While you are alive
Your home generally doesn't count against Medicaid eligibility while you live in it, while your spouse or a dependent relative lives there, or while you intend to return (MA-2230). Estate recovery happens only after death.
What NC Medicaid can recover
Under G.S. 108A-70.5, NC Medicaid seeks repayment from the estates of two groups:
- Members 55 or older, for nursing facility services, home and community-based services (such as CAP/DA), hospital care, prescription drugs and personal care services.
- Members of any age who lived in a nursing facility or other medical institution and could not reasonably be expected to return home.
The claim can't exceed what Medicaid paid for those services. The "estate" is the property available to pay the person's debts under G.S. 28A-15-1, and NC Medicaid is a sixth-class creditor, so funeral costs, taxes and some other claims are paid first.
When recovery is deferred or waived
NC Medicaid's estate recovery claim notice (DHB-5054) lists these protections:
- Deferred while the member's spouse is living, while there is a surviving child under 21, or a surviving child of any age who is blind or disabled.
- Waived when the estate's total assets, or the total Medicaid payments subject to recovery, are below the amounts set in the notice.
- Undue hardship for qualifying heirs. One example: an heir who lived in the home for at least 12 months before the death and still lives there, with household income below 200% of the federal poverty level and limited assets. Other tests cover property that is a family's only source of income and certain co-owned homes.
What families can do
- Read the notice. NC Medicaid sends notice that estates may be subject to recovery when a person applies for long-term care.
- Know the look-back rules before transferring property. See the 60-month look-back.
- After a death, tell the estate's executor. The executor must notify affected family members about the claim and the hardship process.
- Get legal advice for your situation. An estate or elder law attorney can review your options; questions about the claim go to the NC Medicaid Contact Center at 1-888-245-0179.
More in NC Medicaid and Medicare. To review Medicare coverage for yourself or a parent, you can request a call from a licensed insurance agent.
Related questions
What is the Medicaid look-back period in NC?
How gifts and transfers are treated.
Does NC Medicaid pay for nursing home care?
Eligibility and how your income is used.
What is the CAP/DA waiver?
Home care that is also subject to recovery.
Sources
- N.C. General Statutes § 108A-70.5, Medicaid Estate Recovery Plan
- NC Medicaid — DHB-5054, Medicaid Estate Recovery Claim notice (rev. 05/2023)
- NC Medicaid — DHB-5052SA, Special Assistance estate recovery notice (rev. 05/2023)
- NCDHHS — MA-2230, Financial Resources
- NCDHHS — MA-2240, Transfer of Assets
- U.S. Code — 42 U.S.C. 1396p, liens, adjustments and recoveries
More questions in this guide
- Are people with Medicare and Medicaid in NC Medicaid managed care?
- Can I have NC Medicaid and Medicare at the same time?
- Did NC Medicaid expansion change anything for people on Medicare?
- Does NC Medicaid pay for nursing home care?
- Medicare vs. Medicaid in North Carolina
- What is a dual eligible special needs plan in North Carolina?
- What is Special Assistance in North Carolina?
- What is the CAP/DA waiver in North Carolina?
- What is the Medicaid look-back period in North Carolina?
Part of the guide: NC Medicaid and Medicare together · All questions
Frequently asked questions
Does NC Medicaid put a lien on my house?
NC Medicaid's estate recovery notice for Special Assistance recipients says, "No lien will be placed on property as part of the Estate Recovery process," and that Medicaid cannot collect assets that aren't part of your estate when you die. The claim is filed against the estate after death.
Will NC Medicaid recover Medicare Savings Program (MQB) help?
No. Federal law (42 U.S.C. 1396p(b)(1)(B)(ii)) excludes Medicare cost sharing paid through a Medicare Savings Program from estate recovery, and North Carolina's statute lists only nursing facility, home and community-based, hospital, prescription drug and personal care services.
Can I give my house to my children to avoid estate recovery?
Giving it away can cause a Medicaid sanction if you need long-term care within 60 months (MA-2240). Transfers of the home to a spouse, a child under 21, a blind or disabled child, a co-owner sibling who lived there a year, or a caregiving child who lived there two years are allowed.
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