In California W.C., most MSA's are self-administered. The MSA is located at your local bank in The City in an interest bearing account in your name....no designation as MSA or anything else...just your name. When you die, it would act just like any other bank account you might have. You may have a right of survivorship in the account, you may have it pass through your will, you may have it pass through the laws of intestacy if you don't have a will. It becomes part of your estate.
That may depend on whether the MSA is self administered or handled by some other party. Ordinarily, the self administered MSA has a right of survivorship. This is something that is addressed in the settlement. You can negotiate a right of survivorship even if the MSA is not self administered.
Almost all bank accounts have a Pay On Death (POD) beneficiary. If the remaining funds are in the bank account, your designated beneficiary would be entitled to them. If they are with a Trustee, there is likely a beneficiary provision, also.
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I am not 100% sure of this, but I believe medicare has up to 6 months after the death to collect any funds from the MSA account, even if self-administered. A very reputable WC attorney told me this.
Someone at medicare/CMS should know, might want to try and contact them.