The federal rule that protects Medicare Savings Program help
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), section 115, changed the Medicaid estate recovery law, 42 U.S.C. § 1396p(b)(1)(B). Starting January 1, 2010, states may not recover "medical assistance for medicare cost-sharing" from the estates of people 55 and older. CMS told every state, in State Medicaid Director Letter #10-003, that this covers the Medicare cost sharing paid for QMB, SLMB, QI and QDWI members, including people with QMB Plus or SLMB Plus. Medicare cost sharing includes your Part A and Part B premiums, deductibles and coinsurance.
So the Part B premium OHCA pays for you each month (the standard amount is $202.90 in 2026) can't be claimed from your house after you die.
What Oklahoma's rule does cover
Oklahoma's rules (OAC 317:35-9-15 and OAC 317:35-19-4) apply to SoonerCare members who were 55 or older when they received care. They list the services OHCA seeks to recover:
- Nursing facility services
- Home and community-based services, such as the ADvantage waiver
- Related hospital, prescription drug, physician and transportation services
CMS notes that the 2010 exemption doesn't exempt Medicare Savings Program members from all estate recovery. If you also get full SoonerCare and use those services at 55 or older, those SoonerCare payments can still be part of a claim.
Oklahoma's protections for your family and home
| Situation | What OHCA's rule says |
|---|---|
| Surviving spouse | No estate recovery until after the spouse dies |
| Child 20 or younger, or disabled child of any age, living in the home | No lien on the home and no estate recovery while they live there |
| Sibling with an ownership share who lived there a year before admission | No lien on the home |
| Long-Term Care Partnership policy | Assets protected by the policy are not recovered |
| Undue hardship | A waiver may be granted by OKDHS |
Tip: Fear of losing a home keeps some Oklahomans from applying. If you only need help with Medicare premiums and cost sharing, that help is protected. See how to apply and what QMB pays.
For questions about a specific estate, contact OHCA or an Oklahoma attorney. Read more in who pays for nursing homes and the Medicare Savings Programs guide. To review Medicare coverage from the companies they work with, you can request a call from a licensed insurance agent.
Sources
- 42 U.S.C. § 1396p(b)(1)(B), as amended by Pub. L. 110-275, § 115 (effective January 1, 2010)
- CMS — State Medicaid Director Letter #10-003, MIPPA section 115 estate recovery exemption
- OHCA — OAC 317:35-9-15, Medicaid recovery
- OHCA — OAC 317:35-19-4, Medicaid recovery (nursing facility services)
- Oklahoma Health Care Authority — SoonerCare Supplemental
More questions in this guide
- How do I apply for a Medicare Savings Program in Oklahoma?
- What are the Medicare Savings Program income limits in Oklahoma?
- What is Extra Help for Medicare drug costs and how do I apply?
- What is QMB in Oklahoma?
Part of the guide: Medicare Savings Programs in Oklahoma · All questions
Frequently asked questions
What does Oklahoma recover from estates?
OHCA's rule (OAC 317:35-9-15) seeks recovery for SoonerCare members who were 55 or older when they got care, for nursing facility services, home and community-based services, and related hospital, prescription drug, physician and transportation services.
Can Oklahoma put a lien on my home while I'm alive?
Only in limited cases. OHCA's rule allows a lien when, after notice and a chance for a hearing, it finds that a member in a nursing facility can't reasonably be expected to return home. No lien may be filed while a spouse, a child 20 or younger, a disabled child, or certain siblings live in the home.
Is my surviving spouse protected?
Yes. OHCA's rule says estate recovery may happen only after the death of any surviving spouse, and only when no child 20 or younger and no disabled child of any age lives in the home.
Can my family ask Oklahoma to waive recovery?
Yes. Oklahoma has an undue hardship waiver for cases where recovery would endanger someone's health or life or leave dependent family members without food, clothing or shelter. OKDHS decides and sends a written notice.
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