Understanding Medical Assistance Claims

I. Basics

Local agencies file Medical Assistance (MA) claims against a deceased MA member’s estate or the estate of the deceased member’s spouse to recover certain MA payments. See Minnesota Statutes, 256B.15, subdivision 1a, paragraph (f). See also Minnesota Rules, 9505.0135, subpart 4.

A. What is an MA claim?

An MA claim seeks recovery of money paid for certain services that a deceased MA member received. For purposes of estate recovery, “MA claim” is a catchall term that refers to a claim used to recover money paid for a variety of services under a variety of program names.

An MA claim seeks recovery of payment for all these health care services:

· Alternative care (AC) services received on or after July 1, 2003

· General Assistance Medical Care (GAMC) services received at any age

· Medical Assistance (MA) services:

· MA long-term services and supports (LTSS) received by a member 55 years old or older. LTSS include:

· Nursing facility services (NFS)

· Home and community-based services (HCBS)

· Waiver HCBS

· Alternative care (AC)

· Brain injury (BI)

· Community alternative care (CAC)

· Community access for disability inclusion (CADI)

· Developmental disabilities (DD)

· Elderly waiver (EW)

· Nonwaiver HCBS

· Home care services

· Home care nursing

· Home health aide services

· Medical supplies and equipment

· Physical therapy, occupational therapy and speech therapy, when the service is provided by a home health agency

· Personal care assistance (PCA)

· Hospital and prescription drug services received during the time the member was provided NFS or HCBS

· All MA services received by a member, regardless of age, during permanent residence in a medical institution

An MA claim includes capitation payments made to managed care organizations (MCOs) for coverage of these services. A capitation payment is like an insurance premium payment made each month to the MCO on behalf of the MA member. The MCO covers the services in exchange for the payment. Capitation rates are determined based on an actuarial analysis of the State’s historical fee-for-service cost experience with equivalent groups of members.

See State Medicaid Manual, Section 3810.A.6.

B.  When should I file an MA claim?

You can file a claim after an MA member dies, but the timing for collection on the claim depends on the member’s circumstances at death.

For instance, if the member is survived by a spouse or by a child who is under 21 years old, blind, or permanently disabled, collection is postponed until the spouse dies, the child reaches the age of 21, or the blind or permanently disabled child dies.

No statute of limitations limits local agencies in filing and recovering on MA claims.

See Minnesota Statutes, section 256B.15, subdivisions 1a and 2. See also In re Estate of Barg, 752 N.W.2d 52 (Minn. 2008).

C.  Where do I file an MA claim?

Where to file an MA claim depends on the type of process used to distribute the property of the deceased MA member or of the deceased member’s spouse.

If the property is distributed by —	Then —
Probate or special administration	File a written statement of claim with the district court that has jurisdiction.
Decree of descent	Complete a Medical Assistance Clearance Certificate for a Decree of Descent (DHS-6165B) (PDF) and send it to the applicant. The petitioner or the petitioner’s attorney must then file the certificate with the district court. See Minnesota Statutes, 525.313. In addition, you may file a written statement of claim with the district court to ensure recognition of the claim.
Affidavit of collection	Present a completed affidavit for collection for personal property along with a certified death record after all statutory requirements have been met. See Minnesota Statutes, 524.3-1201.
Transfer on death deed (TODD)	Complete a Medical Assistance Clearance Certificate for a Decree of Descent (DHS-5893A) (PDF) and send it to the applicant. See Minnesota Statutes, 507.071, subdivision 23.

D.  How do I determine the final amount of an MA claim?

To determine the final amount of an MA claim, add up the claim totals from the claims history reports you requested from the Minnesota Department of Human Services (DHS), and then subtract premium amounts billed for the member for AC and Medical Assistance for Employed Persons with Disabilities (MA-EPD). The result is the final claim amount. See MA claims-payment histories for more information.

E.  Which services do I prioritize collection for with an MA claim?

When an estate does not have enough assets to pay all the claims made against it, Minnesota law requires the estate’s personal representative to pay claims in a certain order, by category of claims. There are seven categories. MA claims are placed in the category of fourth priority, because they are the “expense(s) of last illness.” See Minnesota Statutes, 524.3-805.

Pursue recovery of these fourth-priority expenses in this order:

1. Payments for Alternative Care services received on and after July 1, 2003. See Minnesota Statutes, 256B.15 and 256B.0913.

2. Payments for GAMC services a member received at any age. Although this program ended in 2011, you can still recover against the estates of people who received GAMC benefits while the program was active. See Minnesota Statutes, 256B.15, subdivision 1a, paragraph (e), clause (2).

3. Payments for MA LTSS a member received at age 55 or older. You can recover all paid amounts for LTSS that a member received at 55 years old or older. See Minnesota Statutes, 256B.15, subdivision 1a, paragraph (e), clause (3).

4. Payments for MA services a member received at any age while permanently residing in a medical institution without expectation of returning home, as certified by the attending physician, advanced practice registered nurse (APRN) or physician assistant (PA). See Minnesota Statutes, 256B.15, subdivision 1a, paragraph (e), clause (1).

F.  How do MA claims interact with MA liens or notices of potential claim (NPCs)?

If the estate contains real property subject to an MA lien or NPC, and you file a claim for recovery of MA, DHS will release the lien at its own cost and allow you to recover MA payments under your own MA claim. See Minnesota Statutes, 256B.15

To obtain a release of the MA lien or NPC, send DHS a secure email indicating your claim has been satisfied. In the subject line, indicate what type of release you are requesting and the lien number. DHS will prepare and send a release of the lien directly to the county recorder for filing.

For practical purposes, wait to request a release until the estate has paid the MA claim.