Massachusetts Medicaid Estate Recovery

Recovery is generally blocked or delayed for: Surviving spouse: MassHealth may recover only after the death of the member's surviving spouse, which delays the claim rather than cancelling it (M.G.L. c. 118E, section 31(b1/2)); Surviving child under 21: recovery is barred while the member has a surviving child under the age of 21 (M.G.L. c. 118E, section 31(b1/2)); Surviving child who is blind or a person with a disability: recovery is barred while such a child survives, whatever that child's age (M.G.L. c. 118E, section 31(b1/2)); Sibling living in the home: where MassHealth holds a lien on the property, repayment is not required while a sibling who had lived there for at least one year before the member entered a nursing facility or other medical institution lawfully resides there, a residence test rather than an ownership-share test (M.G.L. c. 118E, section 31(d)); Caregiver child living in the home: repayment on a lien is not required while a child lawfully resides there who lived in the home for at least two years before the parent's admission, can show that the care they gave let the parent stay at home instead of entering an institution, and has lived there continuously since (M.G.L. c. 118E, section 31(d)); CommonHealth and personal care attendant members: no recovery from the estate of a member who was receiving assistance under the CommonHealth program for adults with disabilities or for payment of personal care attendant services (M.G.L. c. 118E, section 31(e)); Undue hardship: MassHealth must waive recovery for undue hardship under its regulations, and if the personal representative gives notice that hardship conditions exist and MassHealth does not sue within 60 days, the waiver is automatic (M.G.L. c. 118E, section 32(c), (d) and (f)).

MassHealth recovers what it actually paid for a deceased member, and only out of that member's probate estate. For deaths on or after August 1, 2024, M.G.L. c. 118E, section 31(b1/2) allows recovery in two situations. The first covers a member of any age who was a resident of a nursing facility or other medical institution when MassHealth paid, and reaches only assistance paid on or after March 22, 1991. The second covers a member who was 55 or older when MassHealth paid, and reaches only nursing facility services, home and community-based services, and the hospital and prescription drug services related to them, for services provided on or after October 1, 1993. MassHealth recovers the amount it paid, not the value of the estate. Under M.G.L. c. 190B, section 3-805, a debt due to the division of medical assistance is sixth in the order estate claims get paid, behind costs and expenses of administration, reasonable funeral expenses, debts and taxes with a federal preference, reasonable and necessary medical and hospital expenses of the last illness, and debts and taxes with a preference under other Massachusetts laws.

Yes. Massachusetts offers an undue-hardship waiver. Contact MassHealth Estate Recovery Unit (Massachusetts Executive Office of Health and Human Services) to request the waiver and ask about deadlines.

MassHealth Estate Recovery Unit (Massachusetts Executive Office of Health and Human Services), https://www.mass.gov/info-details/massachusetts-medicaid-estate-recovery.