No, the Estate Recovery Unit of the DC Medicaid program determines the amount of medical assistance paid on behalf of the deceased from the age of 55 years or older through the date of death. The Estate Recovery Unit sends a Notice of Proposed Recovery including an Exemption Application/Undue Hardship Application thirty days prior filing the claim/lien.

Send the check and explanation of benefit from the insurance company or a letter with your Medicaid identification number and date of service explaining the nature of the overpayment to: Department of Health Care Finance, Third Party Liability Section, Suite 1000S, 441 4th Street, NW, Washington, DC  20001.

Medicaid needs a letter of representation from the attorney. The claim adjuster may send a written request. Requestors must also send a HIPAA Authorization signed by the recipient, parent, or legal guardian if a minor, permitting the release of information. These statements may be faxed or mailed to the Department of Health Care  Finance, Third Party Liability Section, Suite 1000S, 441 4th Street, NW, Washington, DC  20001, fax  (202)  727-5645.

Lock-in indicates the recipient can receive services only from a certain pharmacy, long term care/ICF or physician provider.

Medicaid will recover all money paid for medical services related to the accident and paid by Medicaid. When your claim against the Insurance Company is settled, a check in the amount paid by Medicaid should be made out to DC Treasurer and sent to the Medicaid Department of Health Care Finance, Third Party Liability Section, Suite 1000S, 441 4th Street, NW, Washington, DC  20001 as reimbursement for the money Medicaid spent.

Please call the Office of Program Operations at (202) 698-2000.

Third party Liability (TPL) refers to the legal obligation of third parties, (i.e., certain individuals, entities or programs0, to pay all or part of the expenditures for medical assistance furnished under a State plan. Medicaid is, by law, intended to be the payer of last resort; that is, all other resources must pay claims before Medicaid pays for the care of an individual eligible for Medicaid.

Please call Economic Security Administration (ESA) at (202) 724-5506. Please have your Medicaid number or social security number available when you call.

Eligibility is never purged; therefore, it goes back many years.

Medicaid will provide non-emergency transportation services to Medicaid eligible beneficiaries that have appointments with Medicaid providers. You must contact MTM (1-866-796-0601) or (202) 263-4640 (DC Office) 72 hours in advance of your scheduled appointment to arrange transportation to your medical appointment.

A lien is a legal action taken by the District to seek recovery for individuals age 55 or older for all Medicaid services, nursing facility services, home and community-based services, and related hospital and prescription drug services. The lien is filed against the real property in the District of Columbia Office of the Recorder of Deeds. The estate is expected to pay 100%. 

Please call the Office of Program Operations at (202) 698-2000 or use the 'Search for Provider' feature on the Web Portal to locate a nearby provider.

Medicaid did not assign you to a drug plan. This is a Medicare program. However, you can contact the George Washington Health Insurance Counseling Project at (202) 739-0668 for assistance. You can also contact Medicare for further information, toll free at 800-Medicare (800-633-4227) or at www.medicare.gov.

The District of Columbia recovers the cost of medical assistance from the estates of persons age 55 or older when receiving medical assistance at Long Term Care facilities, home and community based Waiver services,  all Medicaid services and prescription drugs services.