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  • Ohio Tort Recovery Unit

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SECTION A: Name: Address: Billing Number: Social Security Number: (Optional - see reverse side) I, , hereby authorize, to (Name of Individual) (Name of Covered Entity) disclose protected health information to , for the purpose of (Who ill receive the information).

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Estate recovery seeks to obtain repayment for the cost of Medicaid benefits once a Medicaid eligible individual is deceased. This happens after the death of a Medicaid individual who was either permanently institutionalized or age 55 and older.

The Ohio Tort Recovery Unit is only responsible for the identification and recovery of Medicaid paid funds. The Medicare Secondary Payor (MSP) Unit is responsible for the identification and recovery of Medicare funds. You can contact the MSP unit at (513) 852-4353.

The Ohio Tort Recovery Unit is only responsible for the identification and recovery of Medicaid paid funds. The Medicare Secondary Payor (MSP) Unit is responsible for the identification and recovery of Medicare funds. You can contact the MSP unit at (513) 852-4353.

The State of Ohio has One Year from Decedent's Death to Present a Claim Against an Estate for Medicaid Recovery.

An irrevocable trust can prevent the state from placing a lien on your home or obtaining the proceeds of the house's sale to pay for your Medicaid expenses.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232