Will State Recover for Doctors Visits?

by Annie Lynn
(Hazleton, PA USA)

I just went on Medicare, and because of my low income, my supplemental insurance is Medical Assistance (from the state of PA). Will the state come after my home to recover what they paid out to me for general doctor visits or even a stay in the hospital.


This scenario is without me ever going into a nursing home.

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Aug 26, 2014
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State must seek reimbursement for Medicaid Payments
by: Gabriel Heiser

Under federal law, the state must seek to be reimbursed for all payments made on behalf of a person on Medicaid for payments made while that person is in a nursing home or after the age of 55.

Since you are on Medicare, I assume you are at least age 65, so yes, all medical expenses (whether in a nursing home or not), related hospital and prescription drug costs, will indeed be added to the amount for which the state will eventually seek recovery. Note that there are variations from state to state as to exactly what is subject to recovery or not, so you may need to check with your state’s Medicaid department if you have specific questions in this area.”

Here’s the actual statute:

In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of—
(i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or
(ii) at the option of the State, any items or services under the State plan (but not including medical assistance for medicare cost-sharing or for benefits described in section 1396a (a)(10)(E) of this title).

http://www.law.cornell.edu/uscode/text/42/1396p

You can find out more at www.medicaidsecrets.com.

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