An official State of Texas website.
Revision 18-1; Effective March 1, 2018
Another post-payment resource is through the MERP. On March 1, 2005, Texas implemented MERP in compliance with federal Medicaid and state laws. The program is managed by HHSC. Under this program, HHSC may file a claim against the estate of a deceased Medicaid recipient who: 1) was age 55 or older at the time Medicaid services were received; and 2) initially 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.
Long-term care services and supports that are subject to MERP include:
- nursing facility services;
- intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) services, which include state supported living centers;
- Medicaid waiver programs, such as:
- Community Living Assistance and Support Services (CLASS);
- Deaf Blind with Multiple Disabilities (DBMD);
- Home and Community-based Services (HCS);
- Texas Home Living Program (TxHmL); and
- STAR+PLUS Waiver (SPW);
- Community Attendant Services (CAS); and
- related hospital and prescription drug services.
Notes:
- A person who is placed on an interest list for a Medicaid waiver program is not considered to have applied.
- If a person, aged 55 or older, was eligible for Medicaid or received other Medicaid-paid benefits, such as QMB, SLMB or QI-1, before March 1, 2005, but did not initially apply for or transfer to one of the types of long-term care services and supports subject to MERP until March 1, 2005, or after, the person's estate is subject to recovery of the cost of certain long-term care services and supports received after March 1, 2005.
The acceptance of Medicaid assistance for the covered long-term care services provides a basis for a Class 7 probate claim. (This means there are six other classes of claims that receive priority in payment from the estate before Texas gets paid.) HHSC files a MERP claim in probate court against the estate of a deceased Medicaid recipient to recover the cost of certain Medicaid long-term care services and supports received by the Medicaid recipients. MERP will follow claims procedures specified in the Texas Estates Code and HHSC’s Medicaid Estate Recovery Program rules found at 1 TAC, Part 15, Chapter 373.
For notification requirements, see Section B-2620, HHSC MERP Notification Requirements.