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(a) At the time of application, the division will notify each applicant for Medicaid that the estate of an individual who received medical assistance payments is subject to a claim for recovery under AS 47.07.055 and this section.
(b) When making a claim for reimbursement under AS 47.07.055 (e), the department will include in that claim any hospital and prescription drug services provided to an individual while that individual was receiving services identified in AS 47.07.055 (e)(1) and (2).
(c) Before pursuing a claim under this section, the department will evaluate the cost effectiveness of pursuing the claim. The department will pursue a claim only if the department determines that the potential recovery will exceed the administrative and legal cost of pursuing the claim. The department will not pursue a claim against an estate if the only significant asset of the estate is the recipient's primary residence with an equity value of less than $75,000.
(d) The department may waive estate recovery if the department determines that it would work an undue hardship on the survivors. Reasons the department may find an undue hardship include one or more of the following:
(1) the estate's only significant asset is an income-producing asset, and recovery would cause loss of livelihood to survivors;
(2) the estate's only significant asset is real property that is the primary residence of a survivor, and that was the primary residence of the survivor at the time of the recipient's death;
(3) without the receipt of estate proceeds a survivor would become eligible under AS 47 and this title for public assistance or Medicaid;
(4) allowing a survivor to receive the estate would enable the survivor to discontinue eligibility under AS 47 and this title for public assistance or Medicaid;
(5) recovery would deprive the survivor of
(A) medical care, without which the survivors health or life would be endangered; or
(B) food, clothing, shelter, or other necessities of life;
(6) the survivor made substantial personal contributions to the property or to the recipient so that the recipient could remain home.
(e) The department will not seek recovery under AS 47.07.055 of Medicaid expenditures made for services that the recipient would not have been required to pay for if the recipient were not eligible for Medicaid.
(f) In this section, "estate" has the meaning given in AS 13.06.050 .
(g) In AS 47.07.055 , "medical institution" has the meaning given in 42 C.F.R. 435.1009. For purposes of this subsection, the definition of "medical institution" in 42 C.F.R. 435.1009, as revised as of October 1, 2002, is adopted by reference.
History: Eff. 3/26/2003, Register 165
Authority: AS 47.05.010
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Last modified 7/05/2006