“Straight from the horse’s mouth – Department of Healthcare Services”
What is Estate Recovery?
The Medi-Cal program must seek repayment from the estates of certain deceased Medi-Cal members. Repayment only applies to benefits received by these members on or after their 55th birthday and who own assets at the time of death. If a deceased member owns nothing when they die, nothing will be owed.
For Medi-Cal members who died on or after January 1, 2017: (See Changes to Estate Recovery effective January 1, 2017 due to Legislation SB 833)
- Repayment will be limited only to estate assets subject to probate that were owned by the deceased member at the time of death.
- Repayment will be limited to payments made, including managed care premiums paid, for nursing facility services, home and community based services, and related hospital and prescription drug services received when the member was an inpatient in a nursing facility or received home and community based services.
For Medi-Cal members who died prior to January 1, 2017:
- Repayment will be sought from all assets owned by the deceased member at the time of death.
- Repayment will be owed for payments made for most services received and/or monthly managed care premiums paid on behalf of the Medi-Cal member.
Submitting Notice of Death
If you are the person handling the affairs of the deceased Medi-Cal member, you must provide “Notice of Death” to the Director of DHCS within 90 days of the date of death with a copy of the death certificate. To satisfy the “Notice of Death” requirement and for fastest processing, complete and submit online the “Notice of Death” form with a copy of the death certificate. You may also mail “Notice of Death” with a copy of the death certificate to DHCS at: Department of Health Care Services, Estate Recovery Section, MS 4720, P.O. Box 997425, Sacramento, CA 95899-7425.
Specific limitations or exemptions may apply. The Department of Health Care Services (DHCS) may waive its claim if payment of the claim would cause a substantial hardship. Any request for a substantial hardship waiver must be submitted to DHCS within 60 days of the date on the DHCS Estate Recovery claim letter.
Certain income and resources of American Indians and Alaska Natives are exempt from Estate Recovery. Please be sure to inform DHCS if the decedent’s property is on or near a federally recognized reservation, Pueblo, or Colony. A collection representative will contact you to clarify if DHCS can or cannot collect against these assets. For specific details on what assets are exempt from Estate Recovery please see the State Medicaid Manual, Section 3810 (7) and (8).
Pay a Claim
When you receive our claim amount and are ready to submit payment, we accept Electronic Fund Transfers (EFT) and checks. Regardless of which method you use to pay, you will need your DHCS Account Number to ensure payment is posted to the correct account.
- Email: ER@DHCS.CA.GOV
- Phone: (916) 650-0590
- Mailing Address for written correspondence:
Department of Health Care Services
Third Party Liability and Recovery Division
Estate Recovery Section – MS 47