Casualty & Estate Recovery - Regulatory Authority

What are the applicable laws and regulations?

The following Federal and State laws and regulations guide the NYS OMIG Casualty & Estate Recovery Program.  

  • 1993 Omnibus Budget Reconciliation Act (OBRA) § 13612 requires states to seek recovery from the estate assets of Medicaid recipients who were 55 years of age when they passed away, and from those Medicaid recipients who were under the age of 55 and permanently institutionalized (i.e., resident of a nursing home) when they passed away.
  • 1993 Omnibus Budget Reconciliation Act (OBRA) § 13622 requires that states seek recovery for medical assistance paid from any other third party that has a legal liability to make payment for that assistance.
  • Federal Social Security Act (SSA) § 1917(b) outlines the requirement for states to seek reimbursement from deceased recipient’s property and estate assets for certain costs paid for that recipient’s care. It also details the exemptions for recovery and outlines the requirement for states to consider undue hardship related to potential recovery.
  • Federal Social Security Act (SSA) § 1902(a)(25) requires states to take all reasonable measures to identify and recover from third parties that have the legal liability to pay for care or services furnished to Medicaid recipients.  
  • New York State Social Service Law (SOS) § 104 outlines the circumstances when the state may seek recovery against the estate or estate assets of a recipient who received assistance or care.
  • New York State Social Service Law (SOS) § 104-B details instances where the state must file a lien to recover costs paid for the care and treatment of a recipient’s personal injuries in instances where that recipient has filed suit.
  • New York State Social Services Law (SOS) § 366 details the requirements for medical assistance eligibility in New York State.
  • New York State Social Services Law (SOS) § 367 governs medical assistance payments including emergency medical assistance.
  • New York State Social Services Law (SOS) § 369 outlines additional provisions relevant to SOS § 366, SOS § 104-B, and SOS § 367-A including additional specifications regarding the state’s obligation to recover costs of medical assistance provided in instances of a deceased recipient or a recipient who receives a settlement in connection with a personal injury action or suit.
  • New York State Codes Rules & Regulations, Title 18 (18NYCRR) § 360.7 outlines when the state may or may not impose a lien against a recipient’s property, estate assets, or claims and suits for personal injuries.  
  • New York State Codes Rules & Regulations, Title 18 (18NYCRR) § 542 details the rights of the state to subrogation, or to pursue recovery against liable third-party payors on behalf of the recipient, for costs paid by Medicaid. 
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