MA Liens

A Medical Assistance (MA) lien is a lien filed against an MA member’s real property interest before the member dies to secure repayment of MA costs of the member’s permanent stay in a medical institution. An MA lien is filed in the real estate records of the county in which the real property the lien describes is located. DHS collects on MA liens when real property is sold, which may happen before or after the MA member dies. See Minnesota Statutes, sections 514.980–514.985.

I. When can DHS file an MA lien?

When a person in your county applies for MA coverage of his or her residence in a medical institution, submit a Referral for an MA Lien or Notice of Potential Claim (DHS-3203) to DHS. A lien worker in the DHS Special Recovery Unit (SRU) reviews the referral. For an MA lien to become effective, the lien worker must ensure that all the following have occurred:

· DHS has made MA payments on behalf of the member.

· DHS has obtained verification from the member’s attending physician, advanced practice registered nurse (APRN) or physician assistant (PA) that the member cannot reasonably be expected to be discharged and return home.

· The member has been provided notice of the lien and an opportunity for an administrative hearing.

· All exceptions against the enforcement of the lien no longer apply.

· The lien notice has been filed in the county recorder’s office or memorialized on a certificate of title for the property.

If the above conditions are not met, DHS cannot collect on an MA lien. If an MA member is discharged from a medical institution and returns to their home. DHS must release an MA lien before the real property is sold.

II. What is a medical institution?

DHS files MA liens only after an MA member enters a “medical institution.” Medical institutions include the following:

· Nursing facilities

· Skilled nursing facilities

· Intermediate care facilities

· Intermediate care facilities for people with developmental disabilities

· Inpatient hospitals

III. What if an MA member owns a life estate or joint tenancy interest in real property?

If a person owns a life estate or a joint tenancy interest in real property when he or she dies, and the interest was established on or after August 1, 2003, that interest remains subject to a lien after death to satisfy repayment of MA. Recovery on a life estate is limited to the value of the person's interest on the date of death as determined by the Life Estates Mortality Table found in the Eligibility Policy Manual for Minnesota Health Care Programs.

IV. Are there exceptions that prevent DHS from filing an MA lien?

There are exceptions that prevent DHS from filing an MA lien. However, even if any of the below exceptions apply, email DHS a Referral for an MA Lien or Notice of Potential Claim (DHS-3203) when a person applies for MA coverage of his or her residence in a medical institution.

DHS cannot file an MA lien if the real property at issue is the homestead of one or more of the following people:

· An MA member’s spouse

· An MA member’s child who is younger than age 21

· An MA member’s child of any age who is blind or totally and permanently disabled according to Supplemental Security Income program criteria

· An MA member’s child of any age who:

· lived on the property for at least two years before the member began receiving institutional care,

· has continuously lived on the property since the member’s date of institutionalization, and

· provided care that allowed the member to remain in the community

· An MA member’s sibling who:

· has an equity interest in the homestead,

· resided in the home for at least one year before the member began receiving institutional care, and

· has continuously lived on the property since the member’s date of institutionalization

V. How long does an MA lien last?

An MA lien is enforceable for 10 years from the date of its filing. DHS may renew the lien for an additional 10 years.