Medical Assistance

2.1.1.2.1.2 MA Liens

The Minnesota Department of Human Services (DHS) files liens against real property interests to recover the amount Medical Assistance (MA) paid for certain services described in state and federal law. A lien is a legal right or interest that a creditor has in another person’s property until the creditor’s claim has been repaid or the lien expires. Real property includes land and buildings on land.

The DHS lien process is separate from county-administered estate recovery, though liens help secure county claims against estate assets.

Liens on Real Property

There are two types of liens that DHS files to secure repayment of MA:

MA liens (also called TEFRA liens)
Notices of potential claim (NPCs)

Refer to the MA Estate Recovery Manual for more information about MA liens and NPCs.

Populations Affected by Liens

MA Liens

An MA lien can be filed against an MA enrollee’s real property interests if the enrollee’s eligibility basis was anything other than MA for Families with Children and Adults (MA-FCA) when the enrollee receives services at when residing in a medical institution without reasonable expectation of discharge, as verified by the enrollee's attending physician, advanced practice registered nurse, or physician assistant.

NPCs

An NPC can be filed against an MA enrollee’s real property interests when the enrollee receives MA services at age 55 years old or older, through an NPC is not an effective lien against the real property until after the enrollee dies.

Recoverable Services

An MA lien can recover the costs of the following program services:

MA
- The following MA services received by enrollees 55 years old or older who do not permanently reside in a medical institution:
  - Nursing facility services (NFS)
  - Home and community-based services (H CBS)
  - Hospital and prescription drug services received during the time the enrollee was provided NFS or HCBS
- All MA services received by enrollees, regardless of age, during permanent residence in a medical institution.
General Assistance Medical Care (GAMC)

An NPC can recover the costs of the following program services:

The following MA services received by enrollees 55 years old or older, including those who do not permanently reside in a medical institution:
- NFS
- HCBS
- Hospital and prescription drug services received during the time the enrollee was provided NFS or HCBS
GAMC

Generally, all these program services fall under the definition of “MA” for lien collection purposes.

Nonrecoverable Services

The costs of the following program services cannot be recovered by an MA lien or NPC:

MA services not identified in the Recoverable Services section
MinnesotaCare
Consolidated Chemical Dependency Treatment Fund (CCDTF)

Life Estate and Joint Tenancy Interests

If a person owns a life estate or joint tenancy interest in real property when he or she dies, and the interest was established on or after August 1, 2003, that interest remains subject to a lien after death to satisfy repayment of MA. Recovery on a life estate is limited to the value of the person's interest on the date of death as determined by the Life Estates Mortality Table.

Exceptions to Liens

MA Liens and NPCs

Exceptions to filing or collection on an MA Lien or NPC is provided in the MA Estate Recovery Manual.

American Indian and Alaskan Native Exemptions

Certain real property of American Indians and Alaska Natives is exempt from liens, including real property that is:

Located on a reservation (any federally recognized Indian Tribe's reservation, Pueblo, or Colony, including former reservations, in Oklahoma, Alaska Native regions established by 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
for any federally recognized tribe not described in the above bullet point located within the most recent boundaries of a prior federal reservation.

Legal Citations

Minnesota Statutes, section 256B.15

Minnesota Statutes, sections 514.980 to 514.985

United States Code, title 42, section 1396p