Nevada's Medicaid Estate Recovery Program

If you live in Nevada and you've received Medicaid to pay for certain services during your life, Nevada's Medicaid Program will attempt to recover some costs from your estate when you die. After a Medicaid recipient passes away, Nevada's Medicaid Estate Recovery (MER) locates and recovers assets that belonged to you to repay some of the benefits that had been paid out on your behalf. These funds are then used to help future recipients and to maintain the sustainability of the program.

When you apply for Medicaid in Nevada, you are required to submit forms stating that you agree to Nevada's Medicaid Estate Recovery Program. When you are approved for Medicaid, the state of Nevada will send you information about the estate recovery program. Understanding the basics of the program and letting family members know what to expect will help avoid unpleasant surprises after your death.

Will Nevada seek reimbursement from my estate?

The assets you own at your death make up your "estate." Medicaid will seek reimbursement from your estate if any of the following are true.

• You received Medicaid assistance after the age of 55
• You were the beneficiary of a special needs trust while you received Medicaid assistance (at any age). A special needs trust holds assets for someone who receives Medicaid or Social Security disability (SSI) to preserve eligibility for government assistance. Whether the estate recovery program will try to recover from the trust depends on the type of trust.
• You were an inpatient in a nursing facility, intermediate care facility for individuals with intellectual disabilities, or some other types of medical institution when you received Medicaid assistance (at any age).

Medicaid may not seek recovery if certain exclusions exist. If you are survived by one of the following, Nevada's MER program won't try to recover its costs from your estate:

• your spouse
• your child under 21 years of age, or
• your child who is blind or disabled (as defined by Section 1614 of the Social Security Act).

In addition, certain income, property and resources of Native Americans or Alaska Natives are exempt from being taken by the estate recovery program.

Which Medicaid expenses must my estate repay?

Nevada's estate recovery program seeks reimbursement for all Medicaid services, whether or not they are related to long-term care. Medicaid can only attempt to recover the amount of Medicaid benefits correctly paid up to the determined value of the recipient's estate. The MER program affects only individuals who received Medicaid benefits on or after October 1, 1993.

Under the Affordable Care Act, Medicaid agencies may not seek recovery for Medicare cost-sharing payments. [check]

What assets will Nevada go after for Medicaid recovery?

Nevada's Medicaid Estate Recovery Program can go after many assets, including a Medicaid recipient's home, land, bank accounts, vehicles, cash, household goods, and other assets.

Repayment is made from the assets you owned immediately prior to death, including assets passing by reason of joint tenancy, reserved life estate, survivorship, trust, annuity, homestead or other arrangement.

Family members do not have to repay Medicaid from their own pockets.

Can the state take my house during my life?

No. In Nevada, Medicaid Estate Recovery may seek a lien before you pass away if you say that you no longer intend to return to your home. (A lien is a legal claim against a piece of property that ensures a creditor -- in this case, Medicaid – eventually gets paid.) Only after you pass away will Medicaid Estate Recovery file a claim against your estate -- for the full value of Medicaid benefits paid on your behalf. Then, when your house is sold or transferred (such as through probate), Medicaid will seek to collect what you owe.

The state can place a lien on your house even if someone else is living in it; however, federal law prohibits recovery on the lien if close relatives of yours are living in the home, including:

• your spouse
• your child under 21
• your permanently disabled or blind adult child, or
• a sibling with an ownership interest in the home who lived there for at least a year before you entered the care facility.

If any of the above relatives are living in the home, Medicaid will remove the lien on the home if they sell the home or need to refinance the home. The lien is then extinguished without its having to be paid back.

Could my estate be exempt from Nevada's Medicaid Estate Recovery Program?

In Nevada, there is no complete exemption from Medicaid estate recovery. In some cases, such as when you are survived by a spouse or minor or disabled child, recovery can be delayed. Medicaid reimbursement can become complicated when delayed recovery is involved, especially if the children are very young or a disabled child is likely to live for a long time. If one of these situations applies to you and you have questions, contact the Nevada Medicaid agency (Division of Welfare and Supportive Services).

Could my estate be excused from repaying if it would cause hardship for my family?

Nevada sometimes waives enforcement of an estate recovery claim when relative or other inheritors of the estate are able to show, through convincing evidence, that recovery subjects them to undue hardship. (But there is no hardship waiver provided at the time of lien placement against the real property of a Medicaid recipient who has passed away.)

Medicaid must inform the person in charge of your estate that someone who inherits from you may apply for a hardship waiver under the conditions above. The inheritor then has 30 days to apply for a waiver. If the application is approved, that inheritor's portion of the repayment may be forgiven or modified.

In addition to the above discussed exceptions regarding recovery on a home, in determining whether undue hardship exists, Nevada considers the following information.

• The asset to be recovered is the sole income-producing asset of the applicant (the person requesting the waiver).
• The recovery of the assets would result in the applicant becoming eligible for governmental public assistance based on need and/or medical assistance programs.
• A doctor's written verification of a medical condition that compromises the applicant's ability to repay the Medicaid claim.
• The following factors are also considered when making a decision to temporarily waive, modify, or compromise on estate recovery.
• The gross annual income, property and other assets of the applicant and their immediate family, and
• the type and level of care provided by the person seeking a waiver to the decedent and the extent to which the care delayed or prevented the institutionalization of the decedent.

Who must make sure that the state is notified and any required repayment is made?

The person in charge of wrapping up your estate must contact the Nevada Medicaid agency within 30 days of your death. To make the process easier, you may want to give the person you expect to handle your final affairs a copy of the notice you receive from Medicaid when your benefits begin. (Remember, federal law requires Nevada to provide you with a notice explaining the estate recovery program. You sign this when you apply for Nevada Medicaid benefits.) This notice will help your representative understand how the program works. Otherwise, your representative can contact the Medicaid office using the information below.

The person in charge of your estate should not distribute money or other assets from your estate until any required repayments to Medicaid have been made. A representative who later finds that there are not enough assets left to pay back Medicaid may be personally responsible for the bill.

Learn more

For more information or to contact someone at Nevada's Medicaid Estate Recovery office, visit the Department of Health and Human Services, Division of Health Care Financing and Policy website or call 775-684-3717.

The Nevada statutes related to Medicaid Estate Recovery are contained in NRS 422.29302 and the Nevada Medicaid Operations Manual, Section 100.