1. A. Adjustments or recoveries for Medicaid claims correctly paid are as follows: See 12VAC30-20-141.

   1. 1. For permanently institutionalized individuals, adjustments or recoveries are made from the individual's estate.

   2. 2. For any individual who received medical assistance at age 55 or older, recovery of payments are made for nursing facility services, home- and community-based services, and related hospital and prescription drug services.

      Payments are recovered for all services covered under the plan which are provided to individuals at age 55.

   3. 3. If an individual covered under a qualified long-term care partnership insurance policy pursuant to § 32.1-325 of the Code of Virginia received benefits for which assets or resources were disregarded as provided for in 12VAC30-40-290 G, the Commonwealth does not seek adjustment or recovery from the individual's estate for the amount of assets or resources disregarded.
2. B. No money payments under another program are reduced as a means of recovering Medicaid claims incorrectly paid.

3. C. Liens. See 12VAC30-20-130.

   1. 1. Specifies the process for determining that an institutionalized individual cannot reasonably be expected to be discharged from the medical institution and return home; the description of the process meets the requirements of 42 CFR 433.36(d).

      The Commonwealth does not impose liens; therefore, this subsection is not applicable.

   2. 2. Specifies the criteria by which a son or daughter can establish that he or she has been providing care under 42 CFR 433.36(f).

      The Commonwealth does not impose liens; therefore, this subsection is not applicable.

   3. 3. Definitions: individual's home; equity interest in home; residing in home for at least 1 or 2 years, on a continuing basis; discharge from the medical institution and return home; and lawfully residing.

      The Commonwealth does not impose liens; therefore, this subsection is not applicable.

4. D. Estate recoveries.

   12VAC30-20-141 (Attachment 4.17-C) specifies the policy for estate recoveries.

Liens are not imposed against an individual's property.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-01-53, VR460-01-53.1, eff. March 20, 1983; amended, Virginia Register Volume 11, Issue 26, eff. October 18, 1995; Volume 23, Issue 14, eff. September 1, 2007; Volume 25, Issue 21, eff. July 23, 2009.