In this Aug 5, 2021 Appeals Court decision, the Court reversed the Superior Court's summary judgment in favor of EOHHS in a Medicaid estate recovery claim under G.L. c. 118E, Sec. 31 in which the claim consisted entirely of capitated monthly payments to a Senior Care Options (SCO) program. The court reversed on the grounds that at the time the decedent enrolled in the SCO, the agency had failed to give him the notice required by federal law that it would seek to recover its fixed monthly payment to the SCO regardless of how few services the decedent actually received from the SCO. The estate was represented by Charles Vander Linden and Emily Starr. MLRI filed an amicus brief in support of the estate on behalf of MLRI, NAELA-MA, Justice in Aging, and the Mass. Senior Action Council. A copy of the decision is attached.
In May 2021, while the appeal was pending, the agency undertook a mass mailing to all members age 55 or over or in a nursing home with information about estate recovery including the recovery of the full amount of managed care payments, and it is continuing to send this notice when members turn 55 or entered a nursing home. A copy of the May letter is attached.
The agency decided not to pursue further appellate review, and in November 2021 began to notify personal representatives of estates with pending unpaid claims that it was removing the amount of any managed care premiums paid by the agency prior to June 2021 from the amount of its claim. It also refunded claims paid after the date of the Aug 5, 2021 that represented managed care payments made prior to June 1, 2021. Attached is a copy of one of these letters to a personal representative and the body of an email from the Director of the Office of Program Integrity explaining which cases EOHHS was adjusting. Advocates report also receiving notice of adjusted claims in cases in which estate recovery was deferred during the life of a surviving spouse.
|EOHHS v. Trocki Aug 5 2021 AC Decision.pdf||96.84 KB|
|Letter from MH re refund to estate - redacted (1).pdf||73.52 KB|
|Trocki implementation email Nov 2021.pdf||6.22 KB|
|REVISED Estate Recovery Member Notice.pdf||191.92 KB|