District of Columbia Medicaid Estate Recovery
After someone who received Medicaid long-term care dies, District of Columbia can file a claim against their estate. This guide explains what is recovered, who is protected, and how to ask for relief.
Based on 29 DCMR 6701 (Services subject to recovery: post-death lien, all State Plan services and premiums paid at age 55 or older); 29 DCMR 6799 (Definitions: estate limited to property that does not pass at death by instrument or operation of law); 29 DCMR 6702 (Limitations: home-lien bars, undue hardship, $100 cost-effectiveness floor); 29 DCMR 6703 and 6704 (undue hardship criteria and waiver procedure); 29 DCMR 6705 (appeals); D.C. Code § 7-771.07(1) (DHCF as successor Medicaid agency); federal authority 42 U.S.C. 1396p(b).
By Settled Estate Editorial
Probate estate only
Recovery reach
55+
Age when care was received
Protected
While a spouse is alive
Yes
Hardship waiver
What District of Columbia recovers
After a Medicaid beneficiary dies, the District seeks repayment from the estate for Medicaid it paid on the person's behalf at age 55 or older.
Covered services and programsThe full list of care and waiver programs the claim can include
After a Medicaid beneficiary dies, the District seeks repayment from the estate for Medicaid it paid on the person's behalf at age 55 or older. Under 29 DCMR 6701.2 that covers all services and health premiums paid under the District's State Plan for Medical Assistance, including nursing facility services, home and community-based services, and related hospital and prescription drug services, so the District recovers more than the federal minimum of long-term care costs. 29 DCMR 6701.1 lets the Medicaid program place a lien on the beneficiary's real and personal property after death, subject to the limits in the chapter. Before it asserts a claim, the agency must send the personal representative or attorney of record a written Notice of Proposed Recovery that itemizes the services paid, states the legal basis for the claim, lists the exemptions, and explains how to apply for an undue hardship waiver, with appeal rights and deadlines (29 DCMR 6704.2). The rules name the Department of Health's Medical Assistance Administration; the Department of Health Care Finance is its successor as the District's Medicaid agency (D.C. Code § 7-771.07(1)) and is the office DHCF's own fact sheet names.
District of Columbia recovers only from the probate estate. Assets that pass outside probate, such as joint property with survivorship, life estates, living trusts, and transfer-on-death or pay-on-death accounts, are generally beyond recovery.
Important: The District's estate recovery rule reaches only property that does not pass to someone else at death by the terms of the instrument under which it is held or by operation of law (29 DCMR 6799), so it does not claim non-probate assets directly. The District's general creditor statutes can still pull some of them back if the probate estate is too small to pay allowed claims. Property in a trust the decedent could still revoke at death is subject to the settlor's creditors' claims to the extent the residuary probate estate is inadequate (D.C. Code § 19-1305.05(a)(3)). A person who receives a nonprobate transfer the decedent could have revoked alone, such as a payable-on-death account or a transfer on death deed, is liable to the estate for allowed claims up to the value received (D.C. Code §§ 19-601.02 and 19-604.15). That proceeding needs a creditor's written demand to the personal representative and must start within one year after the death, and it does not reach a survivorship interest in a joint tenancy of real estate. Neither the estate recovery rules nor DHCF's fact sheet says whether DHCF uses these statutes, so a living trust or beneficiary designation is not a guaranteed shield. Confirm your situation with a District elder-law attorney.
55 and older
Who is protected from recovery
Surviving spouse: federal law allows recovery only after the death of the beneficiary's surviving spouse (42 U.S.C. 1396p(b)(2)), and 29 DCMR 6702.1(a) bars a lien against the home while the surviving spouse is lawfully residing there.
Surviving child under 21: no recovery while the beneficiary has a surviving child under age 21 (42 U.S.C. 1396p(b)(2)(A)), and no lien against the home while that child is lawfully residing there (29 DCMR 6702.1(b)).
Surviving blind or disabled child of any age: no recovery while the beneficiary has a surviving child who is blind or disabled (42 U.S.C. 1396p(b)(2)(A)), and no lien against the home while that child is lawfully residing there (29 DCMR 6702.1(b)).
Sibling with an equity interest in the home: no lien against the home while a sibling of the beneficiary who has an equity interest in it, and who lived there for at least one year immediately before the beneficiary was admitted for institutional care, is lawfully residing there (29 DCMR 6702.1(c)).
Caregiver son or daughter: 29 DCMR chapter 67 contains no separate protection for a child who lived in the home and gave care that let the parent stay at home rather than enter a nursing facility. A family in that position should raise it with DHCF in an undue hardship application.
Undue hardship: the agency may waive enforcement of the claim if it would be an undue hardship to an heir, legatee, devisee or other interested person (29 DCMR 6702.2), under the criteria in 29 DCMR 6703.1, and may compromise the claim instead of waiving it in full (29 DCMR 6703.3).
Not cost-effective: the agency may waive a claim when recovery is not cost-effective, which the rule fixes at any claim under $100.00 (29 DCMR 6702.3).
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Property that may be exempt
- Property that passes to someone else at death by the terms of the instrument under which it is held or by operation of law is outside the recoverable estate, because 29 DCMR 6799 defines the estate as property owned by the decedent that does not pass that way. Joint tenancy with a right of survivorship, payable-on-death and transfer-on-death designations, a transfer on death deed, and property held in a living trust generally fall in this group, subject to the creditor rules described in the scope caveat.
- Medicare cost-sharing: DHCF's estate recovery fact sheet states that estate recovery does not include Medicare Part A and B premiums, deductibles, coinsurance and copayments with dates of service on or after January 1, 2010, and federal law excludes medical assistance for Medicare cost-sharing from the optional wider recovery (42 U.S.C. 1396p(b)(1)(B)(ii)).
- Small claims: the agency may waive a claim when recovery is not cost-effective, and 29 DCMR 6702.3 says recovery is not cost-effective when the claim is less than $100.00.
Undue-hardship waiver
District of Columbia can waive recovery when it would cause an undue hardship for the heirs. Contact District of Columbia Department of Health Care Finance (DHCF), Health Care Operations Administration, Third Party Liability Division at (202) 698-2000 to request the waiver.
Under 29 DCMR 6703 (Undue hardship) and 29 DCMR 6704 (Procedures for waiving estate recovery), any of these can qualify:
- The heir, legatee, devisee or other interested person may become eligible for assistance payments without the proceeds from the estate (29 DCMR 6703.1(a)).
- The home is the sole income-producing asset of a family business and recovery would cost an heir, legatee, devisee or other interested person their livelihood. The business must have operated at the property for at least 12 months before the death, and its income must provide 100% of that person's livelihood (29 DCMR 6703.1(b)).
- Receiving the estate proceeds may make the heir, legatee, devisee or other interested person ineligible for assistance payments (29 DCMR 6703.1(c)).
- Recovery would deprive the heir, legatee, devisee or other interested person of shelter, and that person lacks the financial means to obtain and maintain shelter (29 DCMR 6703.1(d)).
Undue hardship does not exist when recovery would merely inconvenience or restrict the person's lifestyle, when the person divested assets to qualify, or when recovery would only prevent an anticipated inheritance (29 DCMR 6703.2). A waiver applies only to the proportionate share of the estate that passes to the person who qualifies (29 DCMR 6703.4). The agency may compromise the claim, weighing the person's contribution to the asset or to the decedent's care, a higher-priority debt such as a mortgage the person assumed, and other compelling circumstances (29 DCMR 6703.3).
Deadline: The personal representative or attorney of record must request the Undue Hardship Waiver Application within 15 business days of the date of the Notice of Proposed Recovery (29 DCMR 6704.3) and return the completed application with supporting documents within 30 calendar days of receiving it (29 DCMR 6704.4). An incomplete application is denied, with 5 more working days from the denial notice to complete it (29 DCMR 6704.5). A late or incomplete application means the agency seeks the full claim (29 DCMR 6704.7). DHCF's 2015 fact sheet describes the timing more simply, as returning the applications sent with the Notice of Proposed Recovery within 30 calendar days of receiving it.
Decision: The agency mails a written response within 30 calendar days of receiving the completed application and documents, with reasons and appeal rights if it denies (29 DCMR 6704.6). The decision can be appealed to the Office of Administrative Hearings within 30 days of the agency's letter, and an appeal does not stop the District from filing its claim against the estate (29 DCMR 6705.1, 6705.2).
Frequently asked questions
Who is protected from Medicaid estate recovery in District of Columbia?
Recovery is generally blocked or delayed for: Surviving spouse: federal law allows recovery only after the death of the beneficiary's surviving spouse (42 U.S.C. 1396p(b)(2)), and 29 DCMR 6702.1(a) bars a lien against the home while the surviving spouse is lawfully residing there; Surviving child under 21: no recovery while the beneficiary has a surviving child under age 21 (42 U.S.C. 1396p(b)(2)(A)), and no lien against the home while that child is lawfully residing there (29 DCMR 6702.1(b)); Surviving blind or disabled child of any age: no recovery while the beneficiary has a surviving child who is blind or disabled (42 U.S.C. 1396p(b)(2)(A)), and no lien against the home while that child is lawfully residing there (29 DCMR 6702.1(b)); Sibling with an equity interest in the home: no lien against the home while a sibling of the beneficiary who has an equity interest in it, and who lived there for at least one year immediately before the beneficiary was admitted for institutional care, is lawfully residing there (29 DCMR 6702.1(c)); Caregiver son or daughter: 29 DCMR chapter 67 contains no separate protection for a child who lived in the home and gave care that let the parent stay at home rather than enter a nursing facility. A family in that position should raise it with DHCF in an undue hardship application; Undue hardship: the agency may waive enforcement of the claim if it would be an undue hardship to an heir, legatee, devisee or other interested person (29 DCMR 6702.2), under the criteria in 29 DCMR 6703.1, and may compromise the claim instead of waiving it in full (29 DCMR 6703.3); Not cost-effective: the agency may waive a claim when recovery is not cost-effective, which the rule fixes at any claim under $100.00 (29 DCMR 6702.3).
What does District of Columbia Medicaid recover after death?
After a Medicaid beneficiary dies, the District seeks repayment from the estate for Medicaid it paid on the person's behalf at age 55 or older. Under 29 DCMR 6701.2 that covers all services and health premiums paid under the District's State Plan for Medical Assistance, including nursing facility services, home and community-based services, and related hospital and prescription drug services, so the District recovers more than the federal minimum of long-term care costs. 29 DCMR 6701.1 lets the Medicaid program place a lien on the beneficiary's real and personal property after death, subject to the limits in the chapter. Before it asserts a claim, the agency must send the personal representative or attorney of record a written Notice of Proposed Recovery that itemizes the services paid, states the legal basis for the claim, lists the exemptions, and explains how to apply for an undue hardship waiver, with appeal rights and deadlines (29 DCMR 6704.2). The rules name the Department of Health's Medical Assistance Administration; the Department of Health Care Finance is its successor as the District's Medicaid agency (D.C. Code § 7-771.07(1)) and is the office DHCF's own fact sheet names.
Can I apply for an undue-hardship waiver in District of Columbia?
Yes. District of Columbia offers an undue-hardship waiver. Contact District of Columbia Department of Health Care Finance (DHCF), Health Care Operations Administration, Third Party Liability Division at (202) 698-2000 to request the waiver and ask about deadlines.
Who handles Medicaid estate recovery in District of Columbia?
District of Columbia Department of Health Care Finance (DHCF), Health Care Operations Administration, Third Party Liability Division, phone (202) 698-2000, https://dhcf.dc.gov/.
Agency and statute sourcesOfficial references used for this page
- 29 DCMR 6700 (General Provisions), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). Purpose of the chapter; rules to be consistent with sections 1902(a) and 1917(a), (b) and (c) of the Social Security Act.
- 29 DCMR 6701 (Services Subject To Recovery), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). 6701.1: lien on real and personal property of a Medicaid recipient after death; 6701.2: all services and health premiums paid under the State Plan, including nursing facility, home and community-based, and related hospital and prescription drug services, paid for anyone who received medical assistance at age 55 or older, subject to recovery against the decedent's estate.
- 29 DCMR 6702 (Limitations), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). 6702.1: no lien against the home while a surviving spouse, a child under 21 or blind or disabled, or a sibling with an equity interest who resided there at least one year before admission is lawfully residing in it; 6702.2: undue hardship waiver; 6702.3: claims under $100.00 not cost-effective; 6702.4-6702.5: definition of the home.
- 29 DCMR 6703 (Undue Hardship), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). Four undue hardship criteria, three circumstances that are not undue hardship, compromise factors, and the proportionate-share limit.
- 29 DCMR 6704 (Procedures For Waiving Estate Recovery), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). Notice of Proposed Recovery contents; 15 business days to request the Undue Hardship Waiver Application; 30 calendar days to return it; 5 working days to cure an incomplete one; 30-day agency response.
- 29 DCMR 6705 (Appeals), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). Appeal to the Office of Administrative Hearings within 30 days; an appeal does not stay the District's claim.
- 29 DCMR 6799 (Definitions), D.C. Municipal Regulations, Title 29, Chapter 67 (Medicaid Program - Liens and Adjustments or Estate Recovery), Office of Documents and Administrative Issuances (dcregs.dc.gov). Defines 'Estate' as all real and personal property and any interest in such property owned by the decedent that does not pass at the time of death to another person by the terms of the instrument under which it is held or by operation of law.
- D.C. Code § 7-771.07. Powers and duties of the Department. Paragraph (1): the Department of Health Care Finance is the single state agency, successor to the Medical Assistance Administration, for the administration of the Medicaid Program.
- D.C. Code § 19-601.02. Liability of nonprobate transferees for creditor claims and statutory allowances. Nonprobate transferees (excluding survivorship in a joint tenancy of real estate) are liable to the probate estate for allowed claims to the extent the estate is insufficient; proceeding on written demand of a creditor, within one year after death.
- D.C. Code § 19-604.15. Liability for creditor claims and statutory allowances. A transfer on death deed beneficiary is liable for allowed claims against the transferor's probate estate to the extent provided in § 19-601.02.
- D.C. Code § 19-1305.05. Creditor’s claim against settlor. Subsection (a)(3): after the settlor's death, property of a trust that was revocable at death is subject to the settlor's creditors' claims to the extent the residuary probate estate is inadequate.
- 42 U.S.C. 1396p (Social Security Act section 1917), United States Code 2023 edition, govinfo.gov (U.S. Government Publishing Office). Subsection (b)(1)(B): recovery for assistance received at 55 or older, excluding Medicare cost-sharing; (b)(2): recovery only after the death of a surviving spouse and only when there is no surviving child under 21 or blind or disabled; (b)(4): estate defined as the probate estate, with the wider definition optional.
- D.C. Department of Health Care Finance, 'Public Notice: Medicaid Estate Recovery Fact Sheet' (release dated Wednesday, Aug 19, 2015; Drupal node 1106761), with attachment https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/release_content/attachments/Estate%20Recovery%20Fact%20Sheet%20-%20Version%20Aug%2019%202015.pdf (Version Date: August 19, 2015). Gives the contact 'Health Care Operations Administration, Third Party Liability Division at (202) 698-2000' and language line (202) 727-5355; excludes Medicare Part A and B premiums, deductibles, coinsurance and copayments with dates of service on or after January 1, 2010.
Information current as of October 4, 2026
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