Rules and Regulations of the State of Georgia
 

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<xmp>.</xmp> <form name="form1" method="post" action="111-3-8?urlRedirected=yes&amp;data=admin&amp;lookingfor=111-3-8" id="form1"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTY5ODkwOTM2Nw8WAh4Ec3BhbQIQFgJmD2QWAgIFDw8WAh4EVGV4dAUFOCArIDhkZGQxsP8OTfV1eWW6ojmBN3QZriVNxw==" /> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="EEBB6393" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWCAKivo+oBgLniKOhBALV5cpNAoa5iIEFAoznisYGAsrv5u0MAsrv4u0MAsrv3u0MYPo93r+2C9+GvwAEq77sn/iW6yQ=" /> <div class='popup'> <div class='cnt223'> <div style="margin-bottom:6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif"/> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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The Official Code of Georgia gives the state the authority to recover these monies. O.C.G.A. § 49-4-147.1. In addition, the recovery methodology must adhere to statutory provisions of the Georgia Revised Probate Code of 1998, O.C.G.A. Title 53.</P> <h2><a href="/GAC/111-3-8-.02" name="111-3-8-.02" title="111-3-8-.02">Rule 111-3-8-.02 Definitions</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Authorized representative" means a guardian or a person designated by the Member to act on his or her behalf during the Member's life.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Debt" means a sum of money owed from one person to another, including the right of the creditor to receive and enforce payment.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Department" means the Georgia Department of Community Health, Division of Medical Assistance.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Discharge from the medical institution and return home" means a qualifying discharge, which involves the Member's dismissal from the nursing institution and/or facility for at least thirty (30) days wherein the Member's personal effects and bed are released at the same time of his or her discharge.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Equity interest in the home" means value of the property in which the Member holds legal interest beyond the amount owed on it in mortgages and liens.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Estate" means all real and personal property under the probate code. Estate also includes real property passing by reason of joint tenancy, right of survivorship, life estate, survivorship, trust, annuity, homestead or any other arrangement. The estate also includes excess funds from a burial trust or contract, promissory note s , cash, and personal property. Estates valued at $25,000 or less are exempt from estate recovery because it is not cost effective for the state to pursue recovery.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Hearing" means a formal proceeding before an Administrative Law Judge or Probate Judge in which parties affected by an action or an intended action of the Department shall be allowed to present testimony, documentary evidence, and argument as to why such action should or should not be taken.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Heirs" means heirs-at-law who are entitled under the statutes of intestate succession to property of a decedent and beneficiaries who are entitled to inherit the estate if there is a lawful will.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Lawfully residing" means permissive use by the owner/power of attorney at the law.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(10)">(10)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Lien" means a claim, encumbrance or charge against the Medicaid Member's real or personal property on account of medical assistance paid to the Member correctly under the State Plan. A Lien may be placed on the real property of a Member who is an inpatient of a nursing facility, intermediate care facility for the mentally retarded, or other institution or a Lien may be placed on both real and personal property of a Member after the Member's death.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(11)">(11)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Long-term care" means a service provided in a long-term care facility or in the home, under federally approved home and community based services, as an alternative to institutionalization.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(12)">(12)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Medical assistance" means payment by the State's program under Title XIX of the Social Security Act or Medicaid program, administered by the Department.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(13)">(13)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Member" means a person who has been certified as Medicaid eligible, pursuant to the terms of the State Plan, to have medical assistance paid on his or her behalf.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(14)">(14)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Member's home" means true, fixed and permanent home and principal establishment to which, whenever absent, the Member has the intention of returning to his or her domicile.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(15)">(15)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Permanently institutionalized" means residing in a nursing facility or intermediate care facility for the mentally retarded and developmentally disabled for six (6) consecutive months or more.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(16)">(16)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Personal representative" means an executor, administrator, guardian, conservator, committee, trustee, fiduciary, or other person having a status which by operation of law or written instrument confers upon such person a duty of distributing property to Heirs.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(17)">(17)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "On a continuous basis" means that the qualifying relative lived with the Member in the Member's home as his or her principal place of residence during an uninterrupted timeframe.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(18)">(18)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Residing in the home for at least one or two years" means the principal place of residence.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.02(19)">(19)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "State Plan" means all documentation submitted by the Commissioner, on behalf of the Department, to and for approval by the Secretary of Health and Human Services pursuant to Title XIX of the federal Social Security Act of 1935, as amended.</td> </tr> </table> <h2><a href="/GAC/111-3-8-.03" name="111-3-8-.03" title="111-3-8-.03">Rule 111-3-8-.03 Notification to Member or Their Heirs</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If a debt is due under this section from the estate of a Member, the administrator of the nursing facility, intermediate care facility for persons with mental retardation, or mental health institute in which the Member resided at the time of his/her death, the Medicaid case manager for community based services and/or the personal representative, if applicable, shall report the death to the Department within thirty (30) days of the death of the Member.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the personal representative of an estate makes a distribution either in whole or in part of the property of an estate to the Heirs, next of kin, distributes, legatees, or devisees without having executed the obligations pursuant to this section, the personal representative may be held personally liable for the amount of medical assistance paid on behalf of the Member, for the full value of the property belonging to the estate which may have been in the custody or control of the personal representative.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> When the Department receives notification of an affected Medicaid Member's death, a written notice will be provided to any known personal representative and any known Heirs which: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Explains the terms and conditions of estate recovery and refers to the applicable statute and regulations;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Advises of the Department's intent to recover the value of Medicaid benefits correctly paid on the Member's behalf from the Member's estate and states the amount;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Explains that the Department's recovery action may include filing a lien on real property when recovery is delayed;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Explains that the Heirs may file an undue hardship waiver and the procedures and time frames for filing the waiver;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Advises the Heirs of their right to a hearing and the method by which they may obtain a hearing;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.03(3)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Includes a statement advising the amount of the claim may increase if there are additional Medicaid claims that have not yet been processed.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/111-3-8-.04" name="111-3-8-.04" title="111-3-8-.04">Rule 111-3-8-.04 Recovery for Payments Made on Behalf of Medicaid-Eligible Persons</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> These regulations shall be construed and applied to further the intent of the Legislature to supplement Medicaid funds that are used to provide medical services to eligible persons. Estate recovery shall be accomplished by the Department or its agent filing a statement of claim against the estate of a deceased Medicaid Member. Recovery shall be made pursuant to federal authority in § 13612 of the Omnibus Budget Reconciliation Act of 1993 which amends § 1917(b)(1) of the Social Security Act, <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1396&amp;title=42#" target="_newtab">42 U.S.C. 1396</a> p(b)(1).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Adjustment or recovery for all medical assistance and/or services pursuant to the State Plan will be from Medicaid Members: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Who at the time of death were any age and an inpatient in a nursing facility, intermediate care facility for the mentally retarded, or other mental institution if the Member is required, as a condition of receiving services in the facility under the State Plan, to spend for costs of medical care all but a minimal amount of the person's income required for personal needs; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Who at the time of death were fifty-five (55) years of age or older when the Member received medical assistance, but only for medical services consisting of nursing facility services, personal care services, home and community based services, and hospital and prescription drug services provided to Members in nursing facilities or receiving home and community based services.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department shall provide written notice of the Estate Recovery program to Members at the time of application for medical assistance and at the annual redetermination. Members currently receiving medical assistance prior to the Estate Recovery program's effective date set forth in Paragraph (17) of this Rule will be notified at his or her annual redetermination.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The acceptance of public medical assistance, as defined by Title XIX of the Social Security Act, including mandatory and optional supplemental payments under the Social Security Act, shall create a debt to the agency in the amount recoverable under the State Plan. Upon filing a statement of claim in the probate proceeding, the Department shall be given priority status.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department may amend the claim as a matter of right until the Member's estate has been closed.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department's provider processing reports shall be admissible as prima facie evidence in substantiating the agency's claim.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any trust provision that denies recovery for medical assistance is void on and after the time of its making.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Adjustment or recovery of debt will be made only after the death of the Member's surviving spouse, if any, and only at a time when the Member has no surviving child who is under the age 21, or a child who is blind or permanently and totally disabled pursuant to the eligibility requirements of Title XIX of the Social Security Act.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> With respect to a lien placed on the home of a permanently institutionalized Member, the Department will not seek adjustment or recovery of Medical assistance correctly paid on the behalf of the Member until the following persons are not residing in the Member's home: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(9)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A sibling of the Member who was residing in the Member's home for at least one (1) year on a continuous basis immediately before the date that the Member was institutionalized; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(9)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A child of the Member who was residing in the Member's home for at least two (2) years on a continuous basis before the date that the Member was institutionalized and who has established to the satisfaction of the Department that he or she provided care that permitted the Member to reside at home rather than to become institutionalized.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(10)">(10)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The sibling or child of the Member must demonstrate that he or she has been lawfully residing in the Member's home on a continuous basis for the periods described in Paragraphs (9)(a) and (b) respectively, since the date of the Member's admission to the medical institution, and must provide the Department with clear and convincing evidence to prove residency which may include, but not be limited to, receipts, mortgage statements, bills, mail forwarded to Member's address, or voter's registration. The sibling or child of the Member must demonstrate that he or she did not reside in any other residence except the Member's home during the periods of time set forth in Paragraphs (9)(a) and (b) respectively. The sibling or child shall maintain the burden of proof in all proceedings.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(11)">(11)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No debt under this section shall be enforced against any property that is determined to be exempt from the claims of creditors under the constitution or laws of this state.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(12)">(12)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department may delay or waive recovery from an estate if doing so would cause undue hardship for the qualified Heirs, as defined in Rule <a title="111-3-8-.08" href="111-3-8-.08">111-3-8-.08</a>. The personal representative of an estate and any Heir may request that the agency waive recovery.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(13)">(13)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The state's right to full reimbursement of the costs of medical assistance shall not be diminished by the recovery of any judgment, settlement, or award of an amount less than the value of the original or settled claim. To enforce its rights, the state may intervene or join in any action or proceeding brought by a claimant against a third person. To aid in the recovery of the cost of medical assistance, the state shall have a first lien in the full amount of the costs of medical assistance against the proceeds from all damages awarded in a suit or settlement.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(14)">(14)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Transfers of real or personal property, on or after the look-back dates defined in <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1396&amp;title=42#" target="_newtab">42 U.S.C. § 1396</a> p, by a Member of such aid, or by their spouse, without adequate consideration are voidable and may be set aside by an action in court.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(15)">(15)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Counsel fees, costs, or other expenses shall not reduce any third party recovery obtained by the state incurred by the Member or the Member's attorney.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(16)">(16)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If, after the reported death of the Member, the Department is prohibited because of exception conditions, the Department may postpone recovery until all exception conditions are no longer present. An estate does not have to be open in order for the Department to execute its claim after all exception conditions are no longer present. Termination of recovery will occur when all real and personal property included as part of the Member's estate is no longer accessible.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.04(17)">(17)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The effective date of the Medicaid Estate Recovery Program is May 3, 2006. Adjustment or recovery shall apply to those costs associated with medical assistance and/or services a Member received on or after the effective date.</td> </tr> </table> <h2><a href="/GAC/111-3-8-.05" name="111-3-8-.05" title="111-3-8-.05">Rule 111-3-8-.05 Recovery of Assistance; Probate</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> After receipt of notice of the death of an affected Member, the Department will file a claim against the estate for the full value of the Medicaid benefits paid on behalf of the Member.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No action to recover a debt due by the deceased Member shall be commenced against the personal representative until the expiration of six (6) months from the date of qualification of the first personal representative to serve.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding any other law, a claim filed for recovery of Medicaid assistance has priority in order of payment from the estate over all other claims, except the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Years support for the family;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Funeral expenses in an amount not to exceed five thousand dollars ($5,000). However, this amount is zero (0) if the deceased Member has prepaid funeral expenses that were excluded as a resource for Medicaid eligibility;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Necessary expenses of administration;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Reasonable expenses of the deceased Member's last illness;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(3)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Unpaid taxes or other debts due the state or the United States. The category of Medicaid Estate Recovery is a debt due the state.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The affidavit of a person designated by the Commissioner to administer this action is prima facie evidence of the amount of the claim.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding any statute of limitations or other claim presentation deadline provided by law, a state claim against an estate is not barred for lack of timely presentation if it is presented in the probate proceeding within the time specified in the published notice to creditors.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.05(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The personal representative must notify the Department of the Member's death before dispersing assets of the Member. The personal representative is personally liable for any incorrectly paid assets if the Department is not informed of the Member's death and assets are distributed to Heirs and/or creditors.</td> </tr> </table> <h2><a href="/GAC/111-3-8-.06" name="111-3-8-.06" title="111-3-8-.06">Rule 111-3-8-.06 Recovery of Assistance; No Estate</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The administrator of the program may present an affidavit to a financial institution requesting that the financial institution release account proceeds to recover the cost of services correctly provided to a Member. The affidavit shall include the following information: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The name of the deceased Member;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The name of any person who gave notice that the Member was a Medicaid Member and that person's relationship to the deceased Member;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The name of the financial institution;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The account number;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the claim for estate recovery;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(1)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The amount of funds to be recovered.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A financial institution shall release account proceeds to the administrator of the program if all of the following conditions apply; <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The deceased Member held an account at the financial institution that was in his or her name only;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No estate has been, and it is reasonable to assume that no estate will be, opened for the deceased Member;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The deceased Member has no outstanding debts known to the administrator of the program;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The financial institution has received no objections or has determined that no valid objections to release proceeds have been received.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.06(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If proceeds have been released pursuant to this section and the Department receives notice of a valid claim to the proceeds that has a higher priority under O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=53-7-40&amp;title=53#" target="_newtab">53-7-40</a> than the claim of this section, the Department may refund the proceeds to the financial institution or pay them to the person or government entity with the claim.</td> </tr> </table> <h2><a href="/GAC/111-3-8-.07" name="111-3-8-.07" title="111-3-8-.07">Rule 111-3-8-.07 Imposition of Liens</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The basis for authority to impose liens is based on the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). The TEFRA lien law provides that the agency can place a Lien on the available real estate of a Member who enters a nursing home and is "permanently institutionalized."</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The state may place a Lien on the Member's home when there is not a reasonable expectation that the Member will return home and when none of the following persons are living in the home: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Member's spouse;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A child under twenty-one (21) years of age;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A disabled child of any age; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A sibling with an equity interest in the home who has lived in the home for at least one (1) year before the Member entered the nursing home, and is lawfully residing in such home. The sibling must provide the State with clear and convincing evidence which demonstrates residency on a continuous basis and the sibling's equity interest. Additionally, the sibling must demonstrate that he or she did not reside in any other residence except the Member's home during the period of time specified in this subparagraph (2)(d). The sibling has the burden of proof in all proceedings.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Liens may be imposed to protect recovery of benefits correctly paid to Medicaid Members when permitted by federal and state law. However, the use of lien authority requires prior notification to the Member or any known Heirs.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department shall notify the Member and the authorized representative, if applicable, of its determination that the Member is permanently institutionalized and not reasonably expected to return home and its intent to file a Lien on Member's real property. Notice must include an explanation of liens and their effect on a Member's ownership of real property. A Lien may not be filed less than thirty-one (31) days from the date of the notice to the Member and after any hearing process has been completed, if a hearing is requested.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A Member or his or her authorized representative may, within thirty (30) days after receipt of notice request an administrative hearing under this Rule <a title="111-3-8-.07" href="111-3-8-.07">111-3-8-.07</a>. A Member is deemed to have received notice within five (5) days from the date of the notice. Administrative hearings and appeals for Medicaid Members are governed by the procedures and time limits set forth in <a href="https://links.casemakerlegal.com/states/us/books/Code_of_Federal_Regulations/browse?ci=25&amp;id=gasos&amp;codesec=431.200&amp;title=42&amp;getbrowsepage=yes#" target="_newtab">42 C.F.R. § 431.200</a><I>et seq.</I> Only one (1) appeal shall be afforded on behalf of a Member, for each notice received. The administrative law judge shall make the determination if a Member can or cannot reasonably be expected to be discharged from the medical institution and returned home or if a specific exception set forth in <a title="111-3-8-.07(2)" href="111-3-8-.07#111-3-8-.07(2)">111-3-8-.07(2)</a> applies.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department or its agent shall file a notice of Lien with the recorder of the county in which the real property subject to the Lien is located. The notice shall be filed prior to the Member's death and shall include the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(6)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Name and place of residence of the real property subject to the Lien; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(6)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Legal description of the real property subject to the Lien.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department shall file one (1) copy of the notice of Lien with the local DFCS office in the county in which the real property is located. The county in which the real property is located shall retain a copy of the notice with the county office's records. The Department or its agent shall provide one (1) copy of the notice of Lien to the Member and the Member's authorized representative, if applicable, whose real property is affected.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Lien continues from the date of filing until the Lien is satisfied, released or expires. From the date on which the notice of Lien is recorded in the office of the county recorder, the notice of lien: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(8)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Constitutes due notice against the Member or Member's estate for any amount then recoverable under this article; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(8)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Gives a specific Lien in favor of the Department on the Medicaid Member's interest in the real property.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.07(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department has the authority to release any Lien placed upon the property of a Member deemed permanently institutionalized should that Member be subject to a Discharge from a medical institution and return home. The Department shall release a lien obtained under this rule within thirty (30) days after the Department receives notice that the Member is no longer institutionalized and is living in his or her home. If the real property subject to the lien is sold, the office shall release its lien at the closing and the lien shall attach to the net proceeds of the sale.</td> </tr> </table> <h2><a href="/GAC/111-3-8-.08" name="111-3-8-.08" title="111-3-8-.08">Rule 111-3-8-.08 Hardship Waiver</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Hardship waivers will be submitted to the program administrator for review. The denial of a hardship waiver may be appealed as provided under the Administrative Procedures Act, O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=50-13-1&amp;title=50&amp;getbrowsepage=yes#" target="_newtab">50-13-1</a> et. seq. The waiver is limited to the period in which the undue hardship exists.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> There is no hardship waiver provided at the time of lien placement against the real property of a deceased Medicaid Member. The equity interest of the heir will be considered to determine the percentage of the deceased member's interest in the property.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Lien placement is utilized to delay recovery until such time as an exemption to recovery does not exist, or in the case of a hardship, until such time as the hardship no longer exists. The state's lien would be for the Medicaid benefits paid on behalf of the Member or the percentage of interest of the deceased Member at the time of sale, whichever is less.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Recovery will be waived in whole or in part pursuant to Rule <a title="111-3-8-.08(1)" href="111-3-8-.08#111-3-8-.08(1)">111-3-8-.08(1)</a> of any estate or lien recovery when the requesting party is able to show, through clear and convincing evidence, that the state's pursuit of recovery subjects them to undue hardship. In determining whether an undue hardship exists, the following criteria will be used: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The asset to be recovered is a income producing farm of one or more of the Heirs and the annual gross income is limited to $25,000 or less; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The recovery of assets would result in the applicant becoming eligible for governmental public assistance based on need and/or medical assistance programs.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Nothwithstanding the provisions of Paragraph (4) of this Rule, an undue hardship exists when it would not be cost effective for the Department to recover the assistance paid. Estates valued at $25,000 or less are exempt from estate recovery because it is not cost effective for the Department to pursue recovery. In this instance, undue hardship does not need to be asserted.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Undue hardship does not exist when: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(6)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The adjustment or recovery of the Member's cost of assistance would merely cause the Member's family members inconvenience or restrict the family's lifestyle;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(6)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Member and/or the Heirs divest assets to qualify under the hardship provision.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> To the extent that there is any conflict between the preceding criteria and the standards that may be specified by the secretary of the Department of Health and Human Services, the federal standards shall prevail.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The personal representative and/or Heirs shall apply for an undue hardship exemption by: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(8)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Making a written request to the Department within thirty (30) days of receipt of the notice.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(8)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Verifying to the Department's satisfaction the criteria specified in this section for an undue hardship waiver.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Department shall issue a decision on an undue hardship exemption request within thirty (30) days of receipt of the request and supporting documentation;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(10)">(10)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the state denies the personal representative's request for an undue hardship waiver, the personal representative may request an appeal. The denial of a waiver must state the requirements of an application for an adjudicative proceeding to contest the Department's decision to deny the waiver and where assistance may be obtained to make such application.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(11)">(11)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If an appeal is requested, a hearing shall be conducted by the probate judge if the estate is in probate court. An administrative law judge shall conduct the administrative hearing if the case is not in probate court.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(12)">(12)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the Department deems a hardship does exist, the state may waive recovery or defer recovery until the death of eligible exempt dependents, on the sole discretion of the Department.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="111-3-8-.08(13)">(13)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The provisions of this section are severable. If any provision of this section is held invalid, the remaining provisions remain in effect.</td> </tr> </table> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/111-3-8-.01" name="111-3-8-.01" title="111-3-8-.01">Rule 111-3-8-.01 Legal Authority</a></li><li><a href="/GAC/111-3-8-.02" name="111-3-8-.02" title="111-3-8-.02">Rule 111-3-8-.02 Definitions</a></li><li><a href="/GAC/111-3-8-.03" name="111-3-8-.03" title="111-3-8-.03">Rule 111-3-8-.03 Notification to Member or Their Heirs</a></li><li><a href="/GAC/111-3-8-.04" name="111-3-8-.04" title="111-3-8-.04">Rule 111-3-8-.04 Recovery for Payments Made on Behalf of Medicaid-Eligible Persons</a></li><li><a href="/GAC/111-3-8-.05" name="111-3-8-.05" title="111-3-8-.05">Rule 111-3-8-.05 Recovery of Assistance; Probate</a></li><li><a href="/GAC/111-3-8-.06" name="111-3-8-.06" title="111-3-8-.06">Rule 111-3-8-.06 Recovery of Assistance; No Estate</a></li><li><a href="/GAC/111-3-8-.07" name="111-3-8-.07" title="111-3-8-.07">Rule 111-3-8-.07 Imposition of Liens</a></li><li><a href="/GAC/111-3-8-.08" name="111-3-8-.08" title="111-3-8-.08">Rule 111-3-8-.08 Hardship Waiver</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 2020 Lawriter LLC - All rights reserved.</span>| <a href="mailto:support@casemakerlegal.com?subject=Rules and Regulations of the State of Georgia">Email Us</a> | 844-838-0769 | <a href="http://livechat.casemakerlegal.com/client.php?locale=en" target="_blank" onclick="if(navigator.userAgent.toLowerCase().indexOf('opera') != -1 && window.event.preventDefault)window.event.preventDefault();this.newWindow = window.open('http://livechat.casemakerlegal.com/client.php?locale=en&url='+escape(document.location.href)+'&referrer='+escape(document.referrer), 'webim','toolbar=0,scrollbars=0,location=0,status=1,menubar=0,width=640,height=480,resizable=1');this.newWindow.focus();this.newWindow.opener=window;return false;">Live Chat</a> </div> </div> </body> </html>