Casualty & Estate Recovery

MEDICAID EXPENSE RECOVERY FROM SETTLEMENTS AND ESTATE ASSETS

Federal and State Law require that the Medicaid Program be the payor of last resort. The Medicaid Program must take all reasonable measures to determine the legal liability of third parties to pay for a Medicaid recipient's health care. The Casualty and Estate (C&E) Recovery Unit within OMIG oversees activities to recover Medicaid funds associated with these third-party payor sources, such as personal injury settlements or estate assets. 

OMIG C&E utilizes a contract vendor to perform certain recovery services on behalf of the state.  More information regarding the contract vendor can be found online at: https://resources.hms.com/state/newyork/medicaid

Casualty 

If a Medicaid recipient is injured and receives a settlement because of that injury, relevant funds are subject to recovery by Medicaid for any amount Medicaid paid for the treatment of injuries sustained. Recovery of Medicaid payments made on behalf of injured individuals from persons liable for those injuries is required by Federal and State law and regulation. 

Estate 

When a Medicaid recipient passes away, any assets owned by the recipient are subject to estate recovery by NYS Medicaid as mandated by Federal and State law and regulation. The amount owed will depend upon the claims Medicaid paid on behalf of the recipient up to 10 years preceding their death. 

Real Property 

The Tax Equity and Fiscal Responsibility Act (TEFRA) governs liens that prevent the transfer of real property made prior to a Medicaid recipient’s death for the purpose of avoiding estate recovery. Liens may be placed on a recipient’s home if the recipient is a resident of a nursing facility for at least six consecutive months and there is no reasonable expectation that they will return home. 

Please see the following links for additional information: