General eligibility requirements that apply to all Apple Health programs

Estate Recovery

Revised Date: 
December 12, 2014

WAC 182-527-2730 Definitions

Effective March 16, 2016

The following definitions apply to this chapter:

"Contract health service delivery area (CHSDA)" means the geographic area within which contract health services will be made available by the Indian health service to members of an identified Indian community who reside in the area as identified in 42 C.F.R. Sec. 136.21(d) and 136.22.

"Estate" means all property and any other assets that pass upon the client's death under the client's will or by intestate succession under chapter 11.04 or 11.62 RCW. The value of the estate will be reduced by any valid liability against the client's property when the client died. An estate also includes:

  1. For a client who died after June 30, 1995, and before July 27, 1997, nonprobate assets as defined by RCW 11.02.005, except property passing through a community property agreement; or
  2. For a client who died after July 26, 1997, and before September 14, 2006, nonprobate assets as defined by RCW 11.02.005.
  3. For a client who died on or after September 14, 2006, nonprobate assets as defined by RCW 11.02.005 and any life estate interest held by the client immediately before death.

"Heir" means a person entitled to inherit a deceased client's property under a valid will accepted by the court, or a person entitled to inherit under the Washington state intestacy statute, RCW 11.04.015. 

Life estate" means an ownership interest in a property only during the lifetime of the person owning the life estate. 

"Lis pendens" means a notice filed in public records warning that title to certain real property is in litigation and the outcome of the litigation may affect the title.

"Long-term care services (LTC)" means, for the purposes of this chapter only, the services administered directly or through contract by the department of social and health services (DSHS) for clients of the home and community services division of DSHS and the developmental disabilities administration of DSHS including, but not limited to, nursing facility care and home and community services.

"Property" means everything a person owns, whether in whole or in part.

  1. "Personal property" means any movable or intangible thing a person owns, whether in whole or in part; 
  2. "Real property" means land and anything growing on, attached to, or built on it, excluding anything that may be removed without injury to the land;
  3. "Trust property" means any type of property held in trust for the benefit of another.

"Qualified long-term care insurance partnership" means an agreement between the Centers for Medicare and Medicaid services (CMS) and the Washington state insurance commission which allows for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of a person who is a beneficiary under a long-term care insurance policy that has been determined by the Washington state insurance commission to meet the requirements of section 1917 (b)(1)(C)(iii) of the act.

"Recover" or "recovery" means the agency or the agency's designee's receipt of funds to satisfy the client's debt.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2734 Liens during a client's lifetime.

Effective July 1, 2017

For the pur­poses of this section, the term "agency" includes the agency's desig­nee.

  1. When the agency may file.
    1. The agency may file a lien against the property of a Washing­ton apple health client during the client's lifetime if:
      1. The client resides in a skilled nursing facility, intermedi­ate care facility for individuals with an intellectual disability, or other medical institution under WAC 182-500-0050;
      2. The agency determines that a client cannot reasonably be expected to return home because:
        1. The agency receives a physician's verification that the client will not be able to return home; or
        2. The client has resided for six months or longer in an institution as defined in WAC 182-500-0050; and
      3. None of the following people lawfully reside in the client's home:
        1. The client's spouse or state-registered domestic partner;
        2. The client's child who is age twenty or younger, or is blind or permanently disabled as defined in WAC 182-512-0050; or
        3. A client's sibling who has an equity interest in the home and who has been residing in the home for at least one year immediately before the client's admission to the medical institution.
    2. If the client returns home from the medical institution, the agency releases the lien.
  2. Amount of the lien.
    1. The agency may file a lien to recoup the cost of all non-MAGI-based and deemed eligible services under WAC 182-503-0510 it correctly purchased on the client's behalf, regardless of the client's age on the date of service.
    2. Services provided under the medicaid transformation project, defined in WAC 182-500-0070, are excluded when determining the amount of the lien.
  3. Notice requirement.
    1. Before the agency may file a lien under this section, it sends notice via first class mail to:
      1. The client's last known address;
      2. The client's authorized representative, if any;
      3. The address of the property subject to the lien; and
      4. Any other person known to hold title to the property.
    2. The notice states:
      1. The client's name;
      2. The agency's intent to file a lien against the client's property;
      3. The county in which the property is located; and
      4. How to request an administrative hearing.
  4. Interest assessed on past-due debt.
    1. Interest on a past-due debt accrues at a rate of one percent per month under RCW 43.17.240.
    2. A lien under this section becomes a past-due debt when the agency has recorded the lien in the county where the property is loca­ted and:
      1. Thirty days have passed since the property was transferred or
      2. Nine months have passed since the lien was filed.
    3. The agency may waive interest if reasonable efforts to sell the property have failed.
  5. Administrative hearing. An administrative hearing under this section is governed by WAC 182-527-2753.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2738 Estate recovery—General right to recover.

Effective March 14, 2016

For the purposes of this section, the term "agency" includes the agency's designee.

  1. When the agency may file. After a Washington apple health client has died, the medicaid agency may file liens to recover the cost of services subject to recovery that were correctly paid on the client's behalf.
  2. Notice requirement.
    1. Before the agency may file a lien under this section, it sends notice via first class mail as follows:
      1. If the estate has a personal representative, the agency sends notification to:
        1. The personal representative; and
        2. Any known title holder.
      2. If the estate has known heirs but no personal representative, the agency sends notification to:
        1. Any known heir; and
        2. Any known title holder.
      3. If the estate has no personal representative and no known heirs, the agency sends notification to:
        1. The address listed on the title; and
        2. Any known title holder.
    2. The notice states:
      1. The agency's intent to file a lien against the deceased client's property;
      2. The amount the agency seeks to recover;
      3. The deceased client's name, identification number, date of birth, and date of death;
      4. The county in which the property is located; and
      5. How to request an administrative hearing.
  3. The agency may not recover from the client's estate so long as there remains:
    1. A surviving spouse; or
    2. A surviving child who:
      1. Is age twenty or younger; or
      2. Is blind or disabled as defined in WAC 182-512-0050.
  4. Interest assessed on past-due debt.
    1. Interest on a past-due debt accrues at a rate of one percent per month under RCW 43.17.240.
    2. A lien under this section becomes a past-due debt when the agency has recorded the lien in the county where the property is located and nine months have passed since the lien was recorded or a creditor's claim was filed, whichever is sooner.
    3. The agency may waive interest if reasonable efforts to sell the property have failed.
  5. Administrative hearing. An administrative hearing under this section is governed by WAC 182-527-2753.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2740 Estate recovery - Age-related limitations.

Effective March 14, 2016

For the purposes of this section, the term "agency" includes the agency's designee.

  1. Liability for medicaid services.
    1. Beginning July 26, 1987, a client's estate is liable for medicaid services subject to recovery that were provided on or after the client's sixty-fifth birthday.
    2. Beginning July 1, 1994, a client's estate is liable for medicaid services subject to recovery that were provided on or after the client's fifty-fifth birthday.
  2. Liability for state-only-funded long-term care services.
    1. A client's estate is liable for all state-only-funded long-term care services provided by the home and community services division of the department of social and health services (DSHS) on or after July 1, 1995.
    2. A client's estate is liable for all state-only-funded long-term care services provided by the developmental disabilities administration of DSHS on or after June 1, 2004.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2742  Estate recovery-Service-related limitations.

Effective July 1, 2017

For the purposes of this section, the term "agency" includes the agency's designee.

The agency's payment for the following services is subject to recovery:

  1. State-only funded services, except:
    1. Adult protective services;
    2. Offender reentry community safety program services;
    3. Supplemental security payments (SSP) authorized by the developmental disabilities administration (DDA); and
    4. Volunteer chore services.
  2. For dates of service on or after January 1, 2014:
    1. Basic Plus waiver services;
    2. Community first choice (CFC) services;
    3. Community option program entry system (COPES) services;
    4. Community protection waiver services;
    5. Core waiver services;
    6. Hospice services;
    7. Intermediate care facility for individuals with intellectual disabilities services provided in either a private community setting or in a rural health clinic;
    8. Individual and family services;
    9. Medicaid personal care services;
    10. New Freedom consumer directed services;
    11. Nursing facility services;
    12. Personal care services funded under Title XIX or XXI;
    13. Private duty nursing administered by aging and long-term support administration (ALTSA) or the DDA;
    14. Residential habilitation center services;
    15. Residential support waiver services;
    16. Roads to community living demonstration project services;
    17. The portion of the managed care premium used to pay for ALTSA-authorized long-term care services under the program of all-inclusive care for the elderly (PACE); and
    18.  The hospital and prescription drug services provided to a client while the client was receiving services listed in this subsection.
  3. For dates of service beginning January 1, 2010, through December 31, 2013:
    1. Medicaid services;
    2. Premium payments to managed care organizations (MCOs); and
    3. The client's proportional share of the state's monthly contribution to the Centers for Medicare and Medicaid Services to defray the costs for outpatient prescription drug coverage provided to a person who is eligible for medicare Part D and medicaid.
  4. For dates of service beginning June 1, 2004, through December 31, 2009:
    1. Medicaid services;
    2. Medicare premiums for individuals also receiving medicaid;
    3. Medicare savings programs (MSPs) services for people also receiving medicaid; and
    4.  Premium payments to MCOs. 
  5. For dates of service beginning July 1, 1995, through May 31, 2004:
    1. Adult day health services;
    2. Home and community-based services;
    3. Medicaid personal care services;
    4. Nursing facility services;
    5. Private duty nursing services; and
    6. The hospital and prescription drug services provided to a client while the client was receiving services listed in this subsection. 
  6. For dates of service beginning July 1, 1994, through June 30, 1995:
    1. Home and community-based services;
    2. Nursing facility services; and 
    3. Hospital and prescription drug services provided to a client while the client was receiving services listed in this subsection.
  7. For dates of service beginning July 26, 1987, through June 30, 1994: Medicaid services.
  8. For dates of service through December 31, 2009.  If a client was eligible for the MSP, but not otherwise medicaid eligible, the client's estate is liable only for any sum paid to cover medicare premiums and cost-sharing benefits.
  9. For dates of service beginning January 1, 2010.  If a client was eligible for medicaid and the MSP, the client's estate is not liable for any sum paid to cover medical assistance cost-sharing benefits.
  10. For dates of service beginning July 1, 2017, long-term services and supports authorized under the medicaid transformation project are exempt from estate recovery. Exempted services include those provided under:
    1. Medicaid alternative care under WAC 182-513-1600;
    2. Tailored supports for older adults under WAC 182-513-1610;
    3. Supportive housing under WAC 388-106-1700 through 388-106-1765; or
    4. Supported employment under WAC 388-106-1800 through 388-106-1865.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2746 Estate recovery—Asset-related limitations.

Effective March 14, 2016

For the purposes of this section, the term "agency" includes the agency's designee.

  1. Before July 25, 1993. For services received before July 25, 1993, that are subject to recovery, the agency may exempt:
    1. The first fifty thousand dollars of the estate's value at the time of the client's death; and
    2. Sixty-five percent of the remaining value of the estate.
  2. July 24, 1993, through June 30, 1994. For services that are subject to recovery that were received on or after July 25, 1993, through June 30, 1994, the agency exempts two thousand dollars' worth of personal property.
  3. Life estate.
    1. The agency may file a lien against a client's life estate interest in real property.
    2. The agency's lien against the property may not exceed the value of the client's life estate. Under this subsection, value means the fair market value of the property multiplied by the life estate factor that corresponds to the client's age on the client's last birthday. For a list of life estate factors, see the life estate and remainder interest tables maintained by the Social Security Administration.
    3. The agency may not enforce a lien under this subsection against any property right that vested before July 1, 2005.
  4. Joint tenancy.
    1. The agency may file a lien against property in which a client was a joint tenant when the client died.
    2. The agency's lien against the property may not exceed the value of the client's interest in the property. Under this subsection, value means the fair market value of the property divided by the number of joint tenants on the day the client died.
    3. The agency may not enforce a lien under this subsection against any property right that vested before July 1, 2005.
  5. Qualified long-term care partnership.
    1. Assets designated as protected by a qualified long-term care partnership (QLTCP) policy issued after November 30, 2011, may be disregarded for estate recovery purposes if:
      1. The insured person's estate is the recipient of the estate recovery exemption; or
      2. The insured person holds title to property which is potentially subject to a predeath lien and that person asserts the property is protected under the QLTCP policy.
    2. A person must provide clear and convincing evidence to the office of financial recovery that the asset in question was designated as protected, including:
      1. Proof of a valid QLTCP policy;
      2. Verification from the LTC insurance company of the dollar amount paid out by the policy; and
      3. A current department of social and health services QLTCP asset designation form when the QLTCP policy paid out more than was previously designated.
    3. The insured person's estate must provide clear and convincing evidence proving an asset is protected before the final recovery settlement.
  6. Rules specific to American Indians and Alaska natives.
    1. Certain properties belonging to American Indians/Alaska natives (AI/AN) are exempt from estate recovery if at the time of death:
      1. The deceased client was enrolled in a federally recognized tribe; and
      2. The estate or heir documents the deceased client's ownership interest in trust or nontrust real property and improvements located on a reservation, near a reservation as designated and approved by the Bureau of Indian Affairs of the U.S. Department of the Interior, or located:
        1. Within the most recent boundaries of a prior federal reservation; or
        2. Within the contract health service delivery area boundary for social services provided by the deceased client's tribe to its enrolled members.
    2. Protection of trust and nontrust property under subsection (4) of this section is limited to circumstances when the real property and improvements pass from an Indian (as defined in 25 U.S.C. Chapter 17, Sec. 1452(b)) to one or more relatives (by blood, adoption, or marriage), including Indians not enrolled as members of a tribe and non-Indians, such as spouses and stepchildren, that their tribe would nonetheless recognize as family members, to a tribe or tribal organization and/or to one or more Indians.
    3. Certain AI/AN income and resources (such as interests in and income derived from tribal land and other resources currently held in trust status and judgment funds from the Indian Claims Commission and the U.S. Claims Court) are exempt from estate recovery by other laws and regulations.
    4. Ownership interests in or usage rights to items that have unique religious, spiritual, traditional, and/or cultural significance or rights that support subsistence or a traditional life style according to applicable tribal law or custom.
    5. Government reparation payments specifically excluded by federal law in determining eligibility are exempt from estate recovery as long as such funds have been kept segregated and not commingled with other countable resources and remain identifiable.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2750 Estate recovery - Delay of recovery for undue hardship.

Effective March 14, 2016

For the purposes of this section, the term "agency" includes the agency's designee.

  1. If an undue hardship exists at the time of the client's death, an heir may ask the agency to delay recovery.
    1. Undue hardship exists only when:
      1. The property subject to recovery is the sole income-producing asset of an heir;
      2. Recovery would deprive an heir of shelter and the heir cannot afford alternative shelter; or
      3. The client is survived by a state-registered domestic partner.
    2. Undue hardship does not exist if the client or the heir created circumstances to avoid estate recovery.
  2. If the agency determines recovery would cause an undue hardship for an heir, the agency may delay recovery until the hardship no longer exists.
  3. If the agency denies an heir's request to delay recovery, the agency notifies the heir in writing.  The notice includes instructions on how to request a hearing.
  4. If the agency grants a delay of recovery under this section, the heir must:
    1. Timely comply with any agency request for information or records;
    2. Not sell, transfer, or encumber the property;
    3. Reside on the property;on the property;
    4. Timely pay property taxes and utilities;
    5. Ensure the property for its fair market  value;
    6. Name the state of Washington as the primary payee on the property insurance policy;
    7. Provide the agency with a copy of the property insurance policy upon request;
    8. Continue to satisfy the requirements in subsection (1) of this section.
  5. If the heir dies, or violates any provision of subsection (4) of this section, the agency may begin recovery.
  6. If the agency denies the request, the heir may request an administrative hearing under WAC 182-527-2753

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-527-2753 Hearings.

Effective March 14, 2016

For the purposes of this section, the term "agency" includes the agency's designee.

  1. An administrative hearing to contest action under this chapter determines only:
    1. In the case of a lien filed during the client's lifetime under WAC 182-527-2734:
      1. Whether the client can reasonably be expected to return home from the medical institution;
      2. Whether the client, or the client's estate, holds legal title to the identified property; and
      3. Whether the client received services subject to recovery.
    2. In the case of a lien filed after the client's death:
      1. The cost the agency correctly paid for services subject to recovery;
      2. Whether the client, or the client's estate, holds legal title to the identified property; and
      3. Whether the agency's denial of an heir's request for a delay of recovery for undue hardship under WAC 182-527-2750 was correct.
  2. A request for an administrative hearing must:
    1. Be in writing;
    2. State the basis for contesting the agency's proposed action;
    3. Be signed by the requestor and include the client's name, the requestor's address and telephone number; and
    4. Within twenty-eight days of the date on the agency's notice, be filed with the office of financial recovery either:
      1. In person at the Office of Financial Recovery, 712 Pear St. S.E., Olympia, WA 98504-0001; or
      2. By certified mail, return receipt requested, to Office of Financial Recovery, P.O. Box 9501, Olympia, WA 98507-9501.
  3. Upon receiving a request for an administrative hearing, the office of administrative hearings notifies any known titleholder of the time and place of the administrative hearing.
  4. An administrative hearing under this subsection is governed by chapters 34.05 RCW and 182-526 WAC and this section. If a provision in this section conflicts with a provision in chapter 182-526 WAC, the provision in this section governs.
  5. Disputed assets must not be distributed while in litigation.
  6. Absent an administrative or court order to the contrary, the agency may file a lien twenty-eight calendar days after the date the agency mailed notice of its intent to file a lien.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

As a result of implementation of the Affordable Care Act (ACA), this clarifying page may no longer be effective for medical coverage applications received on or after 10/01/2013. Please see the ACA Transition Plan for more information. Clients under 65 years of age who need to apply for medical coverage on or after 10/01/2013 should be referred to Washington Healthplanfinder. Applications for medical coverage for households where all members are 65 years of age and older should be referred to Washington Connection.

Estate Recovery and Liens Prior to Death for Recovery

Estate Recovery

The State of Washington's Estate Recovery Program was enacted July 26, 1987. In 1993, federal law mandated that all states enact Estate Recovery programs. State and federal law mandate the State of Washington's estate recovery program. Recovery of the cost of services and the age when recovery applies has changed several times since the program was enacted. The department recovers from estates according to the estate recovery law in effect at the time the services were received.

Costs Subject to Estate Recovery

  • Services provided from 7/26/87 through 6/30/94:
    The cost of all Medicaid services provided for the individual's care after the individual turned 65, or 7/26/87 (whichever is later), through 6/30/94.
  • Services provided from 7/1/94 through 6/30/95:
    Only the cost of the following Medicaid services:
    • Nursing facility services
    • COPES
    • Traumatic Brain Injury - TBI
    • Community Alternatives Program - CAP (DDD program)
    • Outward Bound Residential Alternatives - OBRA (DDD program)
    • Coordinated Community Aids Service Alternatives - CASA (MAA program)
    • Hospital and prescription drug services related to services listed above
  • Services provided from 7/1/95 through 5/31/04:
    Only the cost of the following services:
    • Nursing facility services
    • COPES
    • Traumatic Brain Injury - TBI
    • Community Alternatives Program - CAP (DDA program)
    • Outward Bound Residential Alternatives - OBRA (DDA program)
    • Coordinated Community Aids Service Alternatives - CASA (MAA program)
    • Apple Health Personal Care
    • Adult Day Health
    • Private Duty Nursing administered by AASA
    • State-funded long-term care services (administered by ALTSA)
      (Chore services, Adult Family Home, Adult Residential Care)
    • Hospital and prescription drug services related to services listed above
  • Services provided as of 6/1/04 through 12/31/13
    • All Medicaid services, premium payments to managed care organizations, and Medicare cost-sharing services and Medicare premiums for individuals also receiving Apple Health. This includes long-term care services.
    • Estate recovery does not apply to individuals who only receive benefits from a Medicare Savings Program.
    • All state-funded long-term care services and related hospital and prescription drug services administered by ALTSA and DDA.

Note: Apple Health services are federally funded services and include Family related CN, SSI related CN/MN and ABD cash medical benefits.

  • Services provided on or after 1/1/14
    • Nursing facility services, including those provided in a developmental disabilities administration (DDA) residential habilitation center (RHC);
      • (ii) Home and community-based services authorized by ALTSA or DDA, as follows:
        • (A) Community options program entry system (COPES);
        • (B) New Freedom consumer directed services (NFCDS);
        • (C) Basic Plus waiver;
        • (D) CORE waiver;
        • (E) Community protection waiver;
        • (F) Children's intensive in-home behavioral support (CIIBS) waiver;
        • (G) Medicaid personal care;
        • (H) Residential support waiver;
      • (iii) The portion of the Washington apple health (WAH) managed care premium used to pay for LTC services under the program of all-inclusive care for the elderly (PACE) authorized by ALTSA;
      • (iv) The portion of the WAH managed care premium used to pay for LTC services under the Washington Medicaid integration partnership (WMIP) authorized by ALTSA or DDA;
      • (v) Roads to community living (RCL) demonstration project;
      • (vi) Personal care services funded under Title XIX or XXI;
      • (vii) Private duty nursing administered by ALTSA or DDA;
      • (viii) Intermediate care facility for individuals with intellectual disabilities (ICF/ID) services provided in either a private community setting or in an RHC; and
      • (ix) Hospital and prescription drug services provided to a client while receiving services under subsection (1)(f)(i) through (viii) of this section.
  • Age Recovery When Applies
    • Prior to 7/1/94:
      Age 65
    • From 7/1/94 to 6/30/95:
      Age 55
    • As of 7/1/95:
      Age 55 for Medicaid long term care services
      At any age for state funded long term care services

    Services Exempt from Recovery

    • Services received prior to 7/26/87, when the Estate Recovery Program was enacted
    • Adult protective services provided to a frail elder or vulnerable adult and paid for only by state funds
    • Medicare premiums and other services received under a Medicare Savings Program if the individual was eligible only for assistance under a Medicare Savings Program (such as QMB or SLMB) and not for any other Apple Health program.

    Assets Not Subject to Recovery

    • Certain properties belonging to American Indians/Alaska natives.
    • Government reparation payments specifically excluded by federal law as long as such funds have been kept segregated and not commingled with other countable resources and remain identifiable.

    Recovery Process

    • The Office of Financial Recovery (OFR) administers Estate Recovery collections for the Department of Social and Health Services (DSHS). OFR collects approximately $17 million per year to offset payments made by the State for medical services.
    • DSHS recovers from the estate of a deceased individual. "Estate" includes all real property (land or buildings) and all other property (mobile homes, vehicles, savings, other assets) the individual owned or had an interest in when the individual died. Estate may also include certain other property interests an individual had immediately before death. These include a joint interest or a life estate in a house or land.

      A home transferred to a spouse or to a minor, blind or disabled child prior to the individual's death, is not considered part of the individual's estate.

    • DSHS recovers from estates according to the estate recovery law in effect at the time the services were received.
    • DSHS defers recovery:
      • While there is a surviving child who is under 21, or who is blind or disabled.
      • Until the death of a surviving spouse. When the surviving spouse dies, recovery action will be taken against property in which the deceased individual had an interest in at the time of death.
      • If the estate subject to adjustment or recovery is the sole income-producing asset of one or more qualified individuals and income is limited; or the department determines that recovery would cause an undue hardship for a qualified individual. Qualified individual means an heir or an unmarried individual who, immediately prior to the individual's death, was eighteen years of age or older, shared the same regular and permanent residence with the individual and with whom the individual had an exclusive relationship of mutual support, caring, and commitment. A request for a hardship waiver must be made in writing to the Office of Financial Recovery and each request is reviewed on its own merits. If the request is denied, the decision may be appealed through the Administrative Hearing process.
    • DSHS will file a lien or make a claim against property that is included in the deceased individual's estate. Prior to filing a lien against real or titled property, the department gives notice and an opportunity for a hearing to the probate estate's personal representative, if any, or any other person known to have title to the affected property. Liens placed through the Estate Recovery process are valid for 20 years.

    Liens Establish Prior to Death for Recovery of Medical Services DSHS has the authority to file a lien against the property of a medical assistance individual who is permanently institutionalized in a nursing facility or other medical institution prior to his or her death. The department will recover the costs of long-term care and medical services paid from the individual's estate. If the individual is discharged from the medical institution and returns home, the department releases the lien. No lien will be filed if one or more of the following persons are lawfully residing in the home:

    • The individual's spouse;
    • The individual's child who is under twenty-one years of age or blind or disabled according to Social Security criteria;
    • The individual's sibling who has an equity interest in the home and resided in the property for at least one year prior to the date of the individual's admission to the medical institution.

    The department can recover the medical expenditures without regard to the age of the individual.

Worker Responsibilities

The Department is required to notify all potential Apple Health applicants and Apple Health recipients about the Estate Recovery provisions. The required notification is included in the current DSHS Application for Benefits form and the individual's signature acknowledges receipt of the required notice. At eligibility review, staff need to provide Apple Health recipients with notice of their Rights & Responsibilities as this also includes language explaining Estate Recovery.

Workers are required to enter information regarding all assets and resources owned by the Apple Health individual to the ACES system including assets which are exempt for the purposes of eligibility. Policy changes following the 2005 Deficit Reduction Act (DRA) require all primary residence information and current market value be indicated in ACES since home equity is an eligibility factor for long term care services. An individual may be ineligible for some long term care services if the equity in their primary residence exceeds the limit set in WAC 182-513-1350.

For noninstitutional medical programs, home equity is not an eligibility factor. It is not necessary to get verification of the equity value of the primary residence. Workers may determine fair market value using any reasonable method such as local Assessor's office website, client statement, current market appraisal or other internet resources such as Zillow or Redfin. A current mortgage statement may be used to establish encumbrances but is not required. HCS staff and CSD staff who process long term care programs such as HCS/DDD waivers or nursing home cases will need to request accurate verification of fair market value and encumbrances to support the Excess Home equity provisions of the DRA.

If staff discovers that an asset, or part of an asset, has been transferred out of the individual's name, the worker needs to review the case and determine the effect of the transfer on eligibility. Some transfers prevent the individual from being eligible to receive long term care services and require that the case be terminated, giving advance and adequate notice, and a period of ineligibility be established. OFR may discover transfers by individuals in their review of county records and will notify the financial worker.

Annuities and some trusts owned by Medicaid individuals need to list the State as the beneficiary of any assets remaining in the trust upon the death of the individual in order to qualify for Apple Health benefits. Information regarding Trusts is found in WAC 182-516-0100. Information on Annuities is found in WAC 182-516-0200.

Workers need to ensure that a complete copy of the terms of the trust or annuity is placed in the individual's record and a copy is sent to the Office of Financial Recovery (OFR).

Offices with DMS access may forward a copy of the trust document to Kenneth Washington at OFR or mail a copy to the following address:

Office of Financial Recovery
PO Box 9501
Olympia, WA 98507-9501

The telephone number for the Office of Financial Recovery is 800-562-6114.

Website to check for fair market value.

The Columbia Legal Services bulletin and Estate Recovery sheet used by ALTSA may be useful to staff and may be given out to individuals who request more information on Estate Recovery.