Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a qualified attorney for guidance on your specific situation.
Detailed Answer
Under South Carolina law, the Department of Health and Human Services (SCDHHS) may seek recovery from the estate of a deceased Medicaid recipient for long-term care or related services paid on the recipient’s behalf. This process is governed by South Carolina Code Ann. §44-6-170 (Medicaid Estate Recovery Program).
Step 1: Determine Estate Recovery Applicability
Medicaid estate recovery applies if the decedent:
- Received Medicaid-covered institutional or home- and community-based long-term care services.
- Was age 55 or older when services began.
Review the death certificate and Medicaid eligibility records to confirm dates of service.
Step 2: Obtain Probate Court Records
Locate the probate file in the county where the deceased lived. To do this:
- Contact the Clerk of Court or Probate Court in the appropriate county.
- Request certified copies of the estate documents, including the inventory, account of assets, and creditor claims.
South Carolina’s Probate Code (Title 62) outlines procedures for accessing these records.
Step 3: Request Medicaid Claim Documentation from SCDHHS
To review the exact claim and lien amounts, use the South Carolina Freedom of Information Act (FOIA), SC Code Ann. §30-4-10 et seq. (SC FOIA).
- Prepare a written FOIA request including:
- Decedent’s full name, date of birth, and Medicaid ID number.
- Case or claim number, if available.
- Specific records sought (e.g., estate recovery demand letter, statement of lien, payment ledger).
- Send the request to:
SCDHHS FOIA Officer
1801 Main Street, Columbia, SC 29201
foia@scdhhs.gov - Pay any required duplication fees.
Step 4: Review and Analyze the Documentation
Once you receive the probate file and Medicaid claim records:
- Compare estate asset values with the claimed lien amount.
- Verify dates of service and amounts paid by Medicaid.
- Ensure no duplicate or unsubstantiated charges appear.
Step 5: Challenge or Negotiate If Needed
If you identify errors or overcharges:
- File an administrative appeal with SCDHHS within 30 days of the demand notice.
- Provide supporting evidence (e.g., valuations, invoices).
- Consider mediation or settlement negotiations to reduce the lien.
Helpful Hints
- Gather the decedent’s Medicaid ID and any case numbers before starting.
- Check the SCDHHS website for the latest FOIA request forms.
- Keep copies of all correspondence and certified mail receipts.
- Note any deadlines for probate creditor claims (usually within three months of notice).
- Consult with a probate or elder law attorney to navigate complex disputes.