048-35 Wyo. Code R. § 35-11

Current through April 27, 2019

Section 35-11 - Estate Recoveries

(a) Pursuant to W.S. § 42-4-207(c), the Department may impose a pre-death lien against a client's real property:

(i) If the client is an inpatient in a nursing facility, intermediate care facility for people with intellectual disability, or other medical institution; and the client cannot reasonably be expected to be discharged from the facility and return home; or

(ii) If the client has been institutionalized for ninety (90) days or longer without a discharge plan, it is presumed that the client will not be discharged and return home; however, an applicant or the client will be provided with a notice of their right to a hearing prior to a determination being made that the applicant or the client is permanently institutionalized.

(b) Pursuant to W.S. § 42-4-207(j), the Department may impose a lien upon property of any estate, as defined in W.S. § 42-4-206(g), of a deceased client for the amount of medical assistance provided while the client was fifty-five (55) years of age or older or while the client was an inpatient in a nursing facility, intermediate care facility for people with intellectual disability or other medical institution. The lien may be imposed regardless of the presence in the home of individuals identified in W.S. § 42-4-207(e).

(i) For estate recovery purposes, the Department defines "legal title" for real property in W.S. § 42-4-206(g) to mean title of record in the county public property records.

(c) If the client has purchased a long-term care partnership certified policy, the Department shall take into consideration the benefits paid by the policy in determining the extent of estate recovery.

(d) The Department may recover against a lien imposed under W.S. § 42-4-207 only after the death of the client's surviving spouse, if any, and:

(i) If the client has no surviving child who is under age twenty-one (21), or is blind, or permanently and totally disabled.

(e) A claim filed pursuant to W.S. § 42-4-206(a) against the surviving spouse's estate, is limited to the value of the assets of the estate determined to exist at the time of death of the surviving spouse that were marital property or jointly owned property at any time during the marriage.

(f) The Department may foreclose its lien outside the probate action pursuant to W.S. §§ 2-7-717.

(g) Procedures for recovery from non-probate estate.

(i) The Department shall have the right to recover from non-probate assets pursuant to W.S. §§ 42-4-206 or 207, and shall have the discretion to decide how to proceed.

(ii) The Department shall have the right to recover directly from a transferee or other individual or entity which has possession, control, or ownership of property received from the non-probate estate of a deceased client.

(h) Any lien or claim against the estate or assets of a client age fifty-five (55) years or older when receiving medical assistance or an inpatient in a facility, intermediate care facility for people with intellectual disability or other medical institution shall be limited to amounts expended for nursing facility services, home and community-based services including waiver services, related hospital and prescription drug services, and any items or services under the State Plan.

(i) Reasonable expenses incurred in preserving or disposing of the assets are only allowed if:

(i) They are documented with specificity and by an itemized statement or ledger of expenses with copies of receipts,

(ii) They are paid by someone other than the client (use of the client's personal funds will not be reimbursable), and

(iii) They were paid after one of the following events occurred:
- (A) Client entered a nursing facility, an assisted living facility, an intermediate care facility for people with intellectual disability, or other medical institution, never returned home, and failed to pay the expenses; or
- (B) Client passed away.

(j) The Department may decline to pursue an estate recovery if it determines that it is not cost-effective to recover.

(k) Bona Fide Efforts to Sell. The Department may enter into a stipulation and consent agreement with Medicaid client(s), heirs, or legatees when the following conditions are met:

(i) The client has received Medicaid for a period of at least six (6) months;

(ii) Net proceeds shall be paid to the Department to reimburse medical payments made on behalf of the client;

(iii) The property shall be actively placed on the market;

(iv) The property shall not be sold for less than eighty percent (80%) of fair market value, unless the Department provides approval of the sale of the property for less than eighty percent (80%) of its value; and

(v) If the net proceeds exceed the amount of the Medicaid benefits paid, Medicaid will receive payment in full for the benefits and services provided to the Medicaid client(s) and eligibility for benefits shall be redetermined.

048-35 Wyo. Code R. § 35-11

Amended, Eff. 2/19/2019.