Estate Recovery. 1. Annuities purchased on or after February 8, 2006, will be subject to Estate Recovery.
2. The rules for the Institutional Spouse and the Community Spouse are the same for annuities purchased prior to this date. Source: Social Security Act §1917(d); Deficit Reduction Act of 2005 §6011 and §6016 (Rev. 2006). History: Revised eff. 11/01/2014. A determination must be made on whether the purchase of annuities, other than qualifying IRS annuities, is treated as a transfer of assets for less than fair market value.
A. If the expected return on the annuity is commensurate with a reasonable estimate of the life expectancy of the annuitant, the annuity can be deemed actuarially sound. The life expectancy tables published by the Office of the Actuary of the Security Administration are used.
B. The average number of years of expected life remaining for the individual must coincide with the life of the annuity. If the individual is not reasonably expected to live longer than the guarantee period of the annuity, the individual will not receive fair market value of the annuity based on the projected return.
C. If this is the case, the annuity is not actuarially sound and a transfer of assets for less than fair market value has taken place, subjecting the individual to a penalty.
D. The penalty is assessed based on a transfer of assets that is considered to have occurred at the time the annuity was purchased. Source: Social Security Act §1917(c); Deficit Reduction Act of 2005 §6011 and §6016 (Rev. 2006). History: Revised eff. 11/01/2014.
Estate Recovery. 1. Annuities purchased on or after February 8, 2006, will be subject to Estate Recovery.
2. The rules for the Institutional Spouse and the Community Spouse are the same for annuities purchased prior to this date. History: Revised eff. 11/01/2014.
Estate Recovery. 120 16. Audits ..........................................................121 17. Restitution .....................................................121 SECTION VIII: REPORTING REQUIREMENTS ......................................121 A. General .............................................................121 B. Systems Reports .....................................................121 1. Encounter Data and Subcapitation Data Reports ...................121 2. Federalizing GA Data Reporting ..................................124 3. Third Party Resource Identification .............................125
Estate Recovery. Section 1412 of the Public Welfare Code, 62 P.S. 1412, requires the Department to recover MA costs paid on behalf of certain deceased individuals. Individuals age fifty-five (55) and older who were receiving MA benefits for any of the following services are affected:
a. Public or private Nursing Facility services;
b. Residential care at home or in a community setting; or
c. Any hospital care and prescription drug services provided while receiving Nursing Facility services or residential care at home or in a community setting. The applicable MA costs are recovered from the assets of the individual's probate estate. The Department's TPL Section is solely responsible for administering the Estate Recovery Program.
Estate Recovery. If you are enrolled in Medi-Cal benefits, the State of California is required to seek repayment of some types of Medi-Cal benefits from your estate after you die. In particular, if you are a GMWP member enrolled in Medi-Cal, and you have estate assets subject to probate at the time of your death, your estate must repay the State of California for nursing facility services, home and community-based services, and related hospital and prescription drug services received when you were an inpatient in a nursing facility or received home and community-based services. California will seek this repayment from GMWP and GMWP will in-turn be required to seek repayment from your estate as applicable. Please note that the State of California Department of Health Care Services (DHCS) may waive its claim if payment of the claim would cause a substantial hardship. Any request for a substantial hardship waiver must be submitted to DHCS within 60 days of the date on the DHCS Estate Recovery claim letter. In addition, certain income and resources of American Indians and Alaska Natives are exempt from Estate Recovery. Please be sure to inform GMWP if the decedent’s property is on or near a federally recognized reservation, Pueblo, or Colony. For specific details on what assets are exempt from Estate Recovery please see the State Medicaid Manual, Section 3810 (7) and (8). Chapter 3 – Eligibility You are eligible to enroll in GMWP if you: Reside in the GMWP service area, which includes the following ZIP codes: Are 55 years of age or older. Require the State’s nursing facility level of care, as assessed by our IDT. A “Skilled Nursing Facility” is a level-of-care designation of the need for continuous 24-hour availability of skilled nursing. An “Intermediate Care Facility,” is a level-of-care designation of the need for 24-hour supervised care during the day on weekdays. Are able to live in the community without jeopardizing the health and safety of yourself and others. You must also be: Certified by the California Department of Health Care Services requirements. Because GMWP serves only older individuals who meet the State’s level-of-care requirements for coverage of nursing facility services, an outside review must confirm that your health situation, in fact, qualifies you for our care. The California Department of Health Care Services provides this review before you sign the GMWP Enrollment Agreement based on a review of the documents prepared by the members of the IDT who hav...
Estate Recovery. Section 1412 of the Public Welfare Code, 62 P.S. § 1412, requires the Department to recover Medical Assistance costs paid on behalf of certain deceased individuals. Individuals age fifty-five (55) and older who were receiving Medical Assistance benefits for any of the following services are affected:
a. Public or private Nursing Facility services;
b. Residential care at home or in a community setting; or
c. Any hospital care and prescription drug services provided while receiving Nursing Facility services or residential care at home or in a community setting. The Department's Division of TPL is solely responsible for administering the Estate Recovery Program.
Estate Recovery. Contractor must coordinate activities and cooperate with the Department’s Estate Recovery contractor.
Estate Recovery. The State of California must seek repayment of Medi-Cal benefits from the estate of a deceased Medi-Cal beneficiary for services received on or after the beneficiary's 55th birthday. For Medi-Cal beneficiaries enrolled (either voluntarily or mandatorily) in a managed care organization, the State must seek recovery of the total premium/capitation payments for the period of time they were enrolled in the managed care organization. Additionally, any other payments made for services provided by non-managed care providers will also be recovered from the estate. For further information regarding the Estate Recovery program only, you may call (000) 000-0000, or seek legal advice. Your eligibility worker will not have this information, so they will not be able to help you. Under federal law, {PACE Organization} is subject to the requirements of the Balanced Budget Act of 1997 (P.L. 101-33) as amended and Sections 1894 and 1934 of the Social Security Act. Any provision required to be in this Contract by any of the above shall bind {PACE Organization} whether or not set forth herein, and any provision of the Contract which, on its effective date, is in conflict with California or federal law is hereby amended to conform to the minimum requirements of such statutes.
Estate Recovery. The Department's Division of TPL is solely responsible for administering the Estate Recovery Program.
Estate Recovery. 1. Annuities purchased on or after February 8, 2006, will be subject to Estate Recovery.
2. The rules for the Institutional Spouse and the Community Spouse are the same for annuities purchased prior to this date. Source: Social Security Act §1917(d); Deficit Reduction Act of 2005 §6011 and §6016 (Rev. 2006). History: Revised eff. 11/01/2014. A determination must be made on whether the purchase of annuities, other than qualifying IRS annuities, is treated as a transfer of assets for less than fair market value.
A. If the expected return on the annuity is commensurate with a reasonable estimate of the life expectancy of the annuitant, the annuity can be deemed actuarially sound. The life expectancy tables published by the Office of the Actuary of the Security Administration are used.
B. The average number of years of expected life remaining for the individual must coincide with the life of the annuity. If the individual is not reasonably expected to live longer than the guarantee period of the annuity, the individual will not receive fair market value of the annuity based on the projected return.
C. If this is the case, the annuity is not actuarially sound and a transfer of assets for less than fair market value has taken place, subjecting the individual to a penalty.
D. The penalty is assessed based on a transfer of assets that is considered to have occurred at the time the annuity was purchased, using the full purchase price as the amount transferred. Source: Social Security Act §1917(c); Deficit Reduction Act of 2005 §6011 and §6016 (Rev. 2006). History: Revised eff. 11/01/2014.
X. Xxxxxxxxx – General (Applies Regardless of Purchase Date)
1. An annuity is defined as a contract or agreement by which one receives fixed, non- variable payments on an investment for a lifetime or a specified number of years.
a) An individual may buy an annuity by making payments over a period of time or purchase an immediate annuity by paying a lump sum to a bank or insurance company in return for regular payments of income in certain amounts.
b) When an annuity is “annuitized,” the investment is converted into periodic income payments.
c) These payments may continue for a fixed period of time or for as long as the individual or another beneficiary lives.
2. The annuitant is the person who will receive the payments during the term of the annuity. The annuity contract should identify the purchaser (owner) and the annuitant. The owner and the annuitant may or may not be the same...
