Medi-Cal Estate Recovery: The “Homestead of Modest Value” Waiver California law gives heirs a way out of a Medi-Cal estate recovery claim when the family home is worth relatively little. The rule comes from Welfare & Institutions Code § 14009.5, added by SB 33 in 2015. California Advocates for Nursing Home Reform sponsored the bill. Under § 14009.5, DHCS must consider whether recovery would cause substantial hardship. If the estate is a “homestead of modest value,” DHCS is required to waive its claim, subject to federal approval. The statute defines a homestead of modest value as a home whose fair market value is 50% or less of the average home price in the county, measured as of the date of death. DHCS also has to tell heirs about the waiver and their right to a hearing, and must include this in its Estate Recovery Program pamphlet. The same section limits recovery in other ways: - DHCS can recover only for services federal law requires it to collect for. - “Estate” includes only the assets federal law requires. - There is no recovery at all if the Medi-Cal member is survived by a spouse or registered domestic partner. Heirs who keep the home can agree to a voluntary post-death lien. That lien accrues interest at the lower of two rates: the Surplus Money Investment Fund’s annual average rate for the year before death, or 7% simple interest. The implementing regulation is 22 Cal. Code Regs. § 50963. Under it, DHCS will not grant a hardship waiver if the hardship was created through estate planning, such as transferring assets before death. The federal framework sits behind the state law: - 42 U.S.C. § 1396p(b)(1)(B) makes recovery mandatory for nursing facility care, home and community-based services, and related hospital and drug costs for anyone who received them at age 55 or older. - 42 U.S.C. § 1396p(b)(3) requires every state to have an undue-hardship waiver process. - State Medicaid Manual § 3810.C specifically allows the modest-value homestead exemption, using the same 50%-of-county-average test.