Medi-Cal Estate Recovery is a California state initiative that mandates the Department of Health Care Services (DHCS) to pursue reimbursement from the estate of a deceased Medi-Cal beneficiary for specific Medi-Cal benefits provided on their behalf. The purpose is to assist in funding Medi-Cal for others by recouping some of these expenses after an individual passes away.
Who Does It Apply To?
Estate recovery typically applies only when all of the following conditions are met:
- The individual received Medi-Cal services – especially long-term care (such as nursing facility care or home-and-community-based services) after reaching the age of 55 (or if they were permanently institutionalized, regardless of age).
- The individual possessed assets at the time of death that are included in their probate estate — referring to property that must go through a California probate court following death.
If the individual had no assets at the time of death, the state cannot recover any funds.
What Costs Can the State Recover?
According to current California legislation (effective January 1, 2017, due to Senate Bill 833):
- Only certain long-term care expenses are subject to recovery under federal law. This encompasses:
- Nursing home care
- Home-and-community-based services
- Associated hospital and prescription costs incurred while receiving the aforementioned care
The state cannot pursue recovery for standard medical expenses such as general doctor visits, most prescriptions, or routine hospital visits that are not related to long-term care.
What Is an “Estate”?
For the purposes of recovery, an estate generally consists of:
- Assets solely owned by the deceased that are subject to probate
- Real estate (such as a home) held exclusively in the decedent’s name
- Bank accounts or personal property owned by the decedent without a designated beneficiary
Assets that do not undergo probate and are typically exempt from estate recovery include (assuming they avoid probate).
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The probate process in California can be complex. It is advisable to begin the process promptly to avoid complications. Consulting a qualified probate and estate litigation attorney who has knowledge of Medi-Cal Recovery Estate procedure like Law Office of Antoniette Jauregui . You can also call her at 951-218-4083 or 909-890-2350 to determine whether probate is necessary and to correctly navigate the legal process.
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