The Department of Community Health (DCH) oversees the administration of Georgia’s Medicaid and PeachCare for Kids® programs. HMS is contracted with DCH to operate the Subrogation Unit, Estate Recovery Unit, and Trust Unit.
The Subrogation Unit is responsible for enforcing DCH’s rights to recovery in subrogation claims, and for ensuring that the State receives its reimbursement. The Subrogation Unit’s purpose is to recover the cost of medical expenditures from liable third parties when members are involved in a personal injury action. These suits may be related to an auto accident, medical malpractice claim, general liability, worker’s compensation, mass torts, or any other tort claim where a settlement has been reached or a judgment has been awarded.
To notify DCH of an action, please print and complete the transmittal form and fax it or your standard letter of representation to our office at 855-467-3970. The Subrogation Unit will contact you with the subrogation amount to help you settle your claim. If you require a breakdown of the bills paid by DCH, please include a signed medical authorization. A link to the medical authorization form can be found under the forms menu.
Please note that the Department of Community Health has three rights to recovery:
- Subrogation (Claims against liable third parties)
- Assignment (Medicaid Members assign their rights to tort settlements to DCH as a condition of eligibility)
- Department Lien (State and federal law allows DCH to place a lien in the amount of Medicaid expenditures for injuries to Members for which third parties are liable)
Estate Recovery Unit
Estate Recovery is a program required by the federal government in every state, in which the estate assets of deceased Medicaid members are used to reimburse the taxpayers for long-term care provided through Medicaid. Funds are recovered from the member’s estate after his/her death for the cost of these services. The total value of the estate must be over $25,000 for estate recovery to apply. An estate includes all real and personal property (homes, land, vehicles, cash, bank accounts) held individually or jointly. All assets of a deceased Medicaid member are subject to recovery, including property held with a life estate interest.
Trust Unit – Special Needs Trust
A Special Needs Trust (SNT) is a trust set up to provide for the extra or supplementary needs of a disabled person, beyond the basic assistance provided by government programs. SNTs are also known as Luxury, Discretionary, or Supplementary Trusts. SNTs that hold the beneficiary’s own funds are sometimes called “payback trusts” because when the SNT terminates, Medicaid must be paid back for all medical assistance received by the beneficiary during their lifetime.
Official Georgia Code Annotated and Code of Federal Regulations
The authority and subrogation recovery rights can be referenced in the following state and federal cites:
- O.C.G.A. § 9-2-21 (PDF)
- O.C.G.A §49-4-148 (PDF)
- O.C.G.A. §49-4-149 (PDF)
- 42 CFR 433.138 (PDF)
- GA Estate Recovery Rules: 111-3-8 (PDF)
- GA Estate OCGA 49-4-147.1 (PDF)
Welcome to the Subrogation, Estate Recovery, and Special Needs Trust website for the Georgia Medicaid Program, operated by HMS.