Modifies provisions relating to estates of persons receiving public benefits

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1683
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR MCCREERY .
7105S.03I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 208.215, 473.398, and 473.399, RSMo, and to enact in lieu thereof four new
sections relating to estates of persons receiving public benefits.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 208.215, 473.398, and 473.399, RSMo, 1
are repealed and four new sections enacted in lieu thereof, to 2
be known as sections 208.215, 473.398, 473.399, and 473.402, to 3
read as follows:4
208.215. 1. MO HealthNet is payer of last resort 1
unless otherwise specified by law. When any person, 2
corporation, institution, public agency or private agency is 3
liable, either pursuant to contract or otherwise, to a 4
participant receiving public assistance on account of 5
personal injury to or disability or disease or benefits 6
arising from a health insurance plan to which the 7
participant may be entitled, payments made by the department 8
of social services or MO HealthNet division shall be a debt 9
due the state and recoverable from the liable party or 10
participant for all payments made on behalf of the 11
participant and the debt due the state shall not exceed the 12
payments made from MO HealthNet benefits provided under 13
sections 208.151 to 208.158 and section 208.162 and section 14
208.204 on behalf of the participant, minor or estate for 15
payments on account of the injury, disease, or disability or 16
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benefits arising from a health insurance program to which 17
the participant may be entitled. Any health benefit plan as 18
defined in section 376.1350, third-party administrator, 19
administrative service organization, and pharmacy benefits 20
manager shall process and pay all properly submitted medical 21
assistance subrogation claims or MO HealthNet subrogation 22
claims using standard electronic transactions or paper claim 23
forms: 24
(1) For a period of three years from the date services 25
were provided or rendered; however, an entity: 26
(a) Shall not be required to reimburse for items or 27
services which are not covered under MO HealthNet; 28
(b) Shall not deny a claim submitted by the state 29
solely on the basis of the date of submission of the claim, 30
the type or format of the claim form, failure to present 31
proper documentation of coverage at the point of sale, or 32
failure to provide prior authorization; 33
(c) Shall not be required to reimburse for items or 34
services for which a claim was previously submitted to the 35
health benefit plan, third-party administrator, 36
administrative service organization, or pharmacy benefits 37
manager by the health care provider or the participant and 38
the claim was properly denied by the health benefit plan, 39
third-party administrator, administrative service 40
organization, or pharmacy benefits manager for procedural 41
reasons, except for timely filing, type or format of the 42
claim form, failure to present proper documentation of 43
coverage at the point of sale, or failure to obtain prior 44
authorization; 45
(d) Shall not be required to reimburse for items or 46
services which are not covered under or were not covered 47
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under the plan offered by the entity against which a claim 48
for subrogation has been filed; and 49
(e) Shall reimburse for items or services to the same 50
extent that the entity would have been liable as if it had 51
been properly billed at the point of sale, and the amount 52
due is limited to what the entity would have paid as if it 53
had been properly billed at the point of sale; and 54
(2) If any action by the state to enforce its rights 55
with respect to such claim is commenced within six years of 56
the state's submission of such claim. 57
2. The department of social services, MO HealthNet 58
division, or its contractor may maintain an appropriate 59
action to recover funds paid by the department of social 60
services or MO HealthNet division or its contractor that are 61
due under this section in the name of the state of Missouri 62
against the person, corporation, institution, public agency, 63
or private agency liable to the participant, minor or estate. 64
3. Any participant, minor, guardian, conservator, 65
personal representative, estate, including persons entitled 66
under section 537.080 to bring an action for wrongful death 67
who pursues legal rights against a person, corporation, 68
institution, public agency, or private agency liable to that 69
participant or minor for injuries, disease or disability or 70
benefits arising from a health insurance plan to which the 71
participant may be entitled as outlined in subsection 1 of 72
this section shall upon actual knowledge that the department 73
of social services or MO HealthNet division has paid MO 74
HealthNet benefits as defined by this chapter promptly 75
notify the MO HealthNet division as to the pursuit of such 76
legal rights. 77
4. Every applicant or participant by application 78
assigns his right to the department of social services or MO 79
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HealthNet division of any funds recovered or expected to be 80
recovered to the extent provided for in this section. All 81
applicants and participants, including a person authorized 82
by the probate code, shall cooperate with the department of 83
social services, MO HealthNet division in identifying and 84
providing information to assist the state in pursuing any 85
third party who may be liable to pay for care and services 86
available under the state's plan for MO HealthNet benefits 87
as provided in sections 208.151 to 208.159 and sections 88
208.162 and 208.204. All applicants and participants shall 89
cooperate with the agency in obtaining third-party resources 90
due to the applicant, participant, or child for whom 91
assistance is claimed. Failure to cooperate without good 92
cause as determined by the department of social services, MO 93
HealthNet division in accordance with federally prescribed 94
standards shall render the applicant or participant 95
ineligible for MO HealthNet benefits under sections 208.151 96
to 208.159 and sections 208.162 and 208.204. A participant 97
who has notice or who has actual knowledge of the 98
department's rights to third-party benefits who receives any 99
third-party benefit or proceeds for a covered illness or 100
injury is either required to pay the division within sixty 101
days after receipt of settlement proceeds the full amount of 102
the third-party benefits up to the total MO HealthNet 103
benefits provided or to place the full amount of the third- 104
party benefits in a trust account for the benefit of the 105
division pending judicial or administrative determination of 106
the division's right to third-party benefits. 107
5. Every person, corporation or partnership who acts 108
for or on behalf of a person who is or was eligible for MO 109
HealthNet benefits under sections 208.151 to 208.159 and 110
sections 208.162 and 208.204 for purposes of pursuing the 111
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applicant's or participant's claim which accrued as a result 112
of a nonoccupational or nonwork-related incident or 113
occurrence resulting in the payment of MO HealthNet benefits 114
shall notify the MO HealthNet division upon agreeing to 115
assist such person and further shall notify the MO HealthNet 116
division of any institution of a proceeding, settlement or 117
the results of the pursuit of the claim and give thirty 118
days' notice before any judgment, award, or settlement may 119
be satisfied in any action or any claim by the applicant or 120
participant to recover damages for such injuries, disease, 121
or disability, or benefits arising from a health insurance 122
program to which the participant may be entitled. 123
6. Every participant, minor, guardian, conservator, 124
personal representative, estate, including persons entitled 125
under section 537.080 to bring an action for wrongful death, 126
or his attorney or legal representative shall promptly 127
notify the MO HealthNet division of any recovery from a 128
third party and shall immediately reimburse the department 129
of social services, MO HealthNet division, or its contractor 130
from the proceeds of any settlement, judgment, or other 131
recovery in any action or claim initiated against any such 132
third party. A judgment, award, or settlement in an action 133
by a participant to recover damages for injuries or other 134
third-party benefits in which the division has an interest 135
may not be satisfied without first giving the division 136
notice and a reasonable opportunity to file and satisfy the 137
claim or proceed with any action as otherwise permitted by 138
law. 139
7. The department of social services, MO HealthNet 140
division or its contractor shall have a right to recover the 141
amount of payments made to a provider under this chapter 142
because of an injury, disease, or disability, or benefits 143
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arising from a health insurance plan to which the 144
participant may be entitled for which a third party is or 145
may be liable in contract, tort or otherwise under law or 146
equity. Upon request by the MO HealthNet division, all 147
third-party payers shall provide the MO HealthNet division 148
with information contained in a 270/271 Health Care 149
Eligibility Benefits Inquiry and Response standard 150
transaction mandated under the federal Health Insurance 151
Portability and Accountability Act, except that third-party 152
payers shall not include accident-only, specified disease, 153
disability income, hospital indemnity, or other fixed 154
indemnity insurance policies. 155
8. The department of social services or MO HealthNet 156
division shall have a lien upon any moneys to be paid by any 157
insurance company or similar business enterprise, person, 158
corporation, institution, public agency or private agency in 159
settlement or satisfaction of a judgment on any claim for 160
injuries or disability or disease benefits arising from a 161
health insurance program to which the participant may be 162
entitled which resulted in medical expenses for which the 163
department or MO HealthNet division made payment. This lien 164
shall also be applicable to any moneys which may come into 165
the possession of any attorney who is handling the claim for 166
injuries, or disability or disease or benefits arising from 167
a health insurance plan to which the participant may be 168
entitled which resulted in payments made by the department 169
or MO HealthNet division. In each case, a lien notice shall 170
be served by certified mail or registered mail, upon the 171
party or parties against whom the applicant or participant 172
has a claim, demand or cause of action. The lien shall 173
claim the charge and describe the interest the department or 174
MO HealthNet division has in the claim, demand or cause of 175
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action. The lien shall attach to any verdict or judgment 176
entered and to any money or property which may be recovered 177
on account of such claim, demand, cause of action or suit 178
from and after the time of the service of the notice. 179
9. On petition filed by the department, or by the 180
participant, or by the defendant, the court, on written 181
notice of all interested parties, may adjudicate the rights 182
of the parties and enforce the charge. The court may 183
approve the settlement of any claim, demand or cause of 184
action either before or after a verdict, and nothing in this 185
section shall be construed as requiring the actual trial or 186
final adjudication of any claim, demand or cause of action 187
upon which the department has charge. The court may 188
determine what portion of the recovery shall be paid to the 189
department against the recovery. In making this 190
determination the court shall conduct an evidentiary hearing 191
and shall consider competent evidence pertaining to the 192
following matters: 193
(1) The amount of the charge sought to be enforced 194
against the recovery when expressed as a percentage of the 195
gross amount of the recovery; the amount of the charge 196
sought to be enforced against the recovery when expressed as 197
a percentage of the amount obtained by subtracting from the 198
gross amount of the recovery the total attorney's fees and 199
other costs incurred by the participant incident to the 200
recovery; and whether the department should, as a matter of 201
fairness and equity, bear its proportionate share of the 202
fees and costs incurred to generate the recovery from which 203
the charge is sought to be satisfied; 204
(2) The amount, if any, of the attorney's fees and 205
other costs incurred by the participant incident to the 206
recovery and paid by the participant up to the time of 207
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recovery, and the amount of such fees and costs remaining 208
unpaid at the time of recovery; 209
(3) The total hospital, doctor and other medical 210
expenses incurred for care and treatment of the injury to 211
the date of recovery therefor, the portion of such expenses 212
theretofore paid by the participant, by insurance provided 213
by the participant, and by the department, and the amount of 214
such previously incurred expenses which remain unpaid at the 215
time of recovery and by whom such incurred, unpaid expenses 216
are to be paid; 217
(4) Whether the recovery represents less than 218
substantially full recompense for the injury and the 219
hospital, doctor and other medical expenses incurred to the 220
date of recovery for the care and treatment of the injury, 221
so that reduction of the charge sought to be enforced 222
against the recovery would not likely result in a double 223
recovery or unjust enrichment to the participant; 224
(5) The age of the participant and of persons 225
dependent for support upon the participant, the nature and 226
permanency of the participant's injuries as they affect not 227
only the future employability and education of the 228
participant but also the reasonably necessary and 229
foreseeable future material, maintenance, medical 230
rehabilitative and training needs of the participant, the 231
cost of such reasonably necessary and foreseeable future 232
needs, and the resources available to meet such needs and 233
pay such costs; 234
(6) The realistic ability of the participant to repay 235
in whole or in part the charge sought to be enforced against 236
the recovery when judged in light of the factors enumerated 237
above. 238
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10. The burden of producing evidence sufficient to 239
support the exercise by the court of its discretion to 240
reduce the amount of a proven charge sought to be enforced 241
against the recovery shall rest with the party seeking such 242
reduction. The computerized records of the MO HealthNet 243
division, certified by the director or his or her designee, 244
shall be prima facie evidence of proof of moneys expended 245
and the amount of the debt due the state. 246
11. The court may reduce and apportion the 247
department's or MO HealthNet division's lien proportionate 248
to the recovery of the claimant. The court may consider the 249
nature and extent of the injury, economic and noneconomic 250
loss, settlement offers, comparative negligence as it 251
applies to the case at hand, hospital costs, physician 252
costs, and all other appropriate costs. The department or 253
MO HealthNet division shall pay its pro rata share of the 254
attorney's fees based on the department's or MO HealthNet 255
division's lien as it compares to the total settlement 256
agreed upon. This section shall not affect the priority of 257
an attorney's lien under section 484.140. The charges of 258
the department or MO HealthNet division or contractor 259
described in this section, however, shall take priority over 260
all other liens and charges existing under the laws of the 261
state of Missouri with the exception of the attorney's lien 262
under such statute. 263
12. Whenever the department of social services or MO 264
HealthNet division has a statutory charge under this section 265
against a recovery for damages incurred by a participant 266
because of its advancement of any assistance, such charge 267
shall not be satisfied out of any recovery until the 268
attorney's claim for fees is satisfied, regardless of 269
whether an action based on participant's claim has been 270
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filed in court. Nothing herein shall prohibit the director 271
from entering into a compromise agreement with any 272
participant, after consideration of the factors in 273
subsections 9 to 13 of this section. 274
13. [This section shall be inapplicable to any claim, 275
demand or cause of action arising under the workers' 276
compensation act, chapter 287. From funds recovered 277
pursuant to this section the federal government shall be 278
paid a portion thereof equal to the proportionate part 279
originally provided by the federal government to pay for MO 280
HealthNet benefits to the participant or minor involved. 281
The department or MO HealthNet division shall enforce TEFRA 282
liens, 42 U.S.C. Section 1396p, as authorized by federal law 283
and regulation on permanently institutionalized 284
individuals.] The department or MO HealthNet division shall 285
[have the right to enforce TEFRA liens, 42 U.S.C. Section 286
1396p, as authorized by federal law and regulation on all 287
other institutionalized individuals] collect costs of 288
medical assistance paid for permanently institutionalized 289
individuals pursuant to and to the extent authorized under 290
section 473.402. For the purposes of this subsection, the 291
term "permanently institutionalized individuals" includes 292
those people who the department or MO HealthNet division 293
determines, in compliance with 42 U.S.C. Section 294
1396p(a)(1)(B), cannot reasonably be expected to be 295
discharged and return home[, and "property" includes the 296
homestead and all other personal and real property in which 297
the participant has sole legal interest or a legal interest 298
based upon co-ownership of the property which is the result 299
of a transfer of property for less than the fair market 300
value within thirty months prior to the participant's 301
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entering the nursing facility. The following provisions 302
shall apply to such liens: 303
(1) The lien shall be for the debt due the state for 304
MO HealthNet benefits paid or to be paid on behalf of a 305
participant. The amount of the lien shall be for the full 306
amount due the state at the time the lien is enforced; 307
(2) The MO HealthNet division shall file for record, 308
with the recorder of deeds of the county in which any real 309
property of the participant is situated, a written notice of 310
the lien. The notice of lien shall contain the name of the 311
participant and a description of the real estate. The 312
recorder shall note the time of receiving such notice, and 313
shall record and index the notice of lien in the same manner 314
as deeds of real estate are required to be recorded and 315
indexed. The director or the director's designee may 316
release or discharge all or part of the lien and notice of 317
the release shall also be filed with the recorder. The 318
department of social services, MO HealthNet division, shall 319
provide payment to the recorder of deeds the fees set for 320
similar filings in connection with the filing of a lien and 321
any other necessary documents; 322
(3) No such lien may be imposed against the property 323
of any individual prior to the individual's death on account 324
of MO HealthNet benefits paid except: 325
(a) In the case of the real property of an individual: 326
a. Who is an inpatient in a nursing facility, 327
intermediate care facility for the intellectually disabled, 328
or other medical institution, if such individual is 329
required, as a condition of receiving services in such 330
institution, to spend for costs of medical care all but a 331
minimal amount of his or her income required for personal 332
needs; and 333
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b. With respect to whom the director of the MO 334
HealthNet division or the director's designee determines, 335
after notice and opportunity for hearing, that he cannot 336
reasonably be expected to be discharged from the medical 337
institution and to return home. The hearing, if requested, 338
shall proceed under the provisions of chapter 536 before a 339
hearing officer designated by the director of the MO 340
HealthNet division; or 341
(b) Pursuant to the judgment of a court on account of 342
benefits incorrectly paid on behalf of such individual; 343
(4) No lien may be imposed under paragraph (b) of 344
subdivision (3) of this subsection on such individual's home 345
if one or more of the following persons is lawfully residing 346
in such home: 347
(a) The spouse of such individual; 348
(b) Such individual's child who is under twenty-one 349
years of age, or is blind or permanently and totally 350
disabled; or 351
(c) A sibling of such individual who has an equity 352
interest in such home and who was residing in such 353
individual's home for a period of at least one year 354
immediately before the date of the individual's admission to 355
the medical institution; 356
(5) Any lien imposed with respect to an individual 357
pursuant to subparagraph b. of paragraph (a) of subdivision 358
(3) of this subsection shall dissolve upon that individual's 359
discharge from the medical institution and return home]. 360
14. The debt due the state provided by this section is 361
subordinate to the lien provided by section 484.130 or 362
section 484.140, relating to an attorney's lien and to the 363
participant's expenses of the claim against the third party. 364
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15. Application for and acceptance of MO HealthNet 365
benefits under this chapter shall constitute an assignment 366
to the department of social services or MO HealthNet 367
division of any rights to support for the purpose of medical 368
care as determined by a court or administrative order and of 369
any other rights to payment for medical care. 370
16. All participants receiving benefits as defined in 371
this chapter shall cooperate with the state by reporting to 372
the family support division or the MO HealthNet division, 373
within thirty days, any occurrences where an injury to their 374
persons or to a member of a household who receives MO 375
HealthNet benefits is sustained, on such form or forms as 376
provided by the family support division or MO HealthNet 377
division. 378
17. If a person fails to comply with the provision of 379
any judicial or administrative decree or temporary order 380
requiring that person to maintain medical insurance on or be 381
responsible for medical expenses for a dependent child, 382
spouse, or ex-spouse, in addition to other remedies 383
available, that person shall be liable to the state for the 384
entire cost of the medical care provided pursuant to 385
eligibility under any public assistance program on behalf of 386
that dependent child, spouse, or ex-spouse during the period 387
for which the required medical care was provided. Where a 388
duty of support exists and no judicial or administrative 389
decree or temporary order for support has been entered, the 390
person owing the duty of support shall be liable to the 391
state for the entire cost of the medical care provided on 392
behalf of the dependent child or spouse to whom the duty of 393
support is owed. 394
18. The department director or the director's designee 395
may compromise, settle or waive any such claim in whole or 396
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in part in the interest of the MO HealthNet program. 397
Notwithstanding any provision in this section to the 398
contrary, the department of social services, MO HealthNet 399
division is not required to seek reimbursement from a liable 400
third party on claims for which the amount it reasonably 401
expects to recover will be less than the cost of recovery or 402
for which recovery efforts will not be cost-effective. Cost- 403
effectiveness is determined based on the following: 404
(1) Actual and legal issues of liability as may exist 405
between the participant and the liable party; 406
(2) Total funds available for settlement; and 407
(3) An estimate of the cost to the division of 408
pursuing its claim. 409
473.398. 1. This section shall apply to estates of 1
persons whose deaths occur on or after April 1, 1995, but 2
not on or after August 28, 2026. 3
2. Upon the death of a person, who has been a 4
participant of aid, assistance, care, services, or who has 5
had moneys expended on his behalf by the department of 6
health and senior services, department of social services, 7
or the department of mental health, or by a county 8
commission, the total amount paid to the decedent or 9
expended upon his behalf after January 1, 1978, shall be a 10
debt due the state or county, as the case may be, from the 11
estate of the decedent. The debt shall be collected as 12
provided by the probate code of Missouri[,] in chapters 472, 13
473, 474, and 475. 14
[2.] 3. Procedures for the allowance of such claims 15
shall be in accordance with this chapter, and such claims 16
shall be allowed as a claim of either the sixth or eighth 17
class under subdivisions (6) and (8) of section 473.397. 18
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[3.] 4. Such claim shall not be filed or allowed if it 19
is determined that: 20
(1) The cost of collection will exceed the amount of 21
the claim; 22
(2) The collection of the claim will adversely affect 23
the need of the surviving spouse or dependents of the 24
decedent to reasonable care and support from the estate. 25
[4.] 5. Claims consisting of moneys paid on the behalf 26
of a participant as defined in 42 U.S.C. Section 1396 shall 27
be allowed, except as provided in subsection [3] 4 of this 28
section, upon the showing by the claimant of proof of moneys 29
expended. Such proof may include but is not limited to 30
computerized records maintained by any governmental entity 31
as described in subsection [1] 2 of this section of a 32
request for payment for services rendered to the 33
participant, which shall be deemed to be competent and 34
substantial evidence of payment. 35
[5.] 6. The provisions of this section shall not apply 36
to any claims, adjustments, or recoveries specifically 37
prohibited by federal statutes or regulations duly 38
promulgated thereunder. Further, the federal government 39
shall receive from the amount recovered any portion to which 40
it is entitled. 41
[6.] 7. Before any probate estate may be closed under 42
this chapter, with respect to a decedent who, at the time of 43
death, was enrolled in MO HealthNet, the personal 44
representative of the estate shall file with the clerk of 45
the court exercising probate jurisdiction a release from the 46
MO HealthNet division evidencing payment of all MO HealthNet 47
benefits, premiums, or other such costs due from the estate 48
under law, unless waived by the MO HealthNet division. 49
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473.399. 1. This section shall apply to estates of 1
persons whose deaths occur on or after April 1, 1995, but 2
not on or after August 28, 2026. 3
2. As used in this section, the following terms mean: 4
(1) "Assistance", funds expended by a state agency to 5
or on behalf of a person in the form of aid, care, or 6
services, except that for the purposes of this section, aid 7
to families with dependent children shall not be considered 8
assistance; 9
(2) "Obligor estate", the estate against which an 10
obligation under this section arises; 11
(3) "Recipient", a person to whom or on whose behalf 12
assistance is provided; 13
(4) "State agency", the department of social services, 14
department of health and senior services and department of 15
mental health of the state of Missouri. 16
[2.] 3. For the purposes of this section, the 17
providing of assistance shall create an obligation which may 18
be recovered by filing a claim in the probate division of 19
the circuit court against the decedent estate of the spouse 20
of the deceased recipient upon such spouse's death as 21
provided by the probate code of Missouri[,] in chapters 472, 22
473, 474, and 475. The amount of the state debt shall be 23
the full amount of assistance without interest provided to 24
the recipient during the marriage of such recipient and 25
spouse; provided that the liability of the obligor estate 26
shall not exceed the value of the combined resources of the 27
recipient and the spouse of the recipient on the date of 28
death of the recipient. 29
[3.] 4. The state agency providing the assistance may 30
initiate a claim on the debt against the obligor estate. 31
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[4.] 5. The obligor estate may assert as a defense to 32
the state agency's claim that more than two years prior to 33
the providing of assistance, the recipient voluntarily 34
abandoned the spouse. 35
[5.] 6. An obligor estate shall have the right of 36
setoff against the state debt for any amounts recovered by 37
the state agency from the estate of the deceased recipient 38
pursuant to section 473.398. 39
[6.] 7. Claims shall not be filed under this section 40
when collection of the state debt would be contrary to 41
federal statutes for assistance programs in which federal 42
funds are received. 43
473.402. 1. This section shall apply to estates of 1
persons whose deaths occur on or after August 28, 2026. 2
2. As used in this section, the following terms mean: 3
(1) "Assistance", medical assistance provided under MO 4
HealthNet; 5
(2) "Department", the department of social services; 6
(3) "Estate", the estate of the deceased recipient, 7
exclusive of any real or personal property transferred by a 8
nonprobate transfer in accordance with chapter 461; 9
(4) "Heir", a person who inherits or receives an 10
interest in the deceased recipient's estate; 11
(5) "Recipient", a person to whom or on whose behalf 12
assistance is provided. 13
3. There may be no adjustments or recovery of 14
assistance correctly paid except for recovery from the 15
estate of a recipient who was: 16
(1) Regardless of age, a resident in a nursing 17
facility or other medical institution within the meaning of 18
42 U.S.C. Section 1396p(a)(1)(B) when the recipient received 19
such assistance; provided, however, that recovery of such 20
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assistance shall be limited to assistance provided on or 21
after March 22, 1991; or 22
(2) Fifty-five years of age or older when the 23
recipient received such assistance, where such assistance 24
was for services provided on or after October 1, 1993, but 25
only for medical assistance consisting of nursing facility 26
services, home and community-based services, and related 27
hospital and prescription drug services for which estate 28
recovery is mandated in 42 U.S.C. Section 1396p(b)(1)(B)(i) 29
or other federal law. 30
4. Any recovery allowable under subsection 3 of this 31
section may be made only after the death of the surviving 32
spouse, if any, and only at a time when the recipient has no 33
surviving child who is: 34
(1) Under the age of twenty-one; or 35
(2) A person who is blind or a person with a 36
disability. 37
5. Upon the death of a recipient, recovery allowable 38
under subsection 3 of this section may be collected as 39
provided by the probate code of Missouri in chapters 472, 40
473, 474, and 475. 41
6. Recovery against a recipient's estate may be made 42
only when recovery would meet all of the following criteria: 43
(1) Recovery would not create an undue hardship. An 44
undue hardship includes the following circumstances: 45
(a) Heirs would be eligible for public or medical 46
assistance following the execution of the recovery claim; 47
(b) The Medicaid recipient received medical assistance 48
because the recipient was the victim of a crime, as defined 49
by Missouri law; 50
(c) Recovery is pursued against real property that 51
meets any one of the following criteria: 52
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a. The property subject to recovery is the sole income- 53
producing asset of heirs or legatees, such as a family farm 54
or other family business, and recovery by the state would 55
affect the property and result in the heirs losing their 56
primary source of income; 57
b. The value of the property is less than fifty 58
percent of the average price of homes in the county where 59
the property is located or is less than two hundred thousand 60
dollars, which amount shall be annually adjusted on January 61
first of each year by the department for inflation based on 62
the cost of living adjustment, as provided and officially 63
recorded by the United States Social Security 64
Administration. The director of the department shall 65
furnish the value to the secretary of state for publication 66
in the Missouri Register on the first business day following 67
January first. The value of the real property is the value 68
assessed by the county in which the property is located, 69
minus any debt owed; or 70
c. An heir was using the property as a principal place 71
of residence on a continual basis for at least six months 72
prior to the recipient's death and meets all of the 73
following conditions: 74
(i) The heir continues to live in the property at the 75
time the notice of claim is filed; and 76
(ii) The heir is not being forced to sell the property 77
by other heirs and legatees by a partition action; 78
(d) Any heir, evaluated separately from other heirs, 79
has a family income below three hundred percent of the 80
United States Department of Health and Human Services 81
federal poverty level guidelines as published annually in 82
the Federal Register. As used in this paragraph, the phrase 83
"family income" means that each person will be considered 84
SB 1683 20
separately. Heirs will not be aggregated into one family 85
unless the heirs are minor children who are siblings. An 86
adult heir's family will be limited to the heir, the heir's 87
spouse, and the heir's biological or legally adopted minor 88
children and stepchildren residing in the household. A 89
minor heir's family will be the heir, their parent or 90
parents, or stepparent residing in the household, and the 91
heir's minor siblings residing in the household, including 92
half-siblings, stepsiblings, and legally adopted siblings; or 93
(e) Any other compelling circumstances exist that 94
would result in placing an unreasonable financial burden on 95
an heir; 96
(2) Recovery is cost effective. Collection of a claim 97
is cost effective only if the department determines, prior 98
to initiating a claim or lien, that the potential recovery 99
amount would be at least twice the administrative and legal 100
cost of pursuing the claim. In assessing the net value of 101
the estate, the department will account for allowances, all 102
encumbrances on property, and all other claims against the 103
estate having precedence under state statute. As used in 104
this subdivision, the phrase "administrative and legal 105
costs" includes the costs of: 106
(a) Advertising, filing, and exercising a lien; 107
(b) Legal representation of the state; 108
(c) Tracking property with potential for a lien and 109
then tracking its subsequent recovery; 110
(d) Repair of property to bring it into saleable 111
condition; 112
(e) Insurance to protect property; 113
(f) Advertising, listing, and selling property, 114
including all applicable closing fees; and 115
(g) Any other applicable administrative or legal costs. 116
SB 1683 21
In no event shall collection be considered cost effective if 117
the net value of the estate is at or below fifty thousand 118
dollars as of December 31, 2026, which amount shall be 119
annually adjusted by the department for inflation based on 120
the cost of living adjustment, as provided and officially 121
recorded by the United States Social Security Administration. 122
The department's accounting and all supporting documents 123
shall be filed by the department concurrently with any claim 124
for recovery of public assistance funds from the estate; and 125
(3) Recovery does not violate any of the limitations 126
set forth in 42 U.S.C. Section 1396. 127
7. The department shall make information about estate 128
recovery and hardship exemptions easily accessible. The 129
department shall maintain information about how to request a 130
hardship exemption on its website, including a short guide 131
and simple form to facilitate requesting hardship 132
exemptions. On an annual basis, the department shall 133
publicly report on the number of estate recovery cases that 134
are pursued and the number of undue hardship exemptions 135
granted, including demographic data and zip code of the 136
deceased beneficiaries if available. 137
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