A Estate Recovery Program Overview

Revised 12/06/2022

Policy

1) To Whom Does Estate Recovery Apply?

Estate recovery applies to any person who meets all of the following:

• Received ALTCS nursing home or HCBS benefits;

• Was 55 years or older when benefits were received;

• Received benefits on or after January 1, 1994, and

• Is deceased.

 

2) Payments for Which AHCCCS Seeks Recovery

The amount of the AHCCCS claim is the total of all ALTCS payments made by AHCCCS for a customer aged 55 or older. Costs for ALTCS benefits provided before the customer turns 55 are not included. AHCCCS recovers for the following types of payments:

• Capitation payments.

• Medicare coinsurance and deductibles for services provided on or before December 31, 2009. No recovery is made for services provided on or after, January 1, 2010.

• Medicare Part A and Part B premiums paid for months on or before December 31, 2009. No recovery is made for premiums paid for January 2010 or later.

• Reinsurance.

• Fee-for-Service Payments.

 

3) Assets Subject to Estate Recovery

The AHCCCS estate claim is filed at the time of the customer’s death against all property subject to either Small Estate Affidavit or probate. A home that was solely owned by an ALTCS customer, owned jointly without right of survivorship, or owned jointly with right of survivorship (and the joint owner is deceased) is subject to an AHCCCS claim.

 

4) Long Term Care Partnership Program Claim Exclusion

If a person has a qualifying long-term care partnership insurance policy and was given a resource exclusion (see MA703F), the AHCCCS estate claim is reduced by the amount of resources deducted as a result of the qualified long term care partnership policy.

 

5) The AHCCCS Recovery Agent

Health Management Systems, (HMS) is a private firm that handles recoveries on behalf of the AHCCCS, including:

• Claims against a customer’s estate;

• TEFRA liens;

• Estate Recovery from Special Treatment Trusts (MA803); and

• Achieving a Better Life Experience (ABLE) accounts (MA705I)

NOTE     Recovery from ABLE accounts is only for services provided by AHCCCS from the time the ABLE account was established.

See Estate Recovery Related Procedures for more details on responding to requests from HMS/DBF and customer questions.

 

Definitions

Term	Definition
Claim	A claim is a legal demand against the estate of an ALTCS customer to recover payment for AHCCCS expenditures issued on the customer’s behalf.
Capitation	A payment arrangement for health care service providers. It pays a group of providers in advance for the delivery of health care services. They are paid a set amount for each enrolled person on a monthly basis.
Coinsurance	The percentage of the costs a patient is responsible for toward his health care bill. It is a percentage, not a set amount.
Deductibles	The set amount of expenses that must be paid out of pocket by the insured before an insurer pays any expenses.
Fee-for-Service Payments	AHCCCS directly pays ALTCS customers’ medical bills in limited situations described in MA1103. These payments are called ‘fee-for-service’ payments.
Reinsurance	Additional insurance that is purchased by an insurance company from one or more other insurance companies.
Small Estate Affidavit	An informal procedure for settling estates with less than $50,000 of assets. It is less structured than ordinary probate, and the services of an attorney may not be required. Claims are settled with creditors without probate procedures.

 

Legal Authority

Program	Legal Authorities
ALTCS	42 USC 1396(p) ARS 36-2935 AAC R9-22-1006 AAC R9-28-901 and R9-28-912