MassHealth Estate Recovery- American Indian and Alaska Native Exemptions

The American Recovery and Reinvestment Act (ARRA) of 2009 exempts certain income and resources of American Indians and Alaska Natives from estate recovery (seeking repayment for outlays after a member has died). Additionally, in certain circumstances, American Indians and Alaska Natives are exempt from cost sharing. MassHealth has issued emergency regulations, retroactive to July 1, 2009, to reflect these changes.

130 CMR 501.013: Estate Recovery (Trans. by Eligibility Letter 195 )

(F) Waiver of Estate Recovery Due to Hardship for American Indians and Alaska Natives.

(1) For claims presented on or after July 1, 2009, recovery from the following American Indian and Alaska Natives income, resources, and property will be waived:

(a) certain income and resources (such as interests in and income derived from tribal land and other resources currently held in trust status and judgment funds from the Indian Claims Commission and the U.S. Claims Court) that are exempt from Medicaid estate recovery by other laws and regulations;

(b) ownership interest in trust and non-trust property, including real property and improvements

(i) located on a reservation (any federally recognized Indian tribe’s reservation, pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established by the Alaska Native Claims Settlement Act, and Indian allotments) or near a reservation as designated and approved by the Bureau of Indian Affairs of the U.S. Department of the Interior; or

(ii) for any federally recognized tribe not described in 130 CMR 501.013(F)(2)(a), located within the most recent boundaries of a prior federal reservation.

(c) income left as a remainder in an estate derived from property protected in 130 CMR 501.013(F)(2), that was either collected by an Indian or by a tribe or tribal organization and distributed to Indians, as long as the individual can clearly trace it as coming from protected property;

(d) ownership interests left as a remainder in an estate in rents, leases, royalties, or usage rights related to natural resources, including extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish, or fish products, resulting from the exercise of federally protected rights and income either collected by an Indian or by a tribe or tribal organization and distributed to Indians derived from these sources as long as the individual can clearly trace it as coming from protected sources; or

(e) ownership interests in or usage rights to items not covered by 130 CMR 501.013(F)(1) through (4) that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional life style according to applicable tribal law or custom.

(2) Protection of non-trust property described in 130 CMR 501.013(F)(2)(a) and (b) is limited to circumstances when it passes from an Indian, as defined in section 4 of the Indian Health Care Improvement Act, to one or more relatives (by blood, adoption, or marriage), including Indians not enrolled as members of a tribe and non-Indians, such as spouses or step-children, that their culture would nevertheless protect as family members, to a tribe or tribal organization, or to one or more Indians.

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130 CMR 506.011: MassHealth Standard, CommonHealth, Family Assistance, and the Children’s Medical Security Plan (CMSP) Premiums (Trans. by Eligibility Letter 195 )

(M) Members Exempted from Cost Sharing. American Indians or Alaska Natives who are furnished an item or service directly by the Indian Health Service, an Indian tribe, a tribal organization, or an urban Indian organization are exempt from cost sharing.

-Adapted from “Revisions to Regulations about Estate Recovery: American Recovery and Reinvestment Act of 2009”, MassHealth Eligibility Letter 195, February 1, 2010, http://www.mass.gov/eohhs/docs/masshealth/el2010/el-195.pdf retrieved 2/10/10.

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