Cal. Code Regs. Tit. 22, § 50961 Estate Claims

• Library: California Code of Regulations
• Edition: 2023
• Currency: Current through Register 2023 Notice Reg. No. 52, December 29, 2023
• Citation: Cal. Code Regs. Tit. 22, § 50961
• Year: 2023

(a) The Department shall claim against the estate of a decedent, or against any recipient of the decedent's property by distribution or survival, an amount equal to the lesser of:

(1) All payments made by the Medi-Cal program on behalf of the decedent, except for those payments specified under subsection (c) that are not included in the claim or,

(2) The decedent's equity interest in the property at the time of death (to the extent of such interest).

(b) All payments made by the Medi-Cal program on behalf of decedents:

(1) Age 65 and older, who died prior to July 11, 1994, shall include all payments made for services provided at age 65 and older;

(2) Age 65 and older, who died on or after July 11, 1994, shall include all payments made from age 65 and older, in addition to any payments made from age 55 to 64 that were paid on or after October 1, 1993;

(3) Age 55 to 64, who died on or after July 11, 1994, shall include only those payments made on or after October 1, 1993.

(c) The Department's claim shall include all payments made by the Medi-Cal program on behalf of the decedent, including nursing facility and other long-term care services, home and community based services, inpatient/outpatient services, durable medical equipment, related hospital and prescription drug services, health care and insurance premiums, and payments to managed care plans. The Department's claim shall not include payments made for personal care services provided under In-Home Supportive Services, or the cost of premiums, co-payments, and deductibles paid on behalf of Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Medicare Beneficiaries (SLMBs), Qualifying Individuals, Qualified Disabled and Working Individuals, QMB Plus, and SLMB Plus who are categorized as groups of dual eligibles as defined by Section 22undefined2602(f) of the Patient Protection and Affordable Care Act of 2010 (Pub. L. No. 111-148).

(d) An exemption from the Department's claim exists in any of the following circumstances:

(1) Where the decedent was under age 55 when the Medi-Cal services, as specified in subsection (c), were received, except if the individual is/was an inpatient in a nursing facility, intermediate care facility for individuals with intellectual disabilities, or other medical institution, and both of the following conditions are met (A) The provisions under Title 22, California Code of Regulations, Section 22undefined50428 apply to the individual and (B) The individual spends for costs of medical care all but a minimal amount of his/her income required for personal needs.

(2) During the lifetime of a surviving spouse, after the documentation specified in paragraphs (A) and (B), below, is submitted to, and approved by, the Department at the address specified in Section 22undefined50966(a) However, upon the death of the surviving spouse, the Department shall assert its claim against the estate of the surviving spouse, in accordance with subsections (a), (b) and (c) of this section (A) Proof that the surviving spouse was married to the decedent at the time of death; and (B) Proof of identity of the surviving spouse including name, social security number, and date of birth.

(3) During the lifetime of a surviving person, as specified in subsections (b) and (c) of Section 22undefined50963, who qualifies for a waiver due to a substantial hardship. However, upon the death of the surviving person, the Department shall assert its claim against the estate of the surviving person, in accordance with subsections (a), (b) and (c) of this section.

(4) When, as of the date of decedent's death, there is a surviving child of the decedent who is under age 21, and who can provide the Department with the documentary evidence specified in Section 22undefined50966(a)(2), to the address specified in Section 22undefined50966(a);

(5) When, as of the date of the Department's notice of claim, there is a surviving child of the decedent who is blind, or disabled, within the meaning of Section 22undefined1614 of the federal Social Security Act (42 USC Section 42undefined1382c), and who qualifies for a claim exemption under Section 22undefined50966.

(e) The Department shall waive the proportionate share of its claim against any applicant who qualifies for a waiver due to a substantial hardship, as...