Medicaid Estate Recovery
State program · 51 states
medicaid.gov/medicaid/eligibility-policy/estate-recoveryMedicaid Estate Recovery
How states recover Medicaid long-term care costs from a deceased recipient's estate
Medicaid estate recovery is the process by which a state recovers what it paid for certain Medicaid benefits from the estate of a deceased recipient. Federal law (42 U.S.C. 1396p(b)) requires every state to recover, from the estate of a recipient who was 55 or older when the services were received, what Medicaid paid for nursing facility services, home and community-based services, and related hospital and prescription drug services. A state may also recover for any other Medicaid service provided to those recipients, except Medicare cost-sharing paid for Medicare Savings Program enrollees. Recovery is also required from an individual of any age whose real property the state placed a lien on because the person was institutionalized and could not reasonably be expected to return home. Recovery is made after death against the deceased recipient's estate, so it is a claim the executor or administrator handles during estate settlement. Which assets beyond the probate estate are recoverable, what exemptions apply, and which agency administers the program are set by each state.
Medicaid estate recovery in your state
Administered by each state's Medicaid agency or estate recovery unit. Select a state for its administering office, key facts, and the steps that apply there.
Handling Medicaid estate recovery after a death
The state's claim is addressed during estate settlement, before assets are distributed.
The executor or personal representative reports the death. Medicaid Recovery's page on what to do after a death →
- •A surviving spouse: recovery waits until the spouse dies
- •A surviving child under 21, or a child of any age who is blind or disabled
- •A home under lien where a sibling with one year of residence, or a caregiver son or daughter with two years, still lives
Required Documents
- Death certificate
- Letters testamentary or letters of administration
- The deceased's Medicaid identification or case number: if known
- An inventory of estate assets
Timeline
The claim is resolved during estate administration.
Deadlines1
- Addressing the state Medicaid agency's claim against the estate
during estate administration (state claim windows vary)1
What happens to each matter2
- Debts the person owed
The state Medicaid agency files its claim against the estate after the recipient dies. The claim is treated as a debt of the estate and is addressed before assets are distributed to heirs.1
Recovery may be made only after the death of a surviving spouse, and only when no surviving child is under 21, blind or disabled. Where the state placed a lien on the home, recovery is also barred while a qualifying sibling or a caregiver son or daughter still lives there.2
Every state must reach the probate estate, the real and personal property that passes under state probate law. A state may also elect to reach assets that pass outside probate, such as through joint tenancy, tenancy in common, survivorship, a life estate or a living trust.2
- Program payments and contracts
Every state must recover what Medicaid paid for nursing facility services, home and community-based services, and related hospital and prescription drug services received at 55 or older. A state may choose to recover for any other Medicaid service to those recipients.2
Medicare premiums and cost-sharing paid for Medicare Savings Program enrollees are not recoverable. Recovery is also required from a person of any age whose real property the state placed a lien on while institutionalized and not expected to return home.2
What Medicaid Recovery's rules say3
- Who reports the death
The executor or administrator handles the claim: they identify whether the deceased received Medicaid long-term care, notify the state Medicaid or estate recovery unit as required during probate, and address the claim before distributing assets to heirs.1
- Appeals and disputes
Every state must have a procedure for waiving recovery that would cause undue hardship. The criteria and how to request a waiver are set by each state.2
- What the agency does and does not handle
Federal law requires every state to operate a Medicaid estate recovery program. Each state decides which assets beyond the probate estate are recoverable, what exemptions apply, and which agency administers the program.2
Estate recovery is administered by the state, not by CMS.3
Sources
Data sourced from Medicaid Estate Recovery primary sources (3 pages reviewed). How we research.
Medicaid Estate Recovery death reporting
State Medicaid agency (estate recovery unit)
Website
Tools for Planning and Settling an Estate
Free calculators and checklists for planning or settling an estate, by state: will and trust costs, probate, executor and trustee pay, and inheritance taxes.
How Do I Settle an Estate?
Personalized plan for settling an estate after someone passes away.
How Much Does Probate Cost?
Estimate attorney fees, executor fees, court costs, and timeline for probating an estate.