Overview
You may have rights or options during the MERP process. The availability of an exclusion, exemption, hardship, deferral, or appeal depends on the facts of the case and applicable program rules.
Exclusions, exemptions, and hardship waivers
Some estates may not be subject to recovery, and some heirs may qualify for an exemption or undue-hardship waiver. Eligibility depends on the facts of the case and the documents provided to MERP.
Common situations that may affect recovery
Examples may include:
- The Medicaid recipient has a surviving spouse.
- The Medicaid recipient has a surviving child who is younger than 21.
- The Medicaid recipient has a surviving child of any age who is blind or permanently and totally disabled.
- The estate does not contain property or assets that are subject to recovery.
- Recovery would not be cost-effective under applicable program rules.
Undue-hardship waivers
If no exclusion or exemption applies, an heir may still be able to request an undue-hardship waiver. Examples of circumstances that may be considered include:
- The heir's family income is below the limit established by the program.
- The estate property was used as a qualifying family business, farm, or ranch and was a primary source of family income.
- Other circumstances recognized by applicable state rules would make recovery an undue hardship.
If you believe one of these situations applies
- Respond by the deadline shown on your notice. Do not assume the case will be excluded automatically.
- Tell MERP which exclusion, exemption, or hardship circumstance you believe applies.
- Upload supporting documents, such as proof of relationship, age, disability, income, property ownership, or operation of a family business, farm, or ranch.
- Complete any exemption or hardship-waiver form requested by MERP.
- Contact MERP if you need help identifying the documents to provide or cannot meet the response deadline.
Submitting a request does not guarantee that an exclusion, exemption, or hardship waiver will be approved. MERP will review the information and notify you of the determination.
Hardship review
If you request an undue-hardship waiver, MERP will review the information and supporting documentation you provide. Additional information may be requested before a determination can be made.
During the review, continue to monitor your portal account for messages, document requests, and status updates. Respond promptly to any requests for additional information to help avoid delays.
What happens next?
- Your hardship request is reviewed by MERP.
- You may be asked to provide additional documentation.
- A determination is made based on applicable program requirements.
- You will receive notification of the decision through the portal or by mail.
Deferrals
A deferral temporarily delays recovery. If a deferral is approved, MERP will not pursue recovery while the deferral is in effect. A deferral does not eliminate the amount that may be owed.
MERP will let you know if your deferral is approved, how long it applies, and if you need to provide any additional information.
Appeals
If you disagree with a decision, review the notice carefully. It should explain deadlines, instructions, and where to send appeal-related information.
