Under some circumstances, the state may place a lien on the home of an inpatient hospital resident who is required to contribute to the cost of care, or of a nursing home resident who is not reasonably expected to return home. The state cannot place a lien on the home of a recipient in the community.

Before placing a lien, the Medicaid program must notify the recipient (or his or her responsible party) in writing and inform the recipient of the right to an administrative hearing concerning the lien process.

The state may place a lien on the home of a hospital or a nursing home resident only if the recipient cannot reasonably be expected to return home and none of the following people reside in the home:

• The recipient’s spouse or minor, disabled, or blind child.
   
• A brother or sister of the recipient who has an ownership interest in the home and has continuously lived in the home beginning at least a year prior to the hospital or nursing home admission of the Medicaid recipient.

If a lien is placed on the home, it must be removed when a recipient returns home. If the recipient returns home, the local economic support worker or the recipient should contact the state and the lien will be removed.

A lien will be paid when the home is sold. The lien is paid from the sale amount after the costs of the real estate transaction are paid such as the realtor’s fee and any closing costs, and any mortgages on the home which pre-date the Estate Recovery Program lien.

A lien will not be paid at the sale of a home, before or after the recipient’s death, if the recipient has a living spouse or a minor, disabled, or blind child. In addition, a lien will not be enforced after the recipient’s death as long as either of the following resides in the home:

• A son or daughter of the recipient who continuously lived in the home beginning at least 24 months before the recipient was admitted to the hospital or nursing home and who provided care to the recipient that delayed the recipient’s admission to the hospital or nursing home.
   
• A brother or sister of the recipient who continuously lived in the home beginning at least 12 months before the recipient was admitted to the hospital or nursing home.

At the time a property is sold, a lien enables the state to recover specific amounts paid for Medicaid benefits. The Department may recover funds for:

• All Medicaid services received while living in a nursing home on or after October 1, 1991.
   
• All Medicaid services received while a recipient is institutionalized in an inpatient hospital on or after April 1, 2000.
   
• Home health care services received by recipients age 55 or older on or after April 1, 2000, consisting of:
  • Skilled nursing services.
  • Home health aide services.
  • Home health therapy and speech pathology services.
  • Private duty nursing services.
  • Personal care services.
     
• All home and community-based waiver services (COP Waiver, CIP IA, CIP IB, CIP II, Brain Injury Waiver, Community Supported Living Arrangements) received by recipients age 55 or older on or after April 1, 2000, and
  • Prescription/legend drugs received by waiver participants.
  • Benefits associated with a wavier participant’s inpatient hospital stay.
     
• All pilot program Family Care services received on or after February 1, 2000, and
  • Prescription/legend drugs received by Family Care participants.
  • Benefits associated with a Family Care participant’s inpatient hospital stay.

A lien only recovers for the amount paid by Medicaid for benefits up to the date of sale. If more benefits are provided after the lien is paid, or if all of the benefits already provided were not payable from the sale, the state may file a claim in the recipient’s estate to recover additional amounts.

If you have any questions, you may contact your local county/tribal social or human services department or Medicaid Recipient Services at 1-800-362-3002.

Yes, the state also recovers:

• The cost of benefits paid by the Wisconsin Chronic Disease Program (WCDP) for participants of any age for services that were provided on or after September 1, 1995.
   
• The cost of benefits paid by the Community Options Program (COP) for participants who are age 55 or older for services that were provided on or after January 1, 1996.
   
• The actual costs of non-Medicaid Family Care services provided on or after February 1, 2000, as reported to the Department for enrollees age 55 or older and living in the community; or that are any age and who live in an inpatient hospital and are required to contribute to their cost of care; or who live in a nursing home.

In the case of the COP and Family Care, any amount recovered is returned to the program and used for the benefit of other participants.

Liens are never placed on the homes of COP and/or WCDP participants during their lifetime because of receiving those services. Besides recovering from the estate of the COP or WCDP participant, the State may also recover from the estate of the participant’s spouse. For more information about the Estate Recovery Program and these programs, contact your COP, WCDP, or Family Care caseworker.

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