## Facts

- Julius Tutinas entered a nursing home in 1994 and was approved for Medicaid; the Illinois Department of Public Aid paid $61,154.48 for his care through his death in 1997.
- Julius and his wife, Beverly, held their home and automobile in joint tenancy; upon Julius’s death, full ownership passed to Beverly by survivorship.
- No probate estate was opened for Julius.
- Beverly never applied for or received Medicaid benefits.
- Beverly died in 2001; her probated estate consisted solely of the home and automobile (later liquidated).
- The Department filed a claim against Beverly’s estate seeking reimbursement for Medicaid payments made on Julius’s behalf.

## Issues

1. Whether federal Medicaid estate-recovery law (42 U.S.C. § 1396p(b)) permits a state to recover benefits paid for a deceased recipient from the estate of a surviving spouse who was not a Medicaid recipient, when the spouse’s estate includes assets acquired by survivorship.
2. Whether Illinois law, including section 5-13 of the Illinois Public Aid Code and the Probate Act, authorizes such recovery consistent with federal law.

## Decision

- The Illinois Supreme Court affirmed the appellate court and rejected the Department’s claim against Beverly’s estate.
- The court held federal law limits recovery to the Medicaid recipient’s estate and does not authorize recovery from a different person’s estate.
- The court concluded Julius’s joint-tenancy interests terminated at death; the home and automobile passed to Beverly and were not part of Julius’s estate for estate-recovery purposes.
- The court held Illinois’s Public Aid Code authorizes recovery only from the recipient’s estate, and the Probate Act does not create a broader substantive right of recovery.

## Legal Principles

- Medicaid estate recovery is authorized only to the extent permitted by 42 U.S.C. § 1396p(b); a state recovery scheme cannot exceed federal limits.
- The optional expanded definition of “estate” under § 1396p(b)(4)(B) applies to the estate of the Medicaid recipient and allows inclusion of certain interests the recipient held at death, only to the extent of that interest.
- Under Illinois joint-tenancy law, a decedent joint tenant’s interest terminates at death and the surviving joint tenant takes full title by operation of law.
- Section 5-13 of the Illinois Public Aid Code authorizes recovery from the estate of the Medicaid recipient; absent clear statutory authorization, liability cannot be extended to a non-recipient spouse’s estate.
- General probate claims procedures do not enlarge the substantive scope of Medicaid estate-recovery authority.

## Conclusion

The court held the state could not obtain Medicaid reimbursement for benefits paid on behalf of a deceased recipient by filing a claim against the estate of a non-recipient surviving spouse, even when the spouse’s estate consisted of assets that had passed to her by joint-tenancy survivorship.


Hines v. Department of Public Aid, 221 Ill. 2d 222, 850 N.E.2d 148 (Ill. 2006)