Recovery and Reimbursement of Aid
Recovery of medical assistance
- estate claims
- transfer of assets
(1)The Department of Human Services or the Oregon Health Authority may recover from any person the amounts of medical assistance the department or the authority incorrectly paid to or on behalf of the person.
(2)Except as prohibited by ORS 178.380 (Establishment of qualified ABLE program), medical assistance pursuant to ORS chapter 414 paid to or on behalf of an individual who was 55 years of age or older when the individual received the assistance, or paid to or on behalf of a person of any age who was a permanently institutionalized inpatient in a nursing facility, intermediate care facility for persons with intellectual disabilities or other medical institution, may be recovered from the estate of the individual or from any recipient of property or other assets held by the individual at the time of death including the estate of the surviving spouse. Claim for such medical assistance correctly paid to or on behalf of the individual may be established against the estate, but the claim may not be adjusted or recovered until after the death of the surviving spouse, if any, and only at a time when the individual has no surviving child who is under 21 years of age or who is blind or permanently and totally disabled. Transfers of real or personal property by recipients of such aid without adequate consideration are voidable and may be set aside under ORS 411.620 (Recovery of public assistance or medical assistance obtained or disposed of unlawfully) (2).
(3)Nothing in this section authorizes the recovery of the amount of any aid from the estate or surviving spouse of a recipient to the extent that the need for aid resulted from a crime committed against the recipient.
(4)In any action or proceeding under this section to recover medical assistance paid, it is the legal burden of the person who receives the property or other assets from a medical assistance recipient to establish the extent and value of the recipient’s legal title or interest in the property or assets in accordance with rules established by the authority.
(5)Amounts recovered under this section do not include the value of benefits paid to or on behalf of a beneficiary under a policy or certificate of qualified long term care insurance as defined in ORS 743.652 (Definitions for ORS 743.650 to 743.665), that were disregarded in determining eligibility for or the amount of medical assistance provided to the beneficiary.
(6)As used in this section:
(a)“Estate” includes all real and personal property and other assets in which the deceased individual had any legal title or interest at the time of death including assets conveyed to a survivor, heir or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust or other similar arrangement.
(b)“Medical assistance” includes the state’s monthly contribution to the federal government to defray the costs of outpatient prescription drug coverage provided to a person who is eligible for Medicare Part D prescription drug coverage and who receives medical assistance. [Formerly 414.105; 2011 c.720 §154; 2013 c.688 §87; 2017 c.367 §5]
Notes of Decisions
For purposes of recovering from estate of medical assistance recipient, life estate is valued immediately prior to death regardless of when life estate was created. State Department of Human Services v. Willingham, 206 Or App 156, 136 P3d 66 (2006)