Estate Recovery Information
Services Subject to Estate Recovery
Enclosed is a Notice of Intent to File a Lien against property of someone who has died.
The following are some frequently asked questions about the lien.
Why did I get a notice of
Intent to File a Lien?
What medical expenses are
included in estate recovery?
How much is the lien?
What if more than one person
owns the property?
When is the state prohibited
from collecting on the lien?
Can I continue to live in or rent out
the property if I am a spouse or a
minor, blind, or disabled child?
Can I sell, transfer, or renance the
property if I am a spouse or a
minor, blind, or disabled child?
Who may apply for a
hardship deferral?
Federal law requires the state to recover certain medical and long term care expenses
from a person’s “estate” - their property - after they die. This is called “estate recovery”. It is
something the deceased person agreed to before receiving services. The state records a
lien against property owned by the person to secure its interest. There are important limits
on what, when, and how the state can recover.
The state can only recover amounts it paid for certain medical and long-term care services.
Long-term care includes care in a facility or from a paid caregiver at home. A list of services
and time periods included in estate recovery is on the back of this page. They are also in
the Washington Administrative Code (WAC 182-527-2742).
The lien amount is the lesser of: (a) the amount the state paid for included services (plus
allowed interest); or (b) the value of the deceased person’s equity. Equity is how much you
can sell property for minus liens or other encumbrances, like a mortgage or home equity
loan.
Example: The state paid $150,000 of Bob’s long-term care expenses. Bob owned a home worth
$200,000, but he had a $100,000 mortgage. So Bob had $100,000 in home “equity.” The lien amount is
limited to Bob’s equity in the home, which is less than the total amount the state paid for his long-term
care expenses.
When more than one person owns property, the state’s lien is limited to the share owned by
the person who got state-paid services.
Example: The state paid $150,000 of Bob’s long-term care
expenses. Bob and his brother owned a home 50/50, which is worth $200,000. The state’s lien is limited
to Bob’s share, worth $100,000.
The state cannot collect on the lien when the spouse or a minor, blind, or disabled child is
alive. When a non-disabled child reaches the age of 21, the state may start collection. The
state must also delay collection if someone shows that they qualify for a hardship deferral
(see below).
Yes. You may continue to live in the home and use it without limitations. This includes
renting out the property.
Yes. You may sell, borrow against, or refinance the property. The state must remove the lien
when it receives proof that a bona fide sale or transfer of the real property is complete. You
should call the Estate Recovery Unit at 1-800-562-6114 to request removal of the lien.
A deferral means the state will delay estate recovery. You may request a hardship deferral
if you are the registered domestic partner of the deceased person. You may also request
a hardship deferral if you are an heir of the person who died and: (a) the recovery would
deprive you of a place to live and you don’t have money to live somewhere else, or (b) you
have limited income and the property is your only source of income. An heir is someone
who has a right to inherit property. You may call the Estate Recovery Unit at 1-800-562-6114
to request a hardship deferral.
If you have questions, please contact DSHS’s Office of Financial Recovery at 360-664-5700
or 1-800-562-6114. You can also nd more information about your legal rights at
www.washingtonlawhelp.org, which is not affiliated with DSHS.
DSHS-22-1634 (Rev. 11/15)
Medicaid Funded
Long-Term Care
Services
Effective
January 1, 2014
Nursing facility services and home and community based services (COPES, NFCDS,
Basic Plus Waiver, CORE Waiver, Community Protection Waiver, Medicaid Personal Care
and Residential Support Waiver). The portion of the Washington Apple Health managed
care premium used to pay for long-term care services under the PACE program and the
Washington Medicaid Integration Partnership are included. Roads to Community Living
services, private duty nursing and intermediate care facilities for individuals with intellectual
disabilities. Hospital and prescription drug costs paid for a client while receiving services
listed above. Recovery is limited to services received at age 55 or older.
üNote: Add Community First Choice (CFC), Individual and Family Services (IFS) effective
July 1, 2015.
January 1, 2010 -
December 31, 2013
All Medicaid services, except Medicaid savings programs and Medicare premiums (for those
also receiving Medicaid. Nursing facility and home and community based services along
with associated hospital and prescription drug services. Adult day health, Medicaid Personal
Care and private duty nursing provided by ALTSA. Premium payments to managed care
organizations. Recovery is limited to services received at age 55 or older.
üNote: Beginning January 1, 2010 Medicare Savings Programs and Medicare premiums are
EXEMPT from estate recovery when no other services are provided.
June 1, 2004 -
December 31, 2009
All Medicaid services, including nursing facility and home and community based services
along with associated hospital and prescription drug services including adult day health,
Medicaid Personal Care and private duty nursing provided by ALTSA. Medicare savings
programs and Medicare premiums (for those also receiving Medicaid) as well as premium
payments to managed care organizations are included. Recovery is limited to services
received at age 55 or older.
July 1, 1995 -
May 31,2004
All nursing facility and home and community based services along with associated hospital
and prescription drug services as well as adult day health, Medicaid Personal Care and private
duty nursing provided by ALTSA. Recovery is limited to services received at age 55 or older.
July 1, 1994 -
June 30, 1995
All nursing facility and home and community based services along with associated hospital
and prescription drug services provided to a client 55 or older.
July 26, 1987 -
June 30, 1994
All medical assistance provided to clients who were age 65 or older at the time of the service.
üNote: The first $50,000 of an estate is exempt and recovery is limited to 35% of an estate
over $50,000 up to the amount paid.
State
Funded
Services
Effective
July 1, 1995
All state-funded long-term care services and related hospital and prescription drug services
regardless of age provided to Home and Community Services division clients on and after July
1, 1995 and Developmental Disabilities Administration (DDA) clients on and after June 1, 2004.
üNote: State-only funded adult protective services, supplemental security payments
authorized by the Developmental Disabilities Administration, the offender reentry
community safety program and volunteer chore services are EXEMPT.
üNote: From July 26, 1987 through June 1994 the first $50,000 of an estate is exempt and
recovery is limited to 35% of an estate over $50,000 up to the amount paid.
TEFRA (Pre-death liens)
Effective July 1, 2005 the state may file a pre-death lien on property owned by clients residing in a long-term care facility who are “permanently”
institutionalized, with no potential for discharge. Note: All services are subject to recovery except SSI recipients and MAGI clients may be
excluded from TEFRA liens when they do not pay towards the cost of their care.
Estate Recovery Information
Services Subject to Estate Recovery
Program Dates Estate Recovery is allowed for:
