Disclaimer: This article is for educational purposes only and does not constitute legal advice.
Detailed Answer
Understanding Medicaid Estate Recovery in West Virginia
Under federal law (42 C.F.R. §433.36), West Virginia must seek reimbursement from the estates of deceased Medicaid recipients. The state implements this requirement through the Bureau for Medical Services (BMS). You can find the statutory framework in WV Code §9-5-10, which outlines recovery procedures and exemptions.
Step-by-Step Process to Obtain Documentation
- Establish your role: Obtain letters of administration or executor appointment from the probate court to prove your authority.
- Contact BMS Estate Recovery: Send a written request to West Virginia DHHR, Bureau for Medical Services, Estate Recovery Unit. Include the decedent’s full name, Medicaid ID, date of birth, and proof of your representative status.
- Request specific records: Ask for the Notice of Claim, itemized service records, payment logs, and calculation worksheets that support the total claim amount.
- Invoke the WV Freedom of Information Act: If you need additional documents, submit a FOIA request under WV Code §29B-1-1. This can force disclosure of administration policies and correspondence.
Reviewing and Challenging the Claim
After you receive the documentation, compare billed services against medical records and eligibility dates. Look for:
- Duplicate entries or services billed outside the recipient’s eligibility period.
- Incorrect billing rates or misapplied service codes.
- Potential exemptions, such as surviving spouse, minor child, or permanently disabled child under WV Code §9-5-10(d).
If you identify errors or improper charges, you may request an informal review with BMS or file a formal appeal under the West Virginia Administrative Procedure Act. Pay attention to the appeal deadlines stated in the Notice of Claim.
Helpful Hints
- Obtain letters of administration before making any record requests.
- Keep all correspondence in writing and send via certified mail or another trackable method.
- Mark deadlines on your calendar — estate recovery appeals typically have strict time limits.
- Review both federal regulations and state statutes to understand your rights.
- Consider consulting a probate or elder law attorney for complex disputes or large claims.