Estate Recovery Program
¿Qué es Estate Recovery?
El Programa Medi-Cal debe buscar el reembolso de los patrimonios de ciertos beneficiarios Medi-Cal fallecidos. El reembolso solo se aplica a los beneficios recibidos por estos beneficiarios en o después de cumplir 55 años y aquellos que poseían activos en el momento de la muerte. Si un beneficiario fallecido no posee nada cuando fallece, no se le deberá nada.
For Medi-Cal members who died on or after January 1, 2017: (See Changes to Estate Recovery effective January 1, 2017 due to Legislation SB 833)
- El reembolso se limitará solo a los bienes patrimoniales sujetos a sucesión que eran propiedad del beneficiario fallecido en el momento de la muerte.
- El reembolso se limitará a los pagos realizados, incluidas las primas de atención administrada pagadas, por servicios en centros de enfermería, servicios basados en el hogar y la comunidad, y servicios hospitalarios y de medicamentos recetados relacionados recibidos cuando el beneficiario era un paciente hospitalizado en un centro de enfermería o recibía servicios basados en el hogar y la comunidad.
For Medi-Cal beneficiaries who died prior to January 1, 2017:
- Se solicitará el reembolso de todos los bienes que posea el beneficiario fallecido en el momento de su muerte.
- Se adeudará el reembolso de los pagos realizados por la mayoría de los servicios recibidos y/o las primas mensuales de atención administrada pagadas en nombre del beneficiario de Medi-Cal.
Presentación de un Aviso de Defunción
If you are the person handling the affairs of the deceased Medi-Cal beneficiary, you must provide “Notice of Death” to the Director of DHCS within 90 days of the date of death with a copy of the death certificate. To satisfy the “Notice of Death” requirement and for fastest processing, complete and submit online the “Notice of Death” form with a copy of the death certificate. You may also mail “Notice of Death” with a copy of the death certificate to DHCS at: Department of Health Care Services, Estate Recovery Program, MS 4720, P.O. Box 997425, Sacramento, CA 95899-7425.
Exenciones/Exenciones
Specific limitations or exemptions may apply. The Department of Health Care Services (DHCS) may waive its claim if payment of the claim would cause a substantial hardship. Any request for a substantial hardship waiver must be submitted to DHCS within 60 days of the date on the DHCS Estate Recovery claim letter.
Applications for Hardship Waiver and other documentation pertaining to Hardship Waiver Applications can be submitted via email to HW@DHCS.CA.GOV or by mail.
Certain income and resources of American Indians and Alaska Natives are exempt from Estate Recovery. Please be sure to inform DHCS if the decedent’s property is on or near a federally recognized reservation, Pueblo, or Colony. A collection representative will contact you to clarify if DHCS can or cannot collect against these assets. For specific details on what assets are exempt from Estate Recovery please see the State Medicaid Manual, Section 3810 (7) and (8).
Pagar una reclamación
When you receive our claim amount and are ready to submit payment, we accept Electronic Fund Transfers (EFT) and checks. Regardless of which method you use to pay, you will need your DHCS Account Number to ensure payment is posted to the correct account.
Información de contacto
- Estate Recovery Correo electrónico: ER@DHCS.CA.GOV
- Correo electrónico de exención por dificultades: HW@DHCS.CA.GOV
- Phone: (916) 650-0590
- Dirección postal para correspondencia escrita:
Departamento de Servicios de Salud
División de Responsabilidad Civil y Recuperación
Estate Recovery Program – MS 4720
P.O. Caja 997425
Sacramento, CA 95899-7425
- Dirección postal para pagos:
Departamento de Servicios de Salud
División de Responsabilidad Civil y Recuperación
Estate Recovery Program – MS 4720
P.O. Caja 997421
Sacramento, CA 95899-7421
Solicitud de gastos Medi-Cal sujetos a Estate Recovery
Medi-Cal members or their authorized representative may submit a Request for Medi-Cal Expenses Subject to Estate Recovery, form DHCS 4017, once per calendar year for a five dollar ($5) processing fee if the current or former member meets either of the following descriptions:
a. An individual who is 55 years of age or older when the individual received health care services.
b. A permanently institutionalized individual who is an inpatient in a nursing facility, intermediate care facility of the intellectually disabled, or other medical institution.