MEDICAID ESTATE RECOVERIES.

SEC. 134112. MEDICAID ESTATE RECOVERIES. (a) Mandate To Seek Recovery.— Section 1917(b)(1) (42 U.S.C. 1396p(b)(1)) is amended by striking “except—” and all that follows and inserting the following: “except that the State shall seek adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan in the case of the following individuals: “(A) In the case of an individual described in subsection (a)(1)(B), the State shall seek adjustment or recovery from the individual’s estate or upon sale of the property subject to a lien imposed on account of medical assistance paid on behalf of the individual. “(B) In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of— “(i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or “(ii) at the option of the State, any items or services under the State plan. 107 STAT. 628 “(C) (i) In the case of an individual who has received (or is entitled to receive) benefits under a long-term care insurance policy in connection with which assets or resources are disregarded in the manner described in clause (ii), except as provided in such clause, the State shall seek adjustment or recovery from the individual’s estate on account of medical assistance paid on behalf of the individual for nursing facility and other long-term care services. “(ii) Clause (i) shall not apply in the case of an individual who received medical assistance under a State plan of a State which had a State plan amendment approved as of May 14, 1993, which provided for the disregard of any assets or resources— “(I) to the extent that payments are made under a long-term care insurance policy; or “(II) because an individual has received (or is entitled to receive) benefits under a long-term care insurance policy.”. (b) Hardship Waiver.— Section 1917(b) (42 U.S.C. 1396p(b)) is amended by adding at the end the following new paragraph: “(3) The State agency shall establish procedures (in accordance with standards specified by the Secretary) under which the agency shall waive the application of this subsection (other than paragraph (1)(C)) if such application would work an undue hardship as determined on the basis of criteria established by the Secretary.”. (c) Definition of Estate.— Section 1917(b) (42 U.S.C. 1396p(b)), as amended by subsection (b), is amended by adding at the end the following new paragraph: “(4) For purposes of this subsection, the term ‘estate’, with respect to a deceased individual— “(A) shall include all real and personal property and other assets included within the individual’s estate, as defined for purposes of State probate law; and “(B) may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (1)(C)(i) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.”. (d) Effective Dates.— (1) (A) Except as provided in subparagraph (B), the amendments made by this section shall apply to payments under title XIX of the Social Security Act for calendar quarters beginning on or after October 1, 1993, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. (B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements imposed by such amendments solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature 107 STAT. 629that begins after the date of the enactment of this Act. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature. (2) The amendments made by this section shall not apply to individuals who died before October 1, 1993.