B-2600, Medicaid Estate Recovery Program Notification Requirements

Revision 18-1; Effective March 1, 2018

Medicaid Estate Recovery Program (MERP) is not part of the eligibility determination process for Medicaid.

MERP recovers from a Medicaid recipient’s estate the cost of Medicaid assistance paid for an individual who:

1) was age 55 or older at the time Medicaid services were received; and
2) initially applied for certain types of long-term care (LTC) services on or after March 1, 2005.

Individuals whose estate may be subject to MERP recovery include:

  • an applicant for a Medicaid program that covers these LTC services; or
  • a recipient who requests a change to a Medicaid program that covers these LTC services.

Individuals applying for or receiving these LTC services must be informed about MERP.

A signed Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement, or documentation the Form 8001 was provided, must be in the case record of each applicant whose estate is subject to MERP recovery.

 

B-2610 Types of MEPD Groups Subject to MERP

Revision 18-1; Effective March 1, 2018

On March 1, 2005, Texas implemented MERP in compliance with federal Medicaid and state laws. The program is managed by HHSC. Under this program, the state may file a claim against the estate of a deceased Medicaid recipient who: 1) was age 55 or older when Medicaid services were received; and 2) first applied for certain long-term care services and supports on or after March 1, 2005. The most complete, current and accurate source of information regarding MERP is the HHS website: Medicaid Estate Recovery Program. MERP Claims include the cost of Medicaid assistance paid for the following services:

  • nursing facilities;
  • intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID), which include state supported living centers;
  • Home and Community-Based Services waiver programs. See Chapter O, Waiver Programs, Demonstration Projects and All-Inclusive Care;
  • Community Attendant Services; and
  • related hospital and prescription drug services.

Notes:

  • A person who is placed on an interest list for a Home and Community-Based Services waiver program is not considered to be an applicant.
  • As of Jan. 1, 2010, states are prohibited from recovering the value of Medicare cost-sharing paid under Medicare savings programs as a result of the Medicare Improvements for Patients and Providers Act (MIPPA) signed into law on July 15, 2008.

 

B-2620 HHSC MERP Notification Requirements

Revision 18-1; Effective March 1, 2018

HHSC staff must inform anyone requesting Medicaid assistance for long-term services and supports that may be subject to MERP recovery. Complete the following to document this requirement:

  • Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement, is mailed with all Form H1200 application requests received on or after March 1, 2005.
  • Ensure the signed MERP Receipt Acknowledgement (Form 8001) is imaged in the case record.
  • Include the MERP documentation with SSI monitoring requirements outlined in Section B-7100, SSI Monitoring.
  • Record information (name, address, telephone number) of any of the following individuals representing the applicant:
    • guardian of the person or guardian of the estate of the applicant;
    • agent under a durable power of attorney or a medical power of attorney;  or
    • if none of the above individuals are known, family members acting on behalf of the applicant.
  • If a signed MERP Receipt Acknowledgement form is not returned by the applicant/recipient, send Form 8001 and document in case comments that the MERP information was sent to inform the recipient about MERP and the potential for estate recovery.  Include in the documentation the date the form was sent to the recipient.

If a Form H1746-A, MEPD Referral Cover Sheet, has a mark in the box "MERP shared," do not send MERP notifications to the individual. The agency making the referral has shared MERP information with the individual.

The MERP notification requirement applies to any individual, age 55 or older, who is applying for Medicaid assistance for long-term care services and supports that are subject to MERP on or after March 1, 2005, either through an application or program transfer. Individuals transferring to long-term care services and supports subject to MERP must have documentation of Form 8001 in the case record. If there is no documentation in the case record, send Form 8001 and follow documentation guidelines outlined in this section.

Example: Mr. Andy Allen applied for a Medicare Savings Program (MSP) before Nov. 1, 2004, and was certified, but did not receive Form 8001 since Mr. Allen was on an MSP before March 1, 2005. Mr. Allen entered a nursing facility this month and requested a program transfer. Based on Section B-7450, Medicaid Certified Person Enters Nursing Facility or Home and Community-Based Services Waiver Program, the program transfer is complete, and Form 8001 is sent to Mr. Allen. Staff document in case comments the date the Form H8001 was mailed.