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Family and Children's Medicaid MA-3326 – ESTATE RECOVERY

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III. PROCEDURES

Notification for:

Group 1

Under age 55

Group 2

Age 55 or older

PLA/SA/CAP LTC

DMA-5051, , possibly DMA-5053

DMA-5052/DMA-5052SA

 

1. A/r or representative must sign the DMA-5051, Your Estate May Be Subject to Medicaid Recovery. This form is notice to the a/r explaining that he may be subject to estate recovery and that a determination must be made whether the a/r is considered living in a facility on a permanent or indefinite basis.

2. If the a/r or representative refuses to sign, document this on the DMA-5051, and in the case record.

3. Document in the case record that the notice was given or mailed to the a/r, and file a copy of the form in the case record.

4. Do not delay approval of the application while making the determination of whether the stay is permanent or indefinite.

5. If the placement is found to be permanent or indefinite, mail the DMA-5053, Your Estate Is Subject to Medicaid Recovery, which explains the decision and appeal rights.

6. File a copy of the DMA-5053 in the case record. No further action is required at this time.

1. A/r or his representative must sign the DMA-5052, Your Estate Is Subject To Medicaid Recovery, or the DMA-5052SA, State/County Special Assistance Applicant Medicaid Estate Recovery Notice, if the a/r is SA. Provide a signed copy of the DMA-5052, or the DMA-5052SA, to the applicant and/or his representative and retain one copy for the case file. This is a general notice that explains the a/r is subject to estate recovery.

2. If the a/r or representative refuses to sign, document this on the DMA-5052 or the DMA-5052SA and in the case record.

3. Document in the case record that the notice was given or mailed to the a/r, and file a copy of the form in the case record.

4. No further action is required at this time.

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