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AHCCCS may file a lien against the customer’s real property, including the customer’s home, after the customer becomes permanently institutionalized at a nursing home, mental health hospital, or other long term care medical facility.
The purpose of the lien is to recover the cost of benefits provided upon the customer’s death or upon a sale or transfer of an interest in the property.
The policy in this section covers the following topics:
Customers subject to a TEFRA Lien
Exemptions to filing a TEFRA lien
Notice and filing of a TEFRA lien
Changes after a TEFRA Lien has been filed
Sale or transfer of property that has a TEFRA lien
Non-enforcement of TEFRA liens
ALTCS customers who are permanently institutionalized will have a lien filed against their home or other real property unless an exemption exists.
NOTE If a customer is discharged from a facility and returns to his or her own home on a permanent basis, the lien will be removed.
A lien will not be filed against the following real property belonging to members of federally recognized American Indian tribes:
Tribal land and other resources currently held in trust and judgment funds from the Indian Claims Commission and the U.S. Claims Court;
Property, including real property and improvements, located within or near the bounds of a tribal nation or located within the most recent boundaries of a prior federal tribal lands as designated by the Bureau of Indian Affairs of the U.S. Department of the Interior;
A lien will not be filed if one of the following individuals is lawfully living in the customer’s home:
The customer’s spouse;
The customer’s child who is under age 21;
The customer’s child who is blind or permanently and totally disabled; or
The customer’s sibling who has an equity interest in the home and who was living in the member’s home for at least one year immediately before the date the customer was permanently institutionalized.
Following notification that a customer has lived in an institution for 90 days or more, Health Management Systems (HMS) sends a Notice of Intent to File a Lien and a Questionnaire to the customer or the customer’s authorized representative.
If there is no response or HMS determines that the proper criteria have been met, HMS files a TEFRA Lien against the customer’s home on behalf of AHCCCS.
Should a customer wish to contest the lien, he or she may file a request for a fair hearing within 30 days of receiving the Notice of Intent.
No further action is taken by AHCCCS after the lien has been filed until either:
The customer dies;
The property ownership is sold or transferred; or
The customer returns home and the lien is removed.
When property with a TEFRA lien is sold, the customer must repay AHCCCS for payments made by AHCCCS on the customer’s behalf. The repayment amount is equal to the amount that AHCCCS has paid. AHCCCS cannot collect more than the amount that it has paid at the time the property is sold.
A lien will not be enforced against any real property when the customer is survived by his or her:
Spouse,
Child under the age of 21, or
Child who is blind or permanently and totally disabled.
Sibling who lives in the deceased customer’s home and who was living there for a least one year immediately before the date the customer was institutionalized, or
Child who lives in the deceased customer’s home and who was living there for at least two years immediately before the date the customer was institutionalized.
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Term |
Definition |
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TEFRA Lien |
A lien under 42 USC 1396p of the Tax Equity and Fiscal Responsibility Act of 1982. |
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Permanently Institutionalized |
Permanently institutionalized means the customer has lived in a long-term care nursing facility for at least 90 consecutive days and continues to live there and cannot reasonably be expected to be discharged and return to his or her own home. |
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Program |
Legal Authority |
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ALTCS |
42 USC 1396p AAC R9-28-801 through R9-28-807 |