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Tuesday, December 10, 2013

WHAT IS MEDI-CAL ESTATE RECOVERY?

The Medi-Cal program pays for medical care for some persons whose savings and income are too low for them to be able to pay for their own care. In turn, the person or their estate may be required to pay the medical care costs back to Medi-Cal. When notification of a Medi-Cal recipient’s death is received, the Department of Health Services will determine whether or not the cost of services must be repaid.

This decision will be based on how much was paid by Medi-Cal and what is left in the estate of the deceased Medi-Cal beneficiary. Regardless of what is owed, the Department will never collect more that the value of the assets owned by the person who received Medi-Cal at the time of his/her death.


The Department of Health Services cannot require reimbursement under the following circumstances:
  • During the lifetime of a surviving spouse.
  • For Medi-Cal services provided before the beneficiary’s 55th birthday, unless the beneficiary is institutionalized.
  • If the Medi-Cal beneficiary is survived by a child under 21 years old.
  • If the Medi-Cal beneficiary is survived by a child who is blind or disabled (as defined by the Federal Social Security Act).
  • Beneficiaries receiving assistance through a Medicare Savings Program only are exempt from Estate Recovery.  These include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working Disabled (CWD) program.


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