTC prior to age 55 and whose eligibility terminated prior to age 55.
The Department of Human Services, Bureau of Program Integrity, Division of Third Party Liability, is the state agency responsible for administering the Estate Recovery Program.
The CAO has a limited involvement in the estate recovery process. The role of the CAO personnel is that of providing general information in response to inquires from MA LTC recipients and /or their personal representatives, attorneys and financial advisors. Therefore, the material in this chapter is reference-oriented and informational in nature, and is limited to topics about which the CAO would be most likely to receive inquires.
This chapter is not intended as a sole detailed, or complete source of information on the Estate Recovery Program. Specific and detailed information may be obtained from
55 Pa. Code § 258 20 Pa. C.S. § 3392 62 P.S. § 1412.
Issued May 1, 2012