Disclaimer: This article provides general information about West Virginia Medicaid estate recovery and is not legal advice. Consult a qualified attorney or Medicaid specialist for guidance on your specific situation.
Detailed Answer
Overview of Medicaid Estate Recovery in West Virginia
West Virginia’s Bureau for Medical Services (BMS) must seek reimbursement for certain Medicaid benefits from the estates of deceased beneficiaries under W. Va. Code §9-5-10 (”Right of recovery”). If you own real property at the time of your death, the state can file a claim against your estate to recover costs paid on your behalf.
What Is a Hardship Waiver?
A hardship waiver suspends or reduces estate recovery when enforcing the claim would cause undue hardship. Federal law allows states to grant waivers under 42 C.F.R. §433.36(b) if recovery would deprive your surviving family of basic shelter, food or medical care, or if recovery would be unconscionable under your circumstances.
Eligibility Criteria for West Virginia Hardship Waivers
- You or your heir must demonstrate that estate recovery would cause undue hardship to a surviving spouse, dependent child, or disabled heir.
- Your primary residence equity must fall below limits set by BMS policy (check current limits in the Medicaid Policy Manual, Chapter 18).
- You must apply for the waiver within the time frame specified in the notice of claim.
Steps to Apply for a Hardship Waiver
- Review the estate recovery notice. It will include filing deadlines and contact information.
- Gather required documents, such as:
- Proof of relationship (marriage certificate, birth certificate).
- Income and expense statements for dependents or surviving spouse.
- Property valuation (county assessor’s statement).
- Obtain the BMS Hardship Waiver Application form. Contact your local DHHR office or download from the BMS website.
- Complete and sign the waiver application. Explain in writing how recovery would cause undue hardship.
- Submit the application and supporting documents to the address listed on the claim notice by certified mail.
- Await a written decision. BMS generally issues a determination within 90 days of receiving a complete application.
- If denied, request a fair hearing within 60 days of the decision to appeal.
Helpful Hints
- Apply early. Submit the waiver as soon as you receive the estate recovery notice to avoid missing deadlines.
- Keep copies. Retain copies of all forms, notices, and proof of mailing.
- Track deadlines. Note appeal deadlines and hearing request time frames.
- Gather evidence of undue hardship. Include medical bills, rent/mortgage statements, and affidavits from family members.
- Consult a Medicaid planning attorney. They can advise on additional exemption strategies and appeals.