Medical Assistance (MA) Estate Recovery and Liens

Estate recovery applies to MA members who: 

• At 55 years old or older receive MA long-term services and supports (LTSS)
• At any age permanently reside in a medical institution and receive MA services 

If either of these situations occur, a local agency must claim against an estate after the MA member dies to recover what MA paid for LTSS. In addition, if the MA member was permanently institutionalized, the claim must attempt to recover the costs of all MA services (not just LTSS) that the MA member received during the period of institutionalization. 

No. MinnesotaCare is not the same program as MA and estate recovery does not apply to MinnesotaCare.

For the purpose of MA estate recovery, LTSS are the following:

• Nursing home services
• Home and community-based services:
  • Alternative care (AC)
  • Brain injury (BI)
  • Community alternative care (CAC)
  • Community access for disability inclusion (CADI)
  • Developmental disabilities (DD)
  • Elderly waiver (EW)
  • Home care nursing
  • Home health aide services
  • Medical supplies and equipment
  • Personal care assistance (PCA)
  • Physical therapy, occupational therapy and speech therapy, when the service is provided by a home health agency
• Hospital and prescription drug services received during the time the MA member was provided nursing facility services or home and community-based services 

If an MA member receives any of these LTSS at 55 years old or older, the cost of these LTSS can be recovered from the member’s estate after the member dies.

If an MA member permanently resided in a medical institution at any age, the cost of all MA services received during the period of institutionalization, not just the cost of LTSS, can be recovered from the member’s estate after the member dies.

Generally, estate recovery happens after an MA member dies. But, local agencies delay recovery if the deceased MA member is survived by a spouse or has a child who is under 21 years old, blind or permanently disabled.

Once a deceased MA member’s surviving spouse dies, local agencies are required to recover MA costs from the spouse’s estate. But recovery can be further delayed if a child who is under 21 years old, blind or permanently disabled is still living in the home when the surviving spouse dies. 

Generally, local agencies make an MA estate claim when the property of a deceased person is being distributed after death. Sometimes this happens in a court setting, but sometimes it does not. 

Federal and state law require local agencies to try to recover from the estate of a surviving spouse.

This requirement comes out of a protection for the surviving spouse of a deceased MA member. When an MA member dies, local agencies cannot collect on an estate claim if a spouse survives the deceased MA member. If the surviving spouse receives assets from the deceased MA member’s estate, the surviving spouse can use the assets without having to repay MA for the deceased member’s health insurance costs while the surviving spouse is still alive. 

Once the surviving spouse dies, though, a local agency can claim against the surviving spouse’s estate for repayment to the MA program.

No. An MA member’s children do not have to use their own assets to reimburse the state for any MA services the member received. 

Local agencies that recover on an MA estate claim do so with priority over distributions to heirs. This means that MA should be repaid before heirs receive assets from the estate. Repayment of MA costs ensures that future MA members have funding to receive health care services.

Liens for MA repayment apply to two main populations of MA members. 

First, liens may apply to members who permanently reside in a medical institution. For this situation, DHS may file a lien called an “MA lien.” 

Second, liens apply to MA members who receive LTSS at 55 years old or older. For this situation, DHS files a lien called a “notice of potential claim” (NPC).

DHS files two types of liens to secure repayment of MA: MA liens and notices of potential claim (NPCs). MA liens and NPCs have different impacts on MA members and their estates. 

• MA liens
  
  An MA lien is a lien filed against an MA member’s real property interest before the member dies to secure repayment of all MA costs of the member’s permanent stay in a medical institution. The lien allows DHS to collect on the MA lien when real property is sold or transferred, which may happen before or after the member dies.
  
  DHS files MA liens only after a member enters a “medical institution,” and the member’s attending physician, advanced practice registered nurse or physician assistant certifies in writing that the member is never expected to be discharged and return home.
  
  Medical institutions include the following:
• Nursing facilities
• Skilled nursing facilities 
• Intermediate care facilities 
• Intermediate care facilities for people with developmental disabilities


An MA lien is enforceable for 10 years from the date of its filing. DHS may renew the lien for another 10 years.

• NPCs
  
  An NPC is a lien filed against a member’s real property interest to secure repayment of MA costs subject to estate recovery. DHS can file an NPC before, or within one year after, an MA member’s death.
  
  An NPC is not a lien until the member dies. Until the member dies, the NPC serves only as notice that an MA estate claim could be made against a specific interest in real property in the future.
  
  NPCs are enforceable for 20 years from the date of filing, or from the date of the member’s death, whichever is later.

Yes, DHS can collect on an MA lien before a member dies, but only for an MA member permanently residing in a medical institution. 

Even if an MA member is permanently residing in a medical institution, the law prohibits DHS from filing a lien against the member’s real property in certain situations. For example, DHS cannot file a lien against the member’s real property if the property is the home of the member’s spouse. Also, DHS cannot file a lien if a child who is under 21 years old, blind or permanently disabled lives in the home or if a child, who provided documented care that kept the MA member in the home and out of a nursing home for two years while living in the home, lives in the home.

No. MinnesotaCare is not the same program as MA and liens do not apply to MinnesotaCare.