Case Summary: NC Medicaid Estate Recovery



State of North Carolina Dept. of Health and Human Services v. Thompkins
205 N. C. App. 285 (2010)

North Carolina Court of Appeals

Background

The North Carolina Department of Health and Human Services, Division of Medical Assistance(DHHS) filed a complaint against defendant, Anna Marie Thompkins (Thompkins), in her capacity as Executrix of the estate of Sallie Dye Anthony (Anthony). DHHS sought recovery of the $52,575.14 in nursing home and hospital services that DHHS furnished to Ms. Anthony.

Procedural History

DHHS filed a complaint against Thompkins alleging that medical services received by Ms. Anthony under the Medicaid program subjected her estate to the State’s recovery plan, in order to cover the costs of those services. The Guilford County Superior Court granted summary judgment in favor of DHHS, and it is from that order that Thompkins appealed.

Facts

Ms. Anthony, prior to her death, accrued $52,575.14 in Medicaid benefits for her nursing home and hospital expenses. DHHS sought reimbursement for these expenses from the estate of Ms. Anthony. The particular property that Ms. Anthony owned at the time of her death was sold by her devisees for $110,000.00, over three years after her death, and the devisees also retained the proceeds. DHHS then initiated this lawsuit to recover the entire amount it paid on Ms. Anthony’s behalf from the executrix of Ms. Anthony’s estate, Thompkins.

Governing Law

The Estate Recovery Plan of North Carolina is codified in N.C.G.S. § 108A-70.5 and provides the State with the ability to recover from the estates of recipients an equitable amount of the costs paid on behalf of the recipient. Essentially, this law allows the State to recover against the probate estate of a person who received Medicaid payments during his or her lifetime, but who may have estate property which could satisfy the debt. In this way, the State acts like a creditor against the estate. In order to qualify for Medicaid initially, most assets must be exhausted, so that the only property usually owned by a Medicaid recipient at the time of their death is their home. N.C.G.S § 108A-70.5 further provides that the amount that the State may recover from the estate cannot exceed the amount of medical assistance that was paid for on behalf of the recipient.

Thus, in North Carolina, DHHS has the ability to pursue a claim against the estate for Medicaid benefits paid, and may seek such reimbursement from any of the property of the estate defined in the statute.

Conclusion

The Court of Appeals affirmed the order of the trial court, which granted summary judgment in favor of DHHS. In using the plain language of the statute, the executrix, who had notice of the impending claim by DHHS for Medicaid payments, should have secured that amount from the devisees when the property was sold.



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