Massachusetts Medicaid Estate Recovery

Federal and state Medicaid law requires MassHealth to recover assets from the estates of certain MassHealth members after their death. This process is called “estate recovery.” The assets are used to reimburse (pay back) the state for the cost of care that MassHealth paid for the member.

In some cases, MassHealth may delay this process or “waive” this requirement (not recover assets).

More information about this process and how to request a waiver or delay can be found below and in the Frequently Asked Questions (FAQ) section.

Who does estate recovery apply to?

MassHealth may recover assets from:

• Any members who received care after age 55 or older, or
• Members of any age who were permanently in a long-term care or other medical facility (like a nursing home).

What kind of assets can MassHealth recover?

An asset is anything of value that is part of the member’s probate estate. A probate estate includes assets that were owned only by the member at the time of death.

For example, MassHealth can recover:

• money from bank accounts, and/or
• money from the sale of physical or personal property, such as a home or vehicle that was owned only by the member.

Assets collected during estate recovery are put into the Massachusetts general fund.

How much of the member’s estate can MassHealth recover?

MassHealth may recover the total cost of care it paid for members after they turned 55, or who were placed permanently in a long-term care or other medical facility. If the MassHealth claim exceeds the value of the remaining amount in the estate, MassHealth will recover the remaining amount from the estate and will not pursue any unsatisfied claim amount from the estate.

Estate recovery may apply to MassHealth members whether or not they are enrolled in a MassHealth health plan or whether MassHealth paid for their care directly (Fee for Service).

If the member was enrolled in a MassHealth health plan (like an Accountable Care Organization (ACO) or a One Care plan), MassHealth may recover the total amount it paid to the health plan for their care, regardless of what services the member may have received. This is known as the premium payment made to the plan or the capitation rate. The premium payments may be more or less than the actual cost of services the member received. A member’s estate will never have to repay more than the amount MassHealth paid.

If the member was not enrolled in a MassHealth health plan, MassHealth may recover the amount it paid directly for their care.

Are there exceptions to the estate recovery requirement?

Yes, estate recovery can be delayed or waived in certain cases.

For example, estate recovery will be delayed if the member has:

• a surviving spouse, or
• a surviving child under 21 years old, or
• a surviving child of any age who is permanently blind or disabled,

In these cases, MassHealth will delay the recovery of assets from the estate until these conditions no longer apply (for example, until after a surviving child turns 21).

MassHealth will not pursue any estate recovery if the value of the member’s estate is $25,000 or less. 

In other cases, MassHealth may decide that recovering assets would be unduly hard on the member’s family or on the person who inherited the estate (the “heir”). In these cases, MassHealth may grant a hardship waiver.  This means that MassHealth determines it is not required to recover any assets or to only recover some assets. For example, MassHealth may grant a waiver if, among other circumstances:

• the heir’s income has been below a certain amount for two years, or
• the heir had provided care to the member for two years before the member was placed permanently in a long-term care or other medical facility, or
• the heir is low income and would be forced to sell the home that they had been living in (that they inherited from the member).

There are also other situations in which MassHealth may grant a waiver. The FAQs below will give you more information about who may qualify for a delay or waiver and how to apply for a waiver.

For more information:

More information about the estate recovery process can be found in the FAQs below.

These FAQs provide general information about MassHealth’s estate recovery program requirements, process, hardship waivers, and deferrals. Please note that the information in these FAQs may not apply to every individual situation.

The Fact Sheet provides general information about estate recovery for members. This includes the most commonly asked questions regarding a MassHealth member notice called “Important Information about MassHealth Estate Recovery Requirement”.

To apply for a estate recovery hardship waiver, please review and complete the appropriate application form for your circumstances below.

See below for documents and related links regarding reforms to MassHealth's estate recovery program.