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Health Insurance State Laws

State laws may provide additional rights and benefits to individuals coping with cancer. Various laws related to employment, disability insurancehealth insuranceCOVID-19accessing medical recordsestate-planningother cancer-related state laws, and immigration are included below. We also have a chart of state laws on creating a will that can be found here. Please note that this information changes frequently, so check back for up-to-date information.

This chart includes the state laws related to health insurance options.

StateHas a State Run Health Insurance Marketplace:States that re-opened Marketplaces for 2020 CoverageStates that Imposed Individual MandateState COBRA Law (covering employers with less than 20 employees):States Limiting Short-Term Health PlansProhibit the sale of Medigap policies to people under 65 with a disabilityRequire at least 1 Medigap policy for people under 65 with disabilityState High Risk Pool
ALABAMAxxhttps://www.alabamapolicy.org/research/health-insurance-risk-pools/
ALASKAxxhttp://www.achia.com/
ARIZONAx 18 monthsx
ARKANSASx 4 monthsxxhttp://www.arkleg.state.ar.us/healthcare/timeline/pages/HealthReformProvisions.aspx?nameHigh%20risk%20pools
CALIFORNIAxhttps://coveredca.comThrough June 30, 2020https://www.coveredca.com/Effective January 1, 2020https://www.ftb.ca.gov/about-ftb/newsroom/health-care-mandate/index.htmlx 36 monthshttps://www.dmhc.ca.gov/HealthCareinCalifornia/TypesofPlans/KeepYourHealthCoverage(COBRA).aspxForbids all planshttps://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB910xxhttp://www.dhcs.ca.gov/services/Pages/MajorRiskMedicalInsuranceProgram.aspx
COLORADOxhttps://connectforhealthco.com/3/20/20 through 4/30/20https://connectforhealthco.com/get-started/covid-19-support/x 18 monthshttps://www.colorado.gov/pacific/dhr/cobraSignificantly restricts plans; no insurers offer planshttps://www.sos.state.co.us/CCR/eDocketDetails.do?trackingNum=2018-00596xxhttps://www.coloradohealthinstitute.org/research/colorados-high-risk-pool
CONNECTICUTxhttps://www.accesshealthct.com/AHCT/LandingPageCTHIX3/19/20 through 4/17/20https://agency.accesshealthct.com/access-health-ct-announces-a-new-special-enrollment-period-for-uninsured-connecticut-residentsx 30 monthshttps://portal.ct.gov/-/media/CID/30MonthContinuationFactSheetpdf.pdf?la=enForbids all planshttps://law.justia.com/codes/connecticut/2013/title-38a/chapter-700c/section-38a-476/xxhttps://www.cga.ct.gov/2004/rpt/2004-R-0692.htm
DELAWAREx 9 monthshttps://insurance.delaware.gov/wp-content/uploads/sites/15/2017/01/DomesticForeignInsurersBulletinNo51AMENDED.pdfLimits plans to 3 monthshttps://regulations.delaware.gov/register/january2019/final/22%20DE%20Reg%20607%2001-01-19.htmx
*DISTRICT OF COLUMBIAxhttps://dchealthlink.com/No deadline set as of 5/18/20https://dchealthlink.com/individualsEffective June 30, 2020https://mytax.dc.gov/_/x 3 monthshttps://code.dccouncil.us/dc/council/code/sections/32-732.htmlLimits plans to 3 months and no renewalshttp://lims.dccouncil.us/Legislation/B22-1001?FromSearchResults=true
FLORIDAx 18 monthshttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.6692.htmlxxhttp://www.statecoverage.org/coverage/florida.html
GEORGIAx 3 monthshttps://www.oci.ga.gov/PublicInformation/Alert.aspx?DI=257x
HAWAIIx 3 monthshttps://labor.hawaii.gov/dcd/files/2013/01/PHC-highlights.pdfLimits plans to 3 months; no insurers offer planshttps://www.capitol.hawaii.gov/session2018/bills/HB1520_CD1_.HTMx
IDAHOxhttps://www.yourhealthidaho.org/Renewals required for “enhanced” short-term plans; non-enhanced short-term plans limited to 6 monthshttps://doi.idaho.gov/publicinformation/laws/Rulemakingxxhttps://doi.idaho.gov/displaypdf?catConsumer&idHigh%20Risk%20Pool%20Plan
ILLINOISx 12 monthshttp://insurance.illinois.gov/healthInsurance/continuationRights.pdfLimits plans to 6 monthshttp://www.ilga.gov/legislation/100/HB/10000HB2624sam003.htmxxhttp://www.chip.state.il.us/index.html
INDIANAxxhttps://www.in.gov/idoi/2570.htm
IOWAx 9 monthshttps://das.iowa.gov/sites/default/files/hr/benefits/documents/COBRA.Continuation.Rights.Ltr.pdfxxhttps://www.hipiowa.com/
KANSASx 18 monthshttps://www.ksrevisor.org/statutes/chapters/ch40/040_022_0009.htmlOnly one renewal permittedhttps://codes.findlaw.com/ks/chapter-40-insurance/ks-st-sect-40-2-193.htmlxxhttps://www.ksinsurance.org
KENTUCKYx (uses HealthCare.gov for enrollment)https://healthbenefitexchange.ky.gov/Pages/index.aspxx 18 monthshttp://insurance.ky.gov/ppc/Documents/statecontinuationcoverage012612.pdfx
LOUISIANAx 12 monthshttps://www.bbgulfstates.com/wp-content/uploads/2016/12/10419-Louisiana-COBRA-Chart-091316.pdfLimits plans to 6 months (only if the insurer looks back more than 12 months to determine pre-existing conditions)http://www.ldi.la.gov/docs/default-source/documents/legaldocs/title-22/title-22.pdf?sfvrsn=53dd4b52_6xxhttp://www.lahealthplan.org
MAINEx 12 monthshttps://www.maine.gov/pfr/insurance/faq/cobra_faqs.htmlNo insurers offer plans due to 2020 restrictionshttps://legislature.maine.gov/legis/bills/bills_129th/billtexts/HP092101.aspx
MARYLANDxhttps://www.marylandhealthconnection.gov/3/16/20 through 6/15/20https://www.marylandhealthconnection.gov/coronavirus-sep/x 18 monthshttps://insurance.maryland.gov/Insurer/Documents/bulletins/bulletinlh08-13continuationcoverage.pdfLimits plans to 3 months; no renewalshttps://legiscan.com/MD/bill/HB1782/2018xxhttps://www.healthinsurance.org/maryland/
MASSACHUSETTSxhttps://mahealthconnector.optum.com/individual/Through 5/25/20https://mahealthconnector.optum.com/individual/Has been effective since 2006https://www.mass.gov/info-details/health-care-reform-for-individualsx 18-36 monthshttps://www.mass.gov/service-details/minicobra-continuation-of-coverage-benefits-guideForbids all plansx
MICHIGANLimits plans to 185 days; no renewalshttps://www.legislature.mi.gov/(S(2ceb024oir24qnxnfoavw02t))/mileg.aspx?page=getObject&objectName=mcl-500-2213bx
MINNESOTAxhttps://www.mnsure.org/x 18-36 monthshttps://mn.gov/mmb/segip/notices/cobra-policy.jspLimits plans to 185 days; no renewalshttps://www.revisor.mn.gov/statutes/cite/62a.65xxhttps://mchamn.com
MISSISSIPPIx 12 monthshttp://www.dfa.ms.gov/dfa-offices/human-resources/explanation-of-benefits/cobra/x
MISSOURIx 18-36 monthshttps://insurance.mo.gov/consumers/smallbusiness/health.phpLimits plans to 6 monthshttps://trackbill.com/bill/missouri-senate-bill-103-modifies-provisions-relating-to-health-care-services/1608158/xxhttp://www.mhip.org
MONTANAxxhttps://www.mthealth.org
NEBRASKAx 6-12 monthshttp://das.nebraska.gov/Benefits/Cobra_Retiree.htmlx
NEVADA3/17/20 though 5/15/20https://www.nevadahealthlink.com/coronavirus/x 3-12 monthshttps://www.leg.state.nv.us/NRS/NRS-689B.htmlLimits plans to 185 days and no renewalshttps://www.leg.state.nv.us/NAC/NAC-689A.html#NAC689ASec434x
NEW HAMPSHIREx 18-36 monthshttps://www.nh.gov/insurance/consumers/documents/nh-state-cont.pdfLimits plans to 6 months and no renewalshttps://law.justia.com/codes/new-hampshire/2015/title-xxxvii/chapter-415/section-415-5/xxhttps://www.nhhp.org/nhhp/
NEW JERSEYEffective March 31, 2020https://www.njleg.state.nj.us/2018/Bills/PL18/31_.PDFx 18-36 monthshttps://www.state.nj.us/dobi/division_insurance/ihcseh/bulletins/sehblt07_02.pdfForbids all planshttps://law.justia.com/codes/new-jersey/2009/title-17b/17b-27a/17b-27a-3/x
NEW MEXICOx 6 monthshttps://law.justia.com/codes/new-mexico/2011/chapter59A/article18/section59A-18-16/Limits plans to 3 months and no renewals; no insurers offer planshttps://legiscan.com/NM/bill/HB285/2019xxhttps://nmmip.org/
NEW YORKxhttps://nystateofhealth.ny.gov/3/16/20 through 6/15/20https://nystateofhealth.ny.gov/x 36 monthshttps://www.dfs.ny.gov/consumers/health_insurance/cobra_and_premium_assistanceForbids all planshttps://www.dfs.ny.gov/insurance/circltr/2018/cl2018_07.htmx
NORTH CAROLINAx 18 monthshttps://www.ncdoi.com/_Publications/What Happens to my Coverage if my Job Status Changes State Continuation_CBU1_CHE1_SmPU.pdfxxhttp://www.individualhealthinsurancenc.com/inclusive-health-north-carolina-health-insurance-risk-pool/
NORTH DAKOTAx 39 weeks-36 monthsLimits plans to 185 dayshttps://www.legis.nd.gov/assembly/66-2019/documents/19-8020-01000.pdfxxhttp://www.chand.org/
OHIOx 12 monthshttps://insurance.ohio.gov/wps/portal/gov/odi/about-us/divisions/consumer-services/health/cobra-informationRenewals not permittedhttps://iop-odi-content.s3.amazonaws.com/static/Legal/Bulletins/Documents/2018-05.pdfx
OKLAHOMAx 63 days-6 monthshttps://apps.ok.gov/oid/Consumers/Buying_Insurance/COBRA_Information.htmlxxhttps://apps.ok.gov/oid/Consumers/Buying_Insurance/Oklahoma_Health_Insurance_High_Risk_Pool_Information.html
OREGONx 9 monthshttps://dfr.oregon.gov/insure/health/understand/coverage/Pages/state-continuation.aspxLimits plans to 90 dayshttps://www.oregonlaws.org/ors/743B.005x
PENNSYLVANIAx 9 monthshttps://www.insurance.pa.gov/Coverage/Documents/Health/PA Mini COBRA Update Final 03272015.pdfx
*PUERTO RICO
RHODE ISLANDxhttps://healthsourceri.com/Through 4/15/20https://healthsourceri.com/coverage-through-healthsource-ri/Effective January 1, 2020http://www.tax.ri.gov/healthcoveragemandate/index.phpx 18 monthshttp://www.dbr.ri.gov/documents/rules/insurance/InsuranceRegulation82.pdfSignificantly restricts plans; no insurers offer planshhttp://webserver.rilin.state.ri.us/BillText/BillText18/SenateText18/S2931.pdfx
SOUTH CAROLINAx 6 monthshttps://www.doi.sc.gov/DocumentCenter/View/11353/2019-State-Continuationpdf11-month maximum initial term; 33-month maximum durationhttps://doi.sc.gov/DocumentCenter/View/11057/Bulletin-2018-08-Requirements-Applicable-to-Short-Term-Limited-Duration-Insurance-STLDI-Policies-Sold-in-South-Carolina?bidId=xxhttp://www.doi.sc.gov/703/South-Carolina-Health-Insurance-Pool
SOUTH DAKOTAx 12 monthshttps://dlr.sd.gov/insurance/cobra.aspxLimits plans to 6 monthshttps://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=StatuteChapter&Statute=58-17xxhttps://www.healthpoolsd.org
TENNESSEEx 3-15 monthshttps://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/cobra.pdfxxhttp://echealthinsurance.com/tennessee-health-insurance/public-assistance/accesstn/
TEXASx 9-42 monthshttps://www.tdi.texas.gov/hmo/documents/enrolleecobra.pdfx
UTAHx 12 monthshttps://insurance.utah.gov/consumer/health/extension-conversion-rights/extension363-day maximum initial term; no renewalshttps://le.utah.gov/xcode/Title31A/Chapter30/31A-30-S103.html?v=C31A-30-S103_2014040320140513xxhttp://www.statecoverage.org/coverage/utah.html
VERMONTxhttps://portal.healthconnect.vermont.gov/VTHBELand/welcome.actionEffective January 1, 2020https://info.healthconnect.vermont.gov/mandate_FAQx 18 monthshttps://humanresources.vermont.gov/benefits-wellness/cobraLimits plans to 3 months; no renewals; no insurers offer planshttps://dfr.vermont.gov/reg-bul-ord/short-term-limited-duration-health-insurancex
VIRGINIAx 12 monthshttps://law.lis.virginia.gov/vacode/title38.2/chapter35/section38.2-3541/x
WASHINGTONxhttps://www.wahealthplanfinder.org/3/18/20 through 5/8/20https://www.insurance.wa.gov/when-can-i-buy-individual-health-planLimits plans to 3 monthshttps://www.insurance.wa.gov/short-term-medical-plans-r-2018-01xxhttps://www.wship.org/
WEST VIRGINIAx 18 monthshttps://www.wvinsurance.gov/Portals/0/pdf/pol_leg/rules/ins/114-93 - Mini-COBRA - FINAL FILE - 3-20-12 - sy - CORRECTED NUMBERING - 8-15-12.pdf?ver=2012-08-15-145558-257xxhttps://www.wvinsurance.gov/accesswv/pdf/brochure.pdf
WISCONSINx 18 monthshttps://oci.wi.gov/Documents/Consumers/PI-023.pdfTotal duration limited to 18 monthshttps://docs.legis.wisconsin.gov/statutes/statutes/632/VI/7495xxhttp://www.hirsp.org
WYOMINGx 12 monthshttps://law.justia.com/codes/wyoming/2011/title26/chapter19/section26-19-113/xxhttp://doi.wyo.gov/consumers/bulletins-links/wyoming-health-insurance-pool
GUAM

This chart includes the state laws related to health insurance coverage and navigation.

StateOral Chemotherapy Parity Law*States with Step Therapy LawsClinical Trials Coverage LawLaws on Balance Billing (ER only or All care)Infertility CoverageFertility Preservation CoverageWho Runs External Appeals Process
ALABAMARun by HHShttps://externalappeal.cms.gov/ferpportal/
ALASKAxhttp://www.akleg.gov/basis/Bill/Detail/29?RootSB%20142xhttp://www.akleg.gov/PDF/29/Bills/SB0113A.PDFRun by State Agency https://www.commerce.alaska.gov/web/ins/Consumers/Health/ExternalHealthcareReview.aspx
ARIZONAxhttps://www.azleg.gov/legtext/51leg/2r/laws/0255.pdfxhttps://apps.azleg.gov/BillStatus/GetDocumentPdf/59648All carehttps://apps.azleg.gov/BillStatus/GetDocumentPdf/453367Run by State Agency https://insurance.az.gov/consumers/help-problem/filing-health-care-appeal
ARKANSASxhttp://www.arkleg.state.ar.us/assembly/2017/2017R/Bills/HB1592.pdfHas an Override Processhttps://www.arkleg.state.ar.us/Bills/Document?type=pdf&chamber=SB&source=Bills&bill=665&ddBienniumSession=2017%2F2017Rxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agency https://insurance.arkansas.gov/uploads/pages/er_faq2.pdf
CALIFORNIAxhttps://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id201320140AB219Some Legal Protectionshttp://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB374xhttp://www.leginfo.ca.gov/pub/01-02/bill/sen/sb_0001-0050/sb_37_bill_20010810_chaptered.htmlAll carehttps://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB600Run by State Agency http://www.insurance.ca.gov/01-consumers/150-other-prog/001-ahb/appeal-process.cfm
COLORADOxhttps://legiscan.com/CO/text/HB1202/2010Prohibits Step Therapyhttps://leg.colorado.gov/sites/default/files/2017a_203_signed.pdfxhttp://www.leg.state.co.us/clics/clics2009a/csl.nsf/fsbillcont/23DE7C72ECC7D6FF87257537001A369F?Open&file1059_enr.pdfAll carehttp://leg.colorado.gov/sites/default/files/2019a_1174_signed.pdfxhttps://leg.colorado.gov/sites/default/files/documents/2020A/bills/2020a_1158_enr.pdfRun by State Agencyhttps://drive.google.com/file/d/0BwguXutc4vbpMlZYWkxjWll2TGM/view
CONNECTICUTxhttps://law.justia.com/codes/connecticut/2012/title-38a/chapter-700c/section-38a-504Has an Override Processhttps://www.cga.ct.gov/2014/act/pa/2014PA-00118-R00SB-00394-PA.htmxhttps://www.cga.ct.gov/2001/act/Pa/2001PA-00171-R00SB-00325-PA.htmAll carehttps://www.cga.ct.gov/current/pub/chap_700c.htmxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://www.allianceforfertilitypreservation.org/state-legislation/connecticutRun by State Agencyhttps://portal.ct.gov/CID/Consumer-Affairs/How-To-Guides/How-and-When-to-File-an-External-Review
DELAWARExhttps://delcode.delaware.gov/title18/c033/sc01/index.shtmlHas an Override Processhttps://legiscan.com/DE/text/HB105/2019xhttps://legis.delaware.gov/BillDetail/11875ER onlyhttps://delcode.delaware.gov/title18/c033/sc01/index.shtmlxhttps://delcode.delaware.gov/title18/c035/sc03/index.shtmlxhttp://delcode.delaware.gov/title18/c033/sc01/index.shtmlRun by State Agencyhttps://insurance.delaware.gov/divisions/consumerhp/ihcap/
*DISTRICT OF COLUMBIAxxhttp://www.dccouncil.washington.dc.us/images/00001/20080314142746.pdfRun by State Agencyhttps://dhcf.dc.gov/publication/grievancesappeals-0
FLORIDAxhttp://www.flsenate.gov/Session/Bill/2013/301/BillText/c1/PDFSome Legal Protectionshttps://www.flsenate.gov/Session/Bill/2019/559/BillText/c1/PDFx Agreementhttp://www.bcbsfl.com/DocumentLibrary/Providers/Content/ClinicalTrial.pdfAll carehttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.64194.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
GEORGIAxhttp://www.legis.ga.gov/Legislation/20132014/144444.pdfHas an Override Processhttp://www.legis.ga.gov/Legislation/20192020/187554.pdfx Agreementhttp://www.legis.ga.gov/legis/2003_04/gacode/33-24-59.1.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
HAWAIIxhttps://law.justia.com/codes/hawaii/2013/title-24/chapter-432/Prohibits Step Therapy for Patients with Stage 2 Cancerhttps://www.capitol.hawaii.gov/session2020/bills/SB493_HD1_.HTMxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlLegislation Pendinghttp://www.allianceforfertilitypreservation.org/state-legislation/hawaiiRun by State Agencyhttps://cca.hawaii.gov/ins/external-review-of-health-plan-disputes/
IDAHORun by State Agencyhttps://doi.idaho.gov/Consumer/FAQ/ExternalReviewFAQ
ILLINOISxhttp://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID1249&ChapterID22Has an Override Processhttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099-0761xhttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name093-1000All carehttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=096-1523xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://www.ilga.gov/legislation/publicacts/100/PDF/100-1102.pdfRun by State Agencyhttp://insurance.illinois.gov/ExternalReview/ExternalReviewMain.html
INDIANAxHas an Override Processhttp://iga.in.gov/legislative/2016/bills/senate/41xhttp://www.in.gov/legislative/bills/2009/HE/HE1382.1.htmlAll care (effective July 1, 2020)http://iga.in.gov/legislative/2020/bills/house/1004Run by State Agencyhttps://www.in.gov/idoi/3008.htm
IOWAxhttps://www.legis.iowa.gov/legislation/BillBook?ga83&baSF%20478Has an Override Processhttps://www.legis.iowa.gov/docs/code/514F.7.pdfxhttps://www.legis.iowa.gov/legislation/BillBook?ga83&baHF2075ER onlyhttps://www.legis.iowa.gov/docs/code/514C.16.pdfRun by State Agencyhttps://iid.iowa.gov/external-review
KANSASxhttps://www.ksrevisor.org/statutes/chapters/ch40/040_002_0184.htmlSome Legal Protectionshttp://www.kslegislature.org/li_2016/b2015_16/measures/documents/sb402_enrolled.pdfxhttps://www.ksinsurance.org/documents/department/regulations-adopted/article-4/40-4-43.pdfRun by State Agencyhttps://www.ksinsurance.org/documents/department/publications/independent-medical-review.pdf
KENTUCKYxHas an Override Processhttps://apps.legislature.ky.gov/record/12RS/sb114.htmlxLegislation Pendinghttp://www.allianceforfertilitypreservation.org/state-legislation/kentuckyRun by State Agencyhttp://insurance.ky.gov/ppc/Documents/abdappeal071217.pdf
LOUISIANAxhttps://law.justia.com/codes/louisiana/2017/code-revisedstatutes/title-22/Has an Override Processhttps://law.justia.com/codes/louisiana/2018/code-revisedstatutes/title-22/rs-22-1053/xhttps://law.justia.com/codes/louisiana/2006/6/82801.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://www.ldi.la.gov/docs/default-source/documents/publicaffairs/consumerpublications/understanding-your-healthcare-rights.pdf?sfvrsn=45277652_22
MAINExhttp://www.mainelegislature.org/legis/bills/bills_126th/chapters/PUBLIC449.aspHas an Override Processhttp://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP0751&item=3&snum=129xhttp://www.mainelegislature.org/legis/statutes/24-A/title24-Ach56-A.pdfAll carehttp://legislature.maine.gov/legis/bills/bills_129th/billtexts/HP150101.aspRun by State Agencyhttps://www.maine.gov/pfr/insurance/consumer/individuals_families/health/complaints_appeals_externalreviews/external_reviews.html
MARYLANDxSome Legal Protectionshttps://law.justia.com/codes/maryland/2017/insurance/title-15/subtitle-1/section-15-142/xhttp://mgaleg.maryland.gov/webmga/frmMain.aspx?ys1998rs%2fbillfile%2fhb0045.htmAll carehttp://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg§ion=19-710&enactments=falsexhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttps://govt.westlaw.com/mdc/Document/NA2EF98008F6511E8B8BB8A4FADCC9053?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&bhcp=1Run by State Agencyhttps://insurance.maryland.gov/Consumer/Pages/AppealsAndGrievances.aspx
MASSACHUSETTSxhttps://malegislature.gov/Bills/187/S2363Has an Override Processhttps://malegislature.gov/Bills/191/HD1506.Htmlxhttps://malegislature.gov/Laws/SessionLaws/Acts/2002/Chapter257All carehttps://www.mass.gov/files/documents/2018/03/14/2015-ctr-out-of-network.pdfxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlLegislation Pendinghttps://malegislature.gov/Bills/191/SD1321Run by State Agencyhttps://www.mass.gov/request-an-external-review-of-a-health-insurance-decision
MICHIGANx AgreementRun by State Agencyhttps://difs.state.mi.us/Complaints/ExternalReview.aspx
MINNESOTAxhttps://legiscan.com/MN/text/HF2009/id/1196312Has an Override Processhttps://www.revisor.mn.gov/statutes/cite/62Q.184Non-ERhttps://www.revisor.mn.gov/statutes/cite/62Q.556xhttps://www.revisor.mn.gov/statutes/cite/256b.0625Run by State Agencyhttp://mn.gov/commerce-stat/pdfs/external-review-appeal.pdf
MISSISSIPPIxhttp://billstatus.ls.state.ms.us/documents/2015/html/HB/0900-0999/HB0952SG.htmHas an Override Processhttp://billstatus.ls.state.ms.us/documents/2011/pdf/SB/2700-2799/SB2737SG.pdfAll carehttps://legiscan.com/MS/text/HB374/id/734015/Mississippi-2013-HB374-Enrolled.htmlRun by State Agencyhttps://www.mid.ms.gov/healthcare/external-review.aspx
MISSOURIxhttps://legiscan.com/MO/text/SB668/id/983931Has an Override Processhttps://house.mo.gov/billtracking/bills161/billpdf/intro/HB2029I.PDFxhttp://www.senate.mo.gov/06info/pdf-bill/tat/SB567.pdfER onlyhttps://revisor.mo.gov/main/OneSection.aspx?section=376.690Legislation Pendinghttps://malegislature.gov/Bills/191/SD1321Run by State Agencyhttps://insurance.mo.gov/consumers/health/externalreviewprocess.php
MONTANAxhttps://legiscan.com/MT/text/SB55/2013ER onlyhttps://leg.mt.gov/bills/mca/title_0330/chapter_0020/part_0230/section_0020/0330-0020-0230-0020.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://csimt.gov/your-insurance/health/
NEBRASKAxx AgreementRun by State Agencyhttps://doi.nebraska.gov/sites/doi.nebraska.gov/files/doc/out13261.pdf
NEVADA xhttps://legiscan.com/NV/text/SB266/2013xhttps://www.leg.state.nv.us/73rd/bills/SB/SB29.pdfER onlyhttps://legiscan.com/NV/text/AB469/id/2017524/Nevada-2019-AB469-Enrolled.pdfRun by State Agencyhttp://dhhs.nv.gov/Programs/CHA/ExtRev/External_Review/
NEW HAMPSHIRExhttps://legiscan.com/NH/text/HB508/2015xhttp://www.gencourt.state.nh.us/legislation/2000/sb0409.htmlAll carehttps://www.gencourt.state.nh.us/rsa/html/XXX/329/329-31-b.htmxhttp://gencourt.state.nh.us/bill_status/billText.aspx?sy=2019&id=870&txtFormat=pdf&v=currentRun by State Agencyhttps://www.nh.gov/insurance/consumers/appeals.htm
NEW JERSEYxftp://www.njleg.state.nj.us/20102011/AL11/188_.PDFxhttps://academic.oup.com/jnci/article/92/4/300/2624693All carehttps://www.state.nj.us/dobi/division_consumers/insurance/outofnetwork.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://www.cqstatetrack.com/texis/redir?id=5a94f400a10Run by State Agencyhttps://www.state.nj.us/dobi/division_consumers/insurance/appealcomplaintguide.pdf
NEW MEXICOxhttps://law.justia.com/codes/new-mexico/2006/nmrc/jd_ch59aart22-14353.htmlHas an Override Processhttps://www.nmlegis.gov/Sessions/18%20Regular/final/SB0011.pdfxhttps://www.nmlegis.gov/sessions/01%20Regular/bills/senate/SB0240.htmlAll carehttps://www.nmlegis.gov/Sessions/19 Regular/final/SB0337.pdfRun by State Agencyhttps://www.osi.state.nm.us/index.php/consumer-guide-to-external-review/
NEW YORKxhttps://law.justia.com/codes/new-york/2010/isc/article-32/3221/Has an Override Processhttps://assembly.state.ny.us/leg/?default_fld=&bn=A02834&term=2015&Summary=Y&Actions=Y&Votes=Y&Memo=Y&Text=YAll carehttps://www.nysenate.gov/legislation/laws/FIS/A6xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttps://assembly.state.ny.us/leg/?default_fld=&leg_video=&bn=A02817&term=2019&Summary=Y&Memo=Y&Text=YRun by State Agencyhttps://www.dfs.ny.gov/complaints/file_external_appeal
NORTH CAROLINAxhttps://www.ncleg.net/Sessions/2001/Bills/Senate/HTML/S199v5.htmlER onlyhttps://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_58/Article_3.htmlRun by State Agencyhttps://www.ncdoi.gov/consumers/health-insurance/health-claim-denied/request-external-review
NORTH DAKOTAxhttps://www.legis.nd.gov/assembly/63-2013/interim/15-0117-04000.pdfProhibits Step Therapy for Patients with Metastatic Cancerhttps://www.legis.nd.gov/cencode/t19c02-1.pdf#nameddest=19-02p1-16p3Run by State Agencyhttps://www.nd.gov/ndins/health
OHIOxhttp://archives.legislature.state.oh.us/bills.cfm?ID130_SB_99Has an Override Processhttps://www.steptherapy.com/wp-content/uploads/2019/02/sb265_05_EN-3.pdfxhttp://archives.legislature.state.oh.us/bills.cfm?ID127_SB_186xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://insurance.ohio.gov/wps/portal/gov/odi/about-us/divisions/consumer-services/health/understanding-health-coverage-external-review-appeal
OKLAHOMAxHas an Override Processhttp://webserver1.lsb.state.ok.us/cf_pdf/2019-20%20ENR/SB/SB509%20ENR.PDFRun by State Agencyhttps://www.ok.gov/oid/Consumers/External_Review_Process/
OREGONxSome Legal Protectionshttps://www.oregonlaws.org/ors/414.637xhttps://www.oregonlaws.org/ors/743A.192All carehttps://www.oregonlegislature.gov/bills_laws/ors/ors743b.htmlRun by State Agencyhttps://dfr.oregon.gov/insure/health/understand/coverage/Pages/if-your-claim-was-denied.aspx
PENNSYLVANIAxOverride Legislation Filedhttps://legiscan.com/PA/text/HB1194/2019ER onlyhttp://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/028/chapter9/subchapHtoc.html&d=reduceRun by HHShttps://externalappeal.cms.gov/ferpportal/
*PUERTO RICOxRun by State Agencyhttp://ocs.gobierno.pr/ocspr/index.php/seguros-de-salud/370
RHODE ISLANDxHas an Override Processhttps://trackbill.com/bill/rhode-island-house-bill-5806-an-act-relating-to-insurance-accident-and-sickness-insurance-policies-step-therapy-protocol-creates-a-thirteen-13-member-commission-to-review-and-recommend-guidelines-for-step-therapy-protocols-and-who-would-report-back-to-the-house-by-march-7-2020-and-would-expire-on-may-7-2020/1717189/xhttps://law.justia.com/codes/rhode-island/2013/title-27/chapter-27-18/section-27-18-74All carehttp://webserver.rilin.state.ri.us/BillText/BillText18/SenateText18/S2077Aaa.pdfxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://webserver.rilin.state.ri.us/BillText/BillText17/SenateText17/S0821A.pdfRun by State Agencyhttp://www.eohhs.ri.gov/Consumer/ConsumerInformation/Appeals.aspx
SOUTH CAROLINAx AgreementRun by State Agencyhttps://doi.sc.gov/DocumentCenter/View/2554/Patients-Guide-to-External-Review?bidId=
SOUTH DAKOTAxhttps://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?TypeStatuteChapter&Statute58-17Has an Override Processhttps://mylrc.sdlegislature.gov/api/Documents/66388.pdfRun by State Agencyhttps://dlr.sd.gov/insurance/external_review_health_major_medical.aspx
TENNESSEEOverride Legislation Filedhttp://www.capitol.tn.gov/Bills/111/Fiscal/FM1853.pdfxhttp://www.capitol.tn.gov/Bills/104/Bill/HB0837.pdfRun by State Agencyhttps://www.tn.gov/commerce/tenncare-oversight/mco-dispute-resolution/independent-review-process.html
TEXASxhttps://law.justia.com/codes/texas/2017/insurance-code/title-8/subtitle-e/chapter-1369/Has an Override Processhttps://www.legis.state.tx.us/tlodocs/85R/billtext/html/SB00680I.htmxhttps://capitol.texas.gov/tlodocs/81R/billtext/html/SB00039F.htmAll carehttps://www.tdi.texas.gov/medical-billing/providers.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
UTAHxhttps://le.utah.gov/~2013/bills/sbillint/sb0189.pdfProhibits Step Therapy for Patients with Metastatic Cancerhttps://le.utah.gov/~2019/bills/static/SB0241.htmlxhttps://le.utah.gov/~2014/bills/static/HB0347.htmlRun by State Agencyhttps://insurance.utah.gov/consumer/health/independent-review
VERMONTxhttps://law.justia.com/codes/vermont/2012/title08/chapter107/section4089b/Some Legal Protectionshttps://legislature.vermont.gov/statutes/section/08/107/04089ixhttp://www.leg.state.vt.us/docs/legdoc.cfm?URL/docs/2006/acts/ACT003.HTMER onlyhttps://legislature.vermont.gov/statutes/fullchapter/33/065Run by State Agencyhttps://dfr.vermont.gov/consumers/file-complaint/insurance/healthcare-external-appeal
VIRGINIAxhttps://lis.virginia.gov/cgi-bin/legp604.exe?121+ful+CHAP0641+pdfHas an Override Processhttps://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+CHAP0337&191+ful+CHAP0337xhttp://leg1.state.va.us/cgi-bin/legp504.exe?991+ful+CHAP0643All care (effective Jan. 1, 2021)https://legiscan.com/VA/text/SB172/id/2169472Run by State Agencyhttps://www.scc.virginia.gov/boi/omb/ext_review.aspx
WASHINGTONxHas an Override Processhttp://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/House%20Passed%20Legislature/1879-S.PL.pdfxhttps://apps.leg.wa.gov/wac/default.aspx?dispotrue&cite284-43All carehttps://www.insurance.wa.gov/surprise-billing-and-balance-billing-protection-actRun by State Agencyhttps://www.insurance.wa.gov/appealing-health-insurance-denial
WEST VIRGINIAxhttp://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdochb2493%20intr.htm&yr2015&sesstypeRS&i2493Has an Override Processhttps://legiscan.com/WV/bill/HB2300/2017xhttp://www.wvlegislature.gov/Bill_Text_HTML/2003_SESSIONS/rs/BILLS/hb2675%20enr.htmER onlyhttp://www.wvlegislature.gov/WVCODE/code.cfm?chap=33&art=25Axhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://www.wvinsurance.gov/portals/0/pdf/External Review Request Form 2-4-2016.pdf
WISCONSINxhttps://docs.legis.wisconsin.gov/2013/related/acts/186Has an Override Processhttps://docs.legis.wisconsin.gov/2019/related/acts/12.pdfxhttp://docs.legis.wisconsin.gov/2005/related/proposals/ab617.pdfRun by HHShttps://externalappeal.cms.gov/ferpportal/
WYOMINGxhttps://law.justia.com/codes/wyoming/2016/title-26/chapter-20/article-6/section-26-20-601xhttps://www.wyoleg.gov/2008/Enroll/SF0024.pdfRun by State Agencyhttp://doi.wyo.gov/consumers/consumer-request-for-assistance/medical-claim-denial-external-review-process
GUAMRun by HHShttps://externalappeal.cms.gov/ferpportal/
* Federal law introduced March 14

This chart includes the state laws related to Medicaid coverage and navigation.

StateHas Expanded State Medicaid Program:Medicaid Coverage of Clinical Trials Routine CostsDetails of Medicaid Coverage for Clinical Trials Routine CostsHome Help ProgramsStates That Eliminated Retroactive Medicaid CoverageMedicaid Estate Recorvery AllowedMedicaid Estate Recovery Exceptions
ALABAMAxhttp://www.akleg.gov/basis/Bill/Text/26?Hsid=SB0010ZAs of September 29, 2010, health care insurers in the state must cover routine costs associated with clinical trials “designed to test and improve prevention, diagnosis, treatment or palliation of cancer.” Directs insurers to provide Medicaid services for individuals participating in these trials.xhttp://adss.alabama.gov/assets/e-d-waiver-brochure.pdfxhttps://medicaid.alabama.gov/documents/7.0_Providers/7.1_Benefit_Coordination_3rd_Party/7.1.1_Estate_Recovery/7.1.1_Estate_Recovery_FAQs_Revised_11-5-18.pdf“Undue Hardship” is defined as the existence of a situation, established by convincing evidence, that the estate subject to recovery is an asset such as a family farm or family business which produces “limited income” (defined as equal to or less than the income limit established in Rule 560-X-25.14) and is the sole income-producing asset of one or more heirs to the estate.
ALASKAxhttp://dhss.alaska.gov/HealthyAlaska/Pages/enrollment.aspxxhttp://dhss.alaska.gov/dsds/Pages/pca/default.aspxxhttp://dhss.alaska.gov/Commissioner/Documents/medicaidstateplan/PDF_SP/SP_pgs/SP_att4.17a.pdfOne or more of the following conditions may constitute a finding of undue hardship resulting in all or part of the Department’s claim against an estate to be waived in an effort to avoid impoverishment of the deceased recipient’s family: • The estate’s only asset produces income and recovery would cause the survivors’ loss of livelihood; • A survivor’s primary residence is the estate’s only significant asset and state recovery of it would cause impoverishment of the survivor as defined below: o State recovery of estate’s proceeds would make the survivor eligible for public assistance; o A survivor could discontinue eligibility for public assistance if they were to receive the estate; o Recovery would deprive the survivor of food, clothing, shelter or other necessities of life, or medical care, thereby endangering the survivor’s health and safety. • The estate subject to recovery is a home of modest value defined as 50% or less of the average price of homes within the region or major community, based on Alaska Department of Labor statistics and periodically compared to census data adjusted for inflation. Home value is determined as of the date of the recipient's death. Applicants for undue hardship waivers must have a beneficial interest in the estate and must apply within thirty (30) days of receiving notice of the Department’s claim. An application filed up to thirty (30) days late may be treated as timely if the applicant demonstrates good cause for filing late. The filing of a claim by the Department in a probate proceeding shall constitute notice to all heirs.
ARIZONAxhttps://www.azahcccs.gov/AHCCCS/AboutUs/xhttps://www.azahcccs.gov/Members/Downloads/ALTCS/SDACbrochure.pdfApplies to allA home that is solely owned by the ALTCS member, is owned jointly without right of survivorship, or is owned jointly with right of survivorship but the joint owner is deceased, is subject to Small Estate Affidavit or probate, and is therefore subject to payment of AHCCCS’ claim against the estatehttps://www.azahcccs.gov/Members/Downloads/Publications/DE-810_english.pdfAHCCCS will waive the claim against the ALTCS member’s estate when the heir to the estate meets all of AHCCCS’ undue hardship criteria in either a. or b. below: a. The estate contains real property assets only or both real and personal property assets, and 1. The real property in the estate is listed as residential property by the Arizona Department of Revenue or County Assessor’s Office; and 2. The heir to the estate meets all of the criteria listed in either a. through d. or e. through h. below: a. Owns a business that is located at the residential property; b. The business has been in operation at the residential property for at least 12 months preceding the ALTCS member’s death; c. The business provides more than 50% of the heir’s livelihood; and d. The recovery of the property would result in the heir to the estate losing their means of livelihood. OR e. Currently resides in the residence; f. Resided there at the time of the ALTCS member’s death; g. Has made the residence his or her primary residence for the 12 months immediately preceding the ALTCS member’s death; and h. Owns no other residence.
ARKANSASxhttps://www.healthinsurance.org/arkansas-medicaid/Includes family membershttps://humanservices.arkansas.gov/images/uploads/daas/PUB-416_Independent_Choices_Brochure_rev._6-18.pdfApplies to all except those 65+ or those needing LTSSxhttps://www.sos.arkansas.gov/uploads/rulesRegs/Arkansas%20Register/2008/mar_apr_2008/016.20.08-001.pdfUndue hardship may exist when the estate's asset is the sole asset of the survivors, the asset is their sole source of income, the income is not sufficient to meet their living expenses and also repay the debt to DHS, or there are other compelling circumstances (e.g., the estate assets cannot be readily converted to cash).
CALIFORNIAxhttps://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspxxhttp://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=200120020SB37If a patient’s physician recommends a clinical trial, every health care insurer in the state (including Medi-Cal) must cover routine costs associated with that trial. Effective August 10, 2001 (SB 37)Includes family membershttps://www.cdss.ca.gov/In-Home-Supportive-ServicesAfter 2017, only if home does not transfer by ROS, trust, or payment or transfer on death.https://www.dhcs.ca.gov/services/Pages/TPLRD_ER_cont.aspxHardship waiverhttps://www.dhcs.ca.gov/services/Documents/DHCS-6195-0619-Hardship-Waiver.pdf
COLORADOxhttps://www.colorado.gov/pacific/sites/default/files/Medicaid%20Expansion%20Overview.pdfxhttps://www.colorado.gov/pacific/sites/default/files/Medical%20Assistance%20Estate%20Recovery%20Program.pdf"at discretion of department"
CONNECTICUTxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateConnecticutIncludes family membershttps://ctcommunitycare.org/pca-medicaid-waiver-programxcan't find good siteunsure
DELAWARExhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateDelawareApplies to all except nursing facility residentsxhttps://regulations.delaware.gov/register/october2012/final/16%20DE%20Reg%20423%2010-01-12.htmThese individuals are limited to a civil union partner, children, grandchildren, parents, or siblings of the DHSS long-term care recipient who meet 1 of the following conditions: Receive any Federal or State funded assistance for living expenses (examples: SSI, AFDC, VA Aid and Attendance) and have no other home to which they can return. Or Have total family income less than or equal to 200% of the current monthly Federal Poverty limit, and have total family resources that can be converted to cash less than or equal to $3,000, including any real property that they own.
*DISTRICT OF COLUMBIAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statedistrict-of-columbiaxhttp://dccode.elaws.us/code?no=31-29B&e=8Under state health insurance code 31-2993.02 (October 23, 2012), the District of Columbia Medicaid agency may not “not limit or deny coverage, or impose additional conditions on the payment for the coverage, of routine patient care costs” associated with clinical trials.xhttps://dcoa.dc.gov/sites/default/files/dc/sites/dcoa/service_content/attachments/EPD Waiver Packet_102518.pdf
FLORIDAxhttps://www.flrules.org/gateway/ruleno.asp?id=59G-1.036Florida Administrative Code 59G-1.036 (January 6, 2006) requires that “Florida Medicaid reimburses for services as a result of a recipient participating in a clinical trial.”xhttps://dcoa.dc.gov/sites/default/files/dc/sites/dcoa/service_content/attachments/EPD Waiver Packet_102518.pdfApplies to allHomestead protectedhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0409/Sections/0409.9101.html(8) The agency shall not recover from an estate if doing so would cause undue hardship for the qualified heirs, as defined in s. 731.201. The personal representative of an estate and any heir may request that the agency waive recovery of any or all of the debt when recovery would create a hardship. A hardship does not exist solely because recovery will prevent any heirs from receiving an anticipated inheritance. The following criteria shall be considered by the agency in reviewing a hardship request: (a) The heir: 1. Currently resides in the residence of the decedent; 2. Resided there at the time of the death of the decedent; 3. Has made the residence his or her primary residence for the 12 months immediately preceding the death of the decedent; and 4. Owns no other residence; (b) The heir would be deprived of food, clothing, shelter, or medical care necessary for the maintenance of life or health; (c) The heir can document that he or she provided full-time care to the recipient which delayed the recipient’s entry into a nursing home. The heir must be either the decedent’s sibling or the son or daughter of the decedent and must have resided with the recipient for at least 1 year prior to the recipient’s death; or (d) The cost involved in the sale of the property would be equal to or greater than the value of the property.
GEORGIAxhttps://dch.georgia.gov/sites/dch.georgia.gov/files/related_files/document/17CCSP.pdfxHardship Criteria The following criteria will be used to determine whether an undue hardship exists: The asset to be recovered is an income-producing farm of one or more of the heirs, and the annual gross income is $25,000 or less; or The recovery of assets would result in the applicant becoming eligible for governmental public assistance based on need and/or medical assistance programs.
HAWAIIxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statehawaiixhttp://humanservices.hawaii.gov/ssd/home/adult-services/adult-services/https://humanservices.hawaii.gov/mqd/fss-liens/
IDAHOxhttps://medicaidexpansion.idaho.govxhttps://legislature.idaho.gov/wp-content/uploads/sessioninfo/2016/interim/160829_hacp_02a_TATROMedicaidEstateRecovery.pdf(Undue Hardship
ILLINOISxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateillinoisxTo waive recovery, the heir or beneficiary must show that the recovery would cause them to become or remain eligible for programs such as Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF) or Food Stamps.
INDIANAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateindianaxhttps://www.in.gov/medicaid/files/Clinical%20Trials.pdfAccording to the Indiana Family and Social Services Association, Indiana Health Coverage Programs (IHCP) covers “the routine costs of qualifying clinical trials” and “reasonable and necessary items and services used to diagnose and treat complications arising from the participation in all clinical trial.”xhttps://www.in.gov/fssa/da/3476.htmApplies to all except those 65+ or those needing LTSSxYes - very limited (only what is in the fed statute)
IOWAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateiowaApplies to all except nursing facility residentsxhttps://www.legis.iowa.gov/docs/ico/code/249A.53.pdfIf repayment of the Medicaid debt would cause the heir or beneficiary to: 1. Not have enough money to pay for food, shelter, clothing, or medical care so that their life or health would be in danger, and 2. Have less than $10,000 in assets, and 3. Earn less than 200% of the federal poverty level, theyhttps://dhs.iowa.gov/sites/default/files/Comm266.pdf?041920201940
KANSASxhttps://www.kancare.ks.gov/docs/default-source/consumers/benefits-and-services/fact-sheets/estate-recovery-fact-sheet-2018-02.pdf?sfvrsn=afe94d1b_8; kdheks.gov/hcf/kancare/Jan_2018_Output/keesm1725.htmunsure
KENTUCKYxhttps://www.healthinsurance.org/kentucky-medicaid/xhttps://dhs.iowa.gov/sites/default/files/Comm529.pdf?092320191346Applies to all except those 65+ or those needing LTSSxhttps://chfs.ky.gov/agencies/dms/dpo/epb/Documents/erfaqs.pdfUndue hardship shall exist if the total date-of-death value of the estate is $10,000 or less. This amount is raised from $5,000 or less under the rules prior to September 1, 2003. Undue hardship shall also exist if an asset subject to recovery is the sole income-producing asset of the estate conveyed to the surviving recipient family member (spouse, child or sibling). For example, this could be a family farm or business. However, the sole income-producing asset shall not include residential real property producing income through a lease or rental arrangement. Medicaid may also waive recovery if it is not cost effective to recover from the estate. To be cost effective, the administrative cost of recovering from the estate shall be less than the total date-ofdeath value of the estate subject to recovery. Finally, Medicaid may grant an exemption of the recovery provisions on a case-by-case basis to the extent of the anticipated cost of continuing education or health care needs of an estate heir. The estate representative shall submit to the Department a written request for such an exemption and provide verification to the satisfaction of the Department.
LOUISIANAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statelouisianaIncludes family membershttp://ldh.la.gov/assets/docs/OAAS/publications/CCW_Fact_Sheet.pdfxhttp://ldh.la.gov/assets/medicaid/MedicaidEligibilityPolicy/U-0000.pdfIf recovery would place an unreasonable burden on an heir; and if an heir’s family income is equal to or less than 300 percent of the FPIG, adjustment or recovery may be waived. An undue hardship waiver is limited to the period during which the undue hardship circumstances continue to exist. An undue hardship may exist when: • the estate is the sole income-producing asset of an heir and income from the estate is limited (e.g., a family farm or other family business which produces a limited amount of income when the farm or business is the sole asset of the heir. • recovery would result in the heir’s necessity to apply for and become eligible for public assistance, including but not limited to Medicaid. • other compelling circumstances would
MAINExhttps://www.maine.gov/dhhs/expansion.shtmlIncludes family membershttps://www.maine.gov/dhhs/oads/home-support/elderly-physically-disabled/index.htmlxhttps://www.maine.gov/dhhs/oms/pdfs_doc/member/Estate-Recovery-October2019-Final.pdfCare Given Waiver: Heirs who provided care for the MaineCare member while living in the member’s home for at least two years prior to the member being admitted to a long-term care facility or death may seek a waiver from recovery. The heir must have an income below 200% of the federal poverty level. The amount waived from recovery depends on the level and type of home care provided. For each of the two years: ▪ $6,000 is waived for basic help at least three times a week with transportation, housekeeping, appointments, and daily in-home personal care. ▪ $12,000 is waived for care that includes the above plus dispensing medication, changing dressings, and bathing. ▪ $32,000 is waived if the level of care provided is like care provided in an institutional setting. Hardship Waiver: If estate recovery will create a hardship, heirs may request a hardship waiver. The heirs’ income and assets combined must be below 180% of the federal poverty level, and they must have lived in the member’s home for a period of at least two years prior to the member’s death.
MARYLANDxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statemarylandxhttps://mmcp.health.maryland.gov/healthchoice/Documents/MCO%20Agreement%202019%20for%20CY%202019%20MCO%20file.pdfSection .26-1 of Maryland’s Medicaid managed care organization agreement mandates that Maryland managed care organizations cover routine costs associated with clinical trials.xhttps://mmcp.health.maryland.gov/longtermcare/SiteAssets/SitePages/Community First Choice/HCBOW Fact Sheet 11.17.15.pdfxhttps://mmcp.health.maryland.gov/docs/estatefactsheet_1106final.pdfA hardship means Medicaid’s claim will result in the removal of a dependent who: 1. Lived in the property at the time of the Medicaid recipient’s death. 2. Lived there continuously for a period of two years before the Medicaid recipient’s death, and 3. Cannot find another place to live.
MASSACHUSETTSxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statemassachusettsIncludes family membershttps://www.mass.gov/guides/adult-foster-care-afc-manualApplies to all except those 65+ or those needing LTSSxhttps://aspe.hhs.gov/basic-report/medicaid-liens-and-estate-recovery-massachusettsHardship waiver is available if a sale of real property would be required to satisfy a claim against the recipient’s probate estate and the individual using the property as their primary residence (1) lived on the property for at least one year before the deceased recipient became eligible for MassHealth; (2) the individual inherited or received an interest in the property from the deceased member’s estate; (3) the individual is not being forced to sell the property by other heirs; and (4) the individual’s income is less than 133% of poverty level.https://budget.digital.mass.gov/bb/h1/fy17h1/os_17/h11.htm
MICHIGANxhttps://www.michigan.gov/documents/snyder/Medicaid_expansion_-_factsheet_final_2-6-13_410658_7.pdfIncludes family membershttps://www.michigan.gov/mdhhs/0,5885,7-339-71547_2943_4857_5045-16263--,00.htmlxhttps://www.michigan.gov/mdhhs/0,5885,7-339-71547_4860_56113_58553---,00.htmlAn undue hardship may exist when (1) the estate subject to recovery is the primary income-producing asset of the survivors (where such income is limited), such as a family farm or business; (2) the estate subject to recovery is a home of modest value. To qualify for an undue hardship waiver, the applicant must satisfy a Means Test. This ensures that an actual hardship would result. An applicant will satisfy the means test if both of the following are true: Total household income of the applicant is less than 200% of the poverty level for a household of the same size: and Total household resources of the applicant are less than $10,000. As stated above, there is a presumption that no hardship exists if the hardship resulted from estate planning methods where assets were diverted in order to avoid estate recovery.
MINNESOTAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateminnesotaxhttps://mn.gov/dhs/people-we-serve/people-with-disabilities/services/home-community/programs-and-services/pca.jspxhttps://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=SRU-020102
MISSISSIPPIxhttps://medicaid.ms.gov/programs/elderly-and-disabled-waiver/xhttps://www.mslegalservices.org/resource/medicaid-estate-recoveryExamples of situations where undue hardship will be found in Mississippi include cases in which the estate subject in recovery is the sole income producing asset of the survivors, such as a family farm; a homestead of modest value; or other compelling circumstances. Other compelling circumstances include a situation in which an adult relative has lived in the home of the decedent, depended upon that home for her principle place of residence for at least one year before the decedent entered the nursing home and gave care so that the person did not have to enter a nursing home during that year.
MISSOURIxhttps://health.mo.gov/seniors/nursinghomes/careoptions.phpxhttps://www.legacylawmissouri.com/missouri-medicaid-information-2016/; https://dss.mo.gov/mhd/general/pages/estate-recovery.htm
MONTANAxhttps://www.healthinsurance.org/montana-medicaid/xhttps://legiscan.com/MT/text/SB55/id/791917As of March, 27, 2013, health insurance providers, including Medicaid, may not deny patients’ participation in approved clinical trial, deny coverage of routine patient costs, or discriminate against an individual due to their participation in an approved clinical trial.xhttps://dphhs.mt.gov/sltc/csbxhttps://dphhs.mt.gov/Portals/85/sltc/documents/ADRC/SLTC-011MTMedicaidLienEstateRecoveryProg.pdfA deceased recipient’s heirs may ask the State to waive or reduce recovery based on undue hardship. All requests will be considered, and arrangements will be made if undue hardship exists based on criteria contained in Rule 37.82.431 of the Administrative Rules of Montana (ARM)
NEBRASKAxhttp://dhhs.ne.gov/Pages/Medicaid-Expansion.aspxIncludes family membershttp://dhhs.ne.gov/Pages/Medicaid-Home-and-Community-Based-Services.aspxxhttp://dhhs.ne.gov/Documents/Nebraska%20Medicaid%20Estate%20Recovery%20brochure.pdf
NEVADAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statenevadaxhttp://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Manuals/MSM/C1500/MSM_Ch_1500_20_01_01.pdfThe Healthy Kids Program policy #15-1 (November 1, 2014) requires Medicaid to cover routine costs for phase III and IV clinical trials for children less than 21 years old.xhttp://adsd.nv.gov/Programs/Seniors/PersAsstSvcs/PAS_Prog/xhttp://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Pgms/CPT/Medicaid_Estate_Recovery.pdfCriteria considered (any one of the following): •The asset is the sole income producing asset of the applicant •The recovery of the asset would result in the applicant becoming eligible for government public assistance •There is a doctor’s written verification of a medical condition that compromises the applicant’s ability to repay the Medicaid claim. A claim may be waived, deferred or reduced (on a case by case basis) — The applicant resided in the recipient’s home for at least two years immediately prior to death or admission into a medical institution and/or the arrangement allowed the decedent to continue living in the home rather than in an institution. — The applicant provided daily care to the Medicaid recipient– including assistance with daily living activities and medical needs. — The cost of recovering an asset is more than the value of the asset. — The financial impact of recovery against immediate family members of the applicant would place them in a position of financial hardship.
NEW HAMPSHIRExhttps://www.medicaid.gov/state-overviews/stateprofile.html?statenew-hampshirexhttps://www.dhhs.nh.gov/dcbcs/beas/documents/cfi.pdfApplies to all except those 65+ or those needing LTSSxhttps://www.dhhs.nh.gov/oos/eru/index.htm
NEW JERSEYxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statenew-jerseyxhttps://www.state.nj.us/humanservices/dmahs/home/mltss.htmlxhttps://www.state.nj.us/humanservices/dmahs/clients/The_NJ_Medicaid_Program_and_Estate_Recovery_What_You_Should_Know.pdfThe only time that recovery will not be pursued is: I 1. If it would not be cost-effective to do so; or, 2. If property in the estate is the sole source of income for one or more of the Page 2 of 3 survivors and pursuit of recovery is likely to result in one or more of those survivors becoming eligible for public assistance and/or Medicaid benefits; or, 3. If a family member of a deceased Medicaid beneficiary has, prior to the beneficiary's death, continuously resided in a home owned by the beneficiary at the time of the beneficiary's death, and that home was the client's primary residence, and was, and remains, the family member's primary residence, DMAHS may record a lien against the property, but will not enforce the lien until the property is voluntarily sold, or the resident family member either dies or vacates the property.
NEW MEXICOxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statenew-mexicoxhttps://www.nmlegis.gov/Sessions/09%20Regular/final/SB0042.pdfAs of 2009, New Mexico insurance code requires that all health care insurers in the state (including Medicaid) cover routine costs associated with clinical trials.xhttps://www.hsd.state.nm.us/uploads/FileLinks/3c4e879df7a845369fd43c2e82c0a86d/MAD_MR_13_07_Estate_Recovery_files.pdfSome Estates may qualify for relief from Estate Recovery, but only if HSD decides that one or more of the following hardship conditions are met: • an heir would qualify for public benefits to meet food, clothing and shelter needs; • an heir would not be able to get off of public assistance if the Estate property is used for repayment; • an heir has no source of money other than what the Estate could provide; • the home in the Estate is worth 50% or less than the average price of homes in that county.
NEW YORKxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statenew-yorkIncludes family membershttps://www.health.ny.gov/health_care/medicaid/program/longterm/cdpap.htmxhttps://www.health.ny.gov/health_care/medicaid/publications/adm/11adm8.htmUndue hardship may exist when the asset subject to estate recovery is the sole income-producing asset of the beneficiary(ies), such as a family farm or family business and income produced by the asset is limited, or when the asset subject to recovery is real property of modest value (i.e., having a value no higher than 50 percent of the average selling price in the county where the home is located, as of the decedent's date of death) and the home is the primary residence of the beneficiary(ies). There may be other compelling circumstances that should be considered when deciding whether estate recovery will be waived due to undue hardship.
NORTH CAROLINAxhttps://files.nc.gov/ncdma/documents/files/1A39.pdfAs of October 1, 2015, North Carolina Medicaid programs cover qualifying clinical trials’ routine costs.xhttps://medicaid.ncdhhs.gov/medicaid/get-started/find-programs-and-services/community-alternatives-program-for-disabled-adultsxhttps://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-70.5.html
NORTH DAKOTAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statenorth-dakotaIncludes family membershttp://www.nd.gov/dhs/info/pubs/docs/medicaid/fact-sheet-medicaid-waivers-hcbs.pdfxhttps://www.nd.gov/dhs/services/medicalserv/medicaid/recovery.html; http://www.nd.gov/dhs/policymanuals/45001/Printed%20Docuemntation/Medicaid%20Estate%20Recovery%20Print%201-7-11%20done.pdfNo exceptions
OHIOxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateohioxhttps://aging.ohio.gov/Portals/0/PDF/profile_assisted_living.pdfxhttp://codes.ohio.gov/oac/5160:1-2-07Undue hardship may be found in the following cases. (a) The estate subject to recovery is the sole income-producing asset of the survivor, such as a family farm or other family business, which: (i) Produces a limited amount of income, or (ii) Is the sole asset of the survivor. (b) Without receipt of the estate proceeds, the survivor would become eligible for public assistance. (c) Recovery would deprive the survivor of necessary food, shelter or clothing. Deprivation does not include situations in which the survivor is merely inconvenienced but would not be at risk of serious harm. (d) The survivor provides clear and convincing evidence of substantial personal financial contributions to the deceased individual, creating an equity interest in the property. (e) The survivor is age sixty-five or older and financially dependent upon receipt of the estate proceeds. (f) The estate proceeds are preserved for the benefit of a survivor who: (i) Is totally and permanently disabled as defined in Chapter 5160:1-3 of the Administrative Code; and (ii) Is financially dependent upon receipt of the estate proceeds.
OKLAHOMAxhttp://www.okdhs.org/services/aging/Pages/ADvantageservices.aspxApplies to all except those 65+ or those needing LTSSxhttps://www.okhca.org/xPolicyPart.aspx?id=626&chapter=35&subchapter=9&part=2&title=MEDICAID%20RECOVERY%20PROGRAMUndue hardship exists when enforcing the lien would deprive the individual of medical care such that the individual's health or life would be endangered. Undue hardship exists when application of the rule would deprive the individual or family members who are financially dependent on him/her for food, clothing, shelter, or other necessities of life. Undue hardship does not exist, however, when the individual or his/her family is merely inconvenienced or when their lifestyle is restricted because of the lien or estate recovery being enforced. Decisions on undue hardship waivers are made at OKDHS State Office, Family Support Services Division, Health Related and Medical Services Section.
OREGONxhttps://www.medicaid.gov/state-overviews/stateprofile.html?stateoregonIncludes family membershttp://www.dhs.state.or.us/policy/spd/rules/411_030.pdfxhttps://sharedsystems.dhsoha.state.or.us/DHSForms/Served/me9093.pdf
PENNSYLVANIAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statepennsylvaniaxhttp://www.dhs.pa.gov/citizens/longtermcareservices/x with exceptionshttps://www.dhs.pa.gov/Services/Other-Services/Documents/Estate%20Recovery/Estate%20Recovery-Brochure.pdf• If the gross value of the estate is $2,400 or less, the estate is administered, and there is an heir to the estate, the department will permanently waive its claim for estate recovery. • A hardship waiver, with respect to a primary residence of the deceased, will be granted if all the following criteria are met: a) The person has continuously resided in the primary residence of the decedent for at least two years immediately preceding the decedent’s receipt of nursing facility services, or, for at least two years during the period with MA-funded home and community-based services were received; and b) The person has no other alternative permanent residence; and c) The person has provided care or support to the decedent for at least two years during the period that MA-funded home and communitybased services were received by the decedent, or for at least two years prior to the decedent’s receipt of nursing facility services during which time the decedent needed care or support to remain at home. • A hardship waiver will be granted with respect to an income-producing asset (for example, a working farm) for a spouse, child, parent, sibling, or grandchild of the deceased if they meet both of the following criteria: a) The asset is used to generate the primary source of income for the household; and b) There would be a gross family income of less than 250 percent of the federal poverty income guideline* without the asset. *These amounts change every year. For example, in 2018, a single person could earn up to $4,047 per month, while a couple could earn up to $5,487 per month.
*PUERTO RICOxhttp://webserver.rilin.state.ri.us/Statutes/TITLE40/40-8/40-8-15.HTM; http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/Rules/0312lienspropjan2018.pdf
RHODE ISLANDxhttps://www.medicaid.gov/state-overviews/stateprofile.html?staterhode-islandApplies to all except those 65+ or those needing LTSSxhttps://www.scdhhs.gov/sites/default/files/2014%20ER%20Brochure.pdf; https://www.scdhhs.gov/organizations/estate-recovery(1) With respect to the decedent's home property, if the decedent could have transferred the home property on or after the date of his or her Medicaid application without incurring a penalty under 42 U.S.C. Section 1396p(c) if the property could have been transferred without penalty to a: (a) Surviving sibling of the decedent who possessed an equity interest in the property and who lived in the home for a period of at least one year immediately prior to the date the decedent was institutionalized; or (b) Surviving child of the deceased who lived in the home for a period of at least two years immediately before the decedent became institutionalized and who provided care, which allowed the decedent to delay institutionalization. Does not apply to a child under the age of 21, or a child who is blind or disabled. However, hardship under this item only applies if the individual to whom the property could have been transferred without penalty is actually residing in the home, at the time the hardship is claimed and this hardship status only protects a homestead of modest value. A homestead of modest value is defined as fifty percent (50%) or less of the average price of homes in the county where the homestead is located as of the date of the beneficiary's death. To the extent the value of the home property exceeds this modest value, that portion is subject to recovery by the department. (2) With respect to the decedent's home and one acre of land surrounding the house, if an immediate family member: (a) Has resided in the home for at least two years immediately prior to the recipient's death; (b) Is actually residing in the home at the time the hardship is claimed; (c) Owns no other real property or agrees to sell all other interest in real property and give the proceeds to the department; and (d) Has annual gross family income that does not exceed one hundred eighty-five percent of the federal poverty guidelines. (3) With respect to a sole income producing asset: (a) An immediate family member's annual gross family income would fall below the federal poverty guidelines or immediate family member agrees to pay all income in excess of one hundred eighty-five percent (85%) of the federal poverty guidelines to the department.
SOUTH CAROLINAxhttps://www.scdhhs.gov/sites/default/files/Community Choices Waiver 2016-POST.pdfxhttps://dss.sd.gov/keyresources/benefitfraud/estate.aspx
SOUTH DAKOTAxhttps://dhs.sd.gov/ltss/titlexix.aspxxhttps://www.tn.gov/tenncare/legal/estate-recovery.htmlThe “undue hardship” is defined by Tennessee as existing in the following three circumstances: The property of the estate is the sole income-producing asset of the survivors, such as a family farm or other family business. A sibling of the deceased individual meets the following criteria: He or she was lawfully residing in the individual’s home at least 1 year immediately before the individual’s admission to the medical institution; He or she provided care to such individual for that 1 year, which permitted the individual to reside in the home rather than in an institution; and He or she has lawfully resided in such home on a continuous basis since the date of the individual’s admission to the medical institution. A son or daughter of the individual meets the following criteria: He or she was lawfully residing in the individual’s home for at least 2 years immediately before the individual’s admission to the medical institution; He or she provided care to such individual for those 2 years, which permitted the individual to reside at home rather than in an institution; and He or she has lawfully resided in such home on a continuous basis since the date of the individual’s admission to the medical institution. Note: For purposes of #2 and #3 above, the undue hardship shall be considered to no longer exist when sibling, son, or daughter of the deceased individual, as applicable, no longer resides in such home.
TENNESSEExhttps://www.tn.gov/tenncare/long-term-services-supports/choices.htmlApplies to allxhttps://hhs.texas.gov/laws-regulations/legal-information/your-guide-medicaid-estate-recovery-programThe state may consider it a hardship when: The estate property was a family business, farm, or ranch for at least 12 months before the person on Medicaid dies, and is the main source of income for the heirs. The heirs would need financial help from the government if the state filed a MERP claim to get money back. The heirs could stop getting financial help from the government if the state did not file a MERP claim. The person who died received services because he or she was a crime victim. There are other circumstances that may create a hardship. One type of hardship applies just to the home. If the value of the homestead is under $100,000, and if one or more of the heirs have family income under a certain amount, the state may not ask for money back. In 2019, this income limit for one person is $37,470. For a family of two, it is $50,730. These figures are adjusted each year
TEXASxhttps://statutes.capitol.texas.gov/Docs/IN/htm/IN.1379.htmAll health care insurers in the state, including Medicaid Plans, must cover routine costs associated with approved “clinical trials conducted in relation to the prevention, detection, or treatment of a life-threatening disease or condition.” (Insurance Code Section 1379.001)xhttps://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/community-first-choice-cfcxhttps://medicaid.utah.gov/Documents/pdfs/EstateRecovery.pdfWhen the property is the sole incomeproducing asset and source of support for the survivors (such as a family farm or other family business, which produces a limited amount of income).
UTAHxhttps://medicaid.utah.gov/Documents/pdfs/UTAH%20MEDICAID%20EXPANSION_%20Toolkit.pdfApplies to all except those 65+ or those needing LTSSxhttps://legislature.vermont.gov/statutes/fullchapter/33/019No recovery of medical expenses shall be made under this subchapter against a homestead provided that the homestead would pass to one or more lineal heirs or siblings of the decedent who either have income below 300 percent of the federal poverty level or who have contributed significantly, monetarily or otherwise, to the decedent so as to allow the decedent to delay or avoid nursing home placement. If a maximum homestead value exemption is allowed by federal law, then any recoveries due to the U.S. Department of Health and Human Services on homesteads valued between such maximum and $125,000.00 shall be paid through State general funds provided the caregiving or poverty standards set forth in this section are also met and the probate estate was opened after June 30, 2000.
VERMONTxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statevermontxhttps://dfr.vermont.gov/reg-bul-ord/health-insurance-coverage-cancer-clinical-trialVermont’s Health Care Administration requires Vermont Medicaid providers to cover routine costs associated with clinical trials as of August 5, 2005. (Regulation H-2005-03)xhttps://law.lis.virginia.gov/admincode/title12/agency30/chapter20/section141/1. Special consideration shall be shown in cases in which the estate subject to recovery is: (i) the sole income-producing asset of survivors (where such income is limited), such as a family farm or other family business; (ii) a homestead of modest value; or (iii) one in which other compelling circumstances exist as may be set out in agency guidance documents. Homestead of modest value = means a home that is worth 50% or less of the average or median price, as contained in the most recent U.S. Census data or any other such source of home value information as published in the agency's guidance documents, of homes in the county or city, as appropriate, where the homestead is located as of the date of the individual's death. 2. An undue hardship exists when the Commonwealth determines that it would not be cost effective to recover the assistance paid. 3. In cases where recovery is not waived and heirs of the estate from which recovery is sought wish to satisfy the Commonwealth's claim without selling a nonliquid asset that is subject to recovery, alternative methods of recovery may be considered. DMAS may also establish a reasonable payment schedule. 4. The Commonwealth may limit the hardship waiver to the time period during which the undue hardship circumstances existed or continue to exist.
VIRGINIAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statevirginiaxhttp://www.dmas.virginia.gov/files/links/630/CCC Plus Waiver Fact Sheet.pdfxhttps://www.dshs.wa.gov/sites/default/files/FSA/forms/pdf/14-454.pdfRecovery deprives an heir of a place to live and they cannot afford other shelter; • The estate is the sole income producing asset of an heir; or • You are survived by a state-registered domestic partner.
WASHINGTONxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statewashingtonxhttps://www.hca.wa.gov/health-care-services-supports/program-administration/dda-home-and-community-based-hcb-waiversx, jointly owned property can only be recovered against owner's portion of interesthttp://www.wvrecovery.com/docs/Estate_Recovery_BRO20021.pdf7.1 The following situations are considered undue hardship situations and no lien shall be placed or recovery made on the estates of Medicaid recipients when the following evidence is presented to the Bureau: 7.1.1. An adult child resided continuously in the home for a two year period of time immediately prior to the date the parent became a recipient and continued to reside in the home until the parent’s death and if that child can establish that he/she provided care to the recipient which permitted the parent to remain at home without Medicaid assistance for at least that two year period; 7.1.2. An adult child maintains continuous employment in the family business for a period of time beginning at least three (3) years before the parent became a recipient until the time of the parent’s death and if the property, which would otherwise be subject to an estate recovery lien, is an integral part of the business and is required for the continued viability of the business; or 7.1.3. The secretary determines that it is not cost effective for the Department of Health and Human Resources (DHHR) to pursue recovery from the estate. 7.2 The following situations shall be considered undue hardship, which upon presentation of proof, qualify for limited exclusion from estate recovery: 7.2.1. An adult child, regardless of whether he/she was living in the family home, is able to present proof of monetary support to his/her parent for medical care and other necessities prior to the date the parent became a recipient. Such support shall reduce the medical assistance lien on a dollar for dollar basis; 7.2.2. An adult grandchild whose parents are both deceased prior to the date the grandparent became a recipient is able to present proof of monetary support to his/her grandparent for medical care and other necessities prior to the date the grandparent became a recipient. Such support shall reduce the medical assistance lien on a dollar for dollar basis; or 7.2.3. A sibling is able to present proof of monetary support to his/her sibling for medical care and other necessities prior to the date the sibling became a recipient. Such support shall reduce the medical assistance lien on a dollar for dollar basis. 7.3 An application for an undue hardship waiver to exempt wedding rings from the recipient’s estate shall be granted without presentation of evidence.
WEST VIRGINIAxhttps://www.medicaid.gov/state-overviews/stateprofile.html?statewest-virginiahttps://www.wvlegislature.gov/WVCODE/code.cfm?chap=33&art=25F#01West Virginia insurance code mandates that insurers, including Medicaid and the children's health insurance program, must pay routine costs associated with participation in Phase II through IV clinical trials for treatment of life-threatening condition or the prevention, early detection and treatment of cancer. (Article 25F, Chapter 33 of WV Ins. Code)xhttp://www.wvseniorservices.gov/HelpatHome/MedicaidAgedandDisabledWaiver/tabid/77/Default.aspxxhttps://www.dhs.wisconsin.gov/publications/p0/p00694.pdfAn heir, beneficiary, or co-owner may apply for a waiver of the Department’s claim on their portion of the estate or non-probate property for one of the following reasons: • The heir, beneficiary, or co-owner would become or remain eligible for Supplemental Security Income (SSI), FoodShare, BadgerCare Plus, or Medicaid, if the Department pursued its claim. • The deceased’s estate contains real estate used as part of the heir, beneficiary, or co-owner’s business, which may be, but is not limited to, a working farm, and recovery by the Department would affect the property and would result in the heir, beneficiary, or co-owner losing his or her means of a livelihood. •The heir, beneficiary, or co-owner is receiving general relief or veterans benefits based on need under s. 45.40 (1m), Wis. Stats.
WISCONSINIncludes family membershttps://www.dhs.wisconsin.gov/familycare/fcp-index.htmxhttps://health.wyo.gov/wp-content/uploads/2016/02/Wyoming-Medicaid-Estate-Recovery-Brochure.pdfThe property must be part of a working farm or ranch, be the sole source of income for the heirs, and provide food, shelter for the heirs.
WYOMINGxhttps://health.wyo.gov/wp-content/uploads/2016/04/Community-Choices-Waiver-Policy-Procedures-Manual-July-2016-1.pdfxhttp://dcrules.elaws.us/dcmr/t29_ch29-67Undue hardship shall exist if one of the following criteria has been met: (a)The heir, legatee, devisee or other interested person may become eligible for assistance payments without the proceeds from the estate; (b)The decedent's home is the sole-income producing asset of a family business and recovery would result in an heir, legatee, devisee or other interested person losing their means of livelihood. The following two conditions shall be met to qualify under this criteria: (1)The family business has been in operation at the property for at least twelve (12) months preceding the death; and (2)Income from the business provides one hundred percent (100%) of a surviving heir, legatee, devisee or other interested person's livelihood; (c)If the heir, legatee, devisee or other interested person is allowed to collect the proceeds from the estate, that individual may become ineligible for assistance payments; or (d)Recovery would deprive the heir, legatee, devisee or other interested person of shelter and that individual lacks the financial means to obtain and maintain shelter. 6703.2Undue hardship shall not exist under any of the following circumstances: (a)When recovery would merely inconvenience or restrict the lifestyle of the heir, legatee, devisee or other interested person; (b)The heir, legatee, devisee or other interested person divest assets to qualify under the undue hardship provision; or (c)Recovery will merely prevent the heir, legatee, devisee or other interested person from receiving an anticipated inheritance. 6703.3MAA may compromise its claim when collection of the full amount would result in an undue hardship. Consideration may be given to the following factors: (a)Contribution by the heir, legatee, devisee or other interested person to the value of the asset or to the support or care of the decedent; (b)Any outstanding debt with a higher priority, such as a mortgage, which has been assumed by the heir, legatee, devisee or other interested person; and (c)Other compelling circumstances as determined by the District.
GUAM
*Waivers in AR, KY, and NH have been vacated by federal court, so not currently in effect.