Governor Deval Patrick's Budget Recommendation - House 2 Fiscal Year 2009

Governor's Budget Recommendation FY 2009

Outside Section 19



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Medicaid Clawback Pharmacy Recovery

SECTION 19.   (A) Subsection (b) of section 31 of chapter 118E of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out the last paragraph and inserting in place thereof the following paragraph:-
Any recovery under subsections (a), (b), or (b 1/2) may be made only after the death of the surviving spouse, if any, and only at a time when the surviving spouse has no surviving child who is under age 21 or is blind or permanently and totally disabled. The division shall waive recovery if that recovery would work an undue hardship, as defined by the division in its regulations. If insufficient estate assets are available to repay the full amount due, any amounts recovered shall first be applied to the amount due under subsection (b 1/2).

(B) Said section 31 of said chapter 118E, as so appearing, is hereby further amended by inserting after said subsection (b) the following subsection:-
(b 1/2) This subsection shall apply to estates of individuals dying on or after July 1, 2008. An estate of an individual who was a "full benefit dual eligible", as defined under 42 U.S.C. section 1396u-5, shall be responsible for repaying the state Medicaid program contributions that the state made to the secretary of the federal Department of Health and Human Services for the federal assumption of prescription costs for the dual eligible under 42 U.S.C. section 1396u-5(c).

(C) The first paragraph of subsection (d) of said section 31 of said chapter 118E , as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following 2 sentences:- If the individual at any time on or after July 1, 2008, was a "full benefit dual eligible", as defined by 42 U.S.C. section 1396u-5, the amount due shall also include contributions the state Medicaid program made to the secretary of the federal Department of Health and Human Services for the federal assumption of prescription costs for the dual eligible under 42 U.S.C. section 1396u-5(c). If insufficient assets exist from the proceeds from the sale to repay both the amount of assistance provided and payments for the federal assumption of prescription costs, any amounts recovered shall first be applied to payments for the federal assumption of prescription costs.
 
 

Summary:
This section authorizes the MassHealth program to collect not only Medicaid payments, but also the state's federal pharmacy clawback costs, as part of an estate recovery claim or lien against real estate.



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