Overview
When you applied for OHP, you agreed that any other medical payments you receive would go to the state. This is called “assignment of rights."
When the state collects these other payments, it is called “payment recovery." The state will keep the money it collects from other payers. This money helps other people get the care and services they need.
Estate Recovery
After an OHP member dies, Oregon Department of Human Services (ODHS) will ask to be paid back for services that OHP covered after age 55 for people in long-term care. This is known as “estate recovery.” Federal and state law require this.
Some of the money from estate recovery goes into ODHS programs to help other people. Some is returned to the federal government so Oregon may continue to receive federal money for Medicaid programs.
Estate recovery applies only when OHP has paid for some or all of the cost of a member's long-term care using Medicaid funds. Long-term care can be:
- An assisted living facility
- A residential care facility
- An adult foster home
- In-home care
- A nursing facility
- An intermediate care facility for people with intellectual or developmental disabilities or
- Other similar long-term care.
All Medicaid benefits paid since age 55 during the member's long-term care, such as:
- All long-term care benefits
- Provider payments for services received on a fee-for-service basis
- Monthly fees paid to a coordinated care organization
- Medicare copays, coinsurance, premiums and deductibles paid before Jan. 1, 2010 and
- The monthly fee that OHA paid to Medicare for the member's Part D prescription coverage.
ODHS will not make a claim to recover Medicaid benefits until the OHP member's spouse dies. After that, ODHS will make the claim against the spouse's estate to the extent allowed by law.
Contact the Estate Administration Unit to learn more.
ODHS will not make a claim to recover Medicaid benefits if any living children are:
- Under age 21 or
- Blind or permanently and totally disabled. The disability must meet the Social Security Administration's definition of permanent and total disability.
This only applies to the OHP member's natural or legally adopted children.
ODHS will not make a claim to recover Medicaid benefits from tribal resources, such as:
- Interest and income from tribal land or resources
- Tribal property, including tribal property in or near a recognized reservation or ` Items of unique religious, spiritual, traditional and cultural significance.
To learn more, see Oregon Administrative Rule 461-135-0837.
Any person receiving money or valuables after the OHP member dies may ask ODHS to waive estate recovery. The person must meet the requirements of a hardship waiver. There are important deadlines for hardship waivers. Please contact the Estate Administration Unit right away.
This is a summary of how estate recovery works for benefits received on or after Oct. 1, 2013. The law and rules may change without warning. To learn more, such as how it works for Medicaid benefits received before Oct. 1, 2013:
Contact ODHS Estate Administration Unit:
P.O. Box 14021, Salem, OR 97301
800-826-5675 (toll-free inside Oregon)
503-378-2884 / TTY: 711
Fax: 503-378-3137
Medical Support
If a child living in your home is on OHP and one or both parents are not living with you, you gave the state permission to:
- Find out about your child's absent parent(s) and
- Sign up your child for the parent's health insurance or have the parent(s) pay for the child's OHP coverage.
If you have safety concerns about absent parents, tell us not to contact them. To do this, call ONE Customer Service at 800-699-9075 (TTY 711).
Personal Injury or Accidents
If you have a claim or intend to file a claim for an accident, injury or medical malpractice, please tell us right away.
Filing a claim means that someone else might need to pay back OHP for any health care payments related to your claim.
- This could be from their private insurance, car insurance or another source.
- This applies from the date of your injury to the date the claim is paid.
If you are in a coordinated care organization (CCO), you must also tell the CCO about the claim.
If you do not tell us about a claim or any payments you get from a claim:
OHA or your CCO may take legal action against you. We may file suit or seek an overpayment against you, or you may lose your benefits.
To report a personal injury claim:
Report current claims or your intent to file a claim at www.reportinjury.org.
If you have questions:
Contact ODHS Personal Injury Liens Unit:
P.O. Box 14512, Salem, OR 97309
Toll-free 800-377-3841
503-378-4514 (Salem)
TTY 711