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Series: Medicaid Estate Recovery Program

Announced on  | Last Modified on  | Series Number: W-00-24-31561
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Several States have not implemented all the requirements of their Medicaid Estate Recovery Programs; therefore, they might be running the programs ineffectively and not recovering certain long-term care costs due from the applicable estates of deceased Medicaid recipients. We will determine whether State agencies, under their Medicaid Estate Recovery Programs: (1) had policies and procedures to comply with Federal and State requirements, (2) attempted to recover the applicable reimbursement costs for certain long-term care, (3) accurately reported Medicaid estate recovery amounts associated with certain long-term care services on the CMS-64, and (4) identified the costs incurred to recover from the estates.

There are 2 projects in this series.

COMPLETED PROJECTS IN THIS SERIES (2)

Utah

Project A-07-23-03257 • Completed on November 12, 2024

Review of Medicaid Estate Recovery Program in Kansas

Project A-07-22-03254 • Completed on March 12, 2024

TIMELINE

  • September 6, 2022
    Series Number W-00-24-31561 Assigned
  • September 6, 2022
    Project Announced

    Review of Medicaid Estate Recovery Program in Kansas - A-07-22-03254

  • August 14, 2023
    Project Announced

    Utah - A-07-23-03257

  • March 12, 2024
    Project Complete - A-07-22-03254

    Review of Medicaid Estate Recovery Program in Kansas has been marked as complete. This audit resulted in 2 recommendations.

  • November 12, 2024
    Project Complete - A-07-23-03257

    Utah has been marked as complete. This audit resulted in 3 recommendations.

  • November 12, 2024
    Series Complete

    Medicaid Estate Recovery Program has been marked as complete.

2 REPORT PUBLISHED

Kansas’s Medicaid Estate Recovery Program Was Cost Effective, but Kansas Did Not Always Follow Its Procedures, Which Could Have Resulted in Reduced Recoveries (A-07-22-03254)

24-A-07-047.01 to CMS - Closed Implemented
Closed on 03/17/2025
We recommend that the Kansas Department of Health and Environment improve its estate recovery program by confirming that all deceased Medicaid recipients who are subject to estate recovery are identified and by providing relevant information on those recipients to the contractor in a timely manner so as to give the contractor adequate time to file liens and initiate probate.

24-A-07-047.02 to CMS - Closed Implemented
Closed on 03/17/2025
We recommend that the Kansas Department of Health and Environment improve its oversight of the estate recovery contractor's performance by: verifying that the contractor files liens and initiates probate in a timely manner; confirming that the contractor's current process for MMIS claims verification is accurate; and verifying that the contractor performs applicable estate recovery procedures (including the opening of cases, sending of notices, and independent asset research) for deceased Medicaid recipients.

View in Recommendation Tracker

Utah Generally Operated Its Medicaid Estate Recovery Program in Accordance With Requirements and in a Cost Effective Manner, but Utah Did Not Have Formal Written Procedures (A-07-23-03257)

25-A-07-012.01 to CMS - Open Unimplemented
Update expected on 04/02/2026
We recommend that the Utah Department of Health and Human Services improve its estate recovery program by establishing formal written estate recovery policies and procedures, to include policies and procedures regarding documentation to support its performance of estate recovery procedures for deceased Medicaid enrollees.

25-A-07-012.02 to CMS - Open Unimplemented
Update expected on 04/02/2026
We recommend that the Utah Department of Health and Human Services improve its estate recovery program by implementing formal procedures to periodically review open cases and establish a timeframe for doing so.

25-A-07-012.03 to CMS - Open Unimplemented
Update expected on 04/02/2026
We recommend that the Utah Department of Health and Human Services improve its estate recovery program by verifying that system edits are functioning properly and improving those system edits as necessary, and by verifying that caseworkers perform and document all applicable estate recovery procedures (including determining the amount of Medicaid paid claims, determining whether the enrollee had a surviving spouse or child(ren), and performing asset research) for deceased Medicaid enrollees.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship
Target Groups
-
Financial Groups
Medicaid