Pennsylvania Medicaid Estate Recovery

No. Pennsylvania recovers only from the probate estate, so assets that pass outside probate, such as joint tenancy with right of survivorship, life estates, living trusts, and transfer-on-death or pay-on-death accounts, are generally beyond recovery.

Recovery is generally blocked or delayed for: Surviving spouse: no recovery while the spouse is living; if the property passes to the surviving spouse outside the estate (for example by tenancy by the entireties or joint tenancy with right of survivorship), there is no recovery; recovery is otherwise postponed until the surviving spouse's death; Child under 21: recovery is postponed until the surviving dependent child reaches age 21; Blind or permanently and totally disabled child of any age: recovery is postponed until that adult child dies; Sibling with an equity interest in the home who resided there for at least one year before the recipient's death: recovery is postponed until the sibling dies, transfers the property, or vacates it; Small estate: if the gross value of the estate is $2,400 or less, the estate is administered, and there is an heir, DHS permanently waives its estate recovery claim; Caregiver-residence undue hardship waiver: permanent waiver of recovery against the decedent's primary residence when the requester (1) continuously resided in the primary residence for at least two years immediately preceding the decedent's receipt of nursing facility services, or for at least two years during the period MA-funded HCBS were received; (2) has no other alternative permanent residence; and (3) provided care or support to the decedent for at least two years during the MA-funded HCBS period or for at least two years before the decedent's receipt of nursing facility services (for HCBS cases a physician statement is required that the decedent would have needed at minimum intermediate care in a nursing facility absent that care); Income-producing property (such as a family farm or family business) undue hardship waiver: waiver when the asset is the primary source of household income and the family income without it would fall below the applicable threshold (250% of the federal poverty level).

Pennsylvania recovers the total of all Medical Assistance payments made for a deceased recipient who was age 55 or older when the benefits were received, for nursing facility services, home and community based services (HCBS), and any related hospital and prescription drug services provided while receiving nursing facility care or care at home or in a community setting (services rendered on or after August 15, 1994). DHS files a statement of claim against the deceased recipient's estate (the probate estate administered by the personal representative). The amount recovered is what the state paid, even if the recipient paid part of the bill themselves or through insurance. Necessary and reasonable expenses for maintaining the deceased's vacant home (real estate taxes, utility bills, home repairs and home maintenance) are deducted from the recovery amount. Recovery only occurs after the recipient's death.

Yes. Pennsylvania offers an undue-hardship waiver. Contact Pennsylvania Department of Human Services (DHS), Division of Third Party Liability, Medical Assistance Estate Recovery Program at 800-528-3708 to request the waiver and ask about deadlines.

Pennsylvania Department of Human Services (DHS), Division of Third Party Liability, Medical Assistance Estate Recovery Program, phone 800-528-3708, https://www.pa.gov/agencies/dhs/resources/for-residents/estate-recovery.