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Disclaimer

This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.

Detailed Answer

1. Understand Medicaid Estate Recovery

Under federal law, Medicaid can seek reimbursement from a deceased recipient’s estate for long-term care costs paid by the program (42 U.S.C. § 1396p; 42 C.F.R. § 433.36). South Dakota’s Department of Social Services (DSS) administers this program through its Estate Recovery Unit.

2. Establish Your Authority

Only the personal representative (executor or administrator) of the decedent’s estate can request and review Medicaid records. To prove your authority, gather:

• Letters Testamentary or Letters of Administration from the South Dakota probate court (SDCL Title 28)
• Certified copy of the decedent’s death certificate
• Photo ID for the personal representative
• Signed HIPAA authorization if requested by DSS

3. Submit a Records Request to DSS

Send a written request to:

Include in your request:

• Case number or Medicaid ID (if known)
• Decedent’s full name and date of birth
• Copy of your Letters Testamentary/Administration
• Certified death certificate

DSS typically responds within 30-60 days. You may receive a statement of claim showing the dates of service, provider names, amounts paid, and total balance due.

4. Review the Claim Documentation

Carefully examine each item:

• Dates of service and type of care (e.g., nursing facility, home health)
• Provider names and addresses
• Billed amounts vs. Medicaid payments
• Total outstanding balance

Compare the DSS statement with estate records (e.g., funeral home invoices, facility statements) to verify accuracy.

5. Dispute or Appeal If Necessary

If you find errors or have questions, you can request an informal review by DSS. To file a formal appeal, submit a written hearing request within 60 days of the date on the claim notice. Appeals follow Administrative Rule of South Dakota procedures.

Helpful Hints

• Keep copies of all mailed documents and use certified mail for important correspondence.
• Track deadlines: probate, appeals, and statute of limitations.
• Consult the SD DSS Estate Recovery webpage for forms and instructions.
• Review federal Medicaid Estate Recovery guidance at CMS.gov for additional context.
• Speak with a probate attorney if the claim significantly impacts estate assets.