State officials may assert a lien against medicaid beneficiaries under circumstances set forth in state law, but it must be consistent with the general parameters of federal law set forth in 42 U.S. Code § 1396p.
It has been an evolving standard. Medicaid liens on real property of deceased recipients have been permitted since the beginning of the Medicaid program. They have also been authorized in limited circumstances on real property of living recipients since 1982. States have increased their use in response to the 1993 estate recovery mandate, enacted in the Omnibus Budget Reconciliation Act (OBRA 93). This legislation required states to recoup the costs of long-term care and related Medicaid services from the estates of certain deceased recipients.
OBRA 93 mandates the state attempt recovery against the estate of deceased beneficiaries who meet the following requirements:
- Were age 55 or older when they received Medicaid benefits;
- Had been determined to be permanently institutionalized, regardless of age; and
- Were not survived by a spouse or certain other dependents deemed to have a deserving claim on the estate.
Some states apply this only to probate estates, others to non-probate assets.
The state may place liens upon
