Medicaid Estate Recovery in Maine

What is recovered

Since November 24, 2021, MaineCare seeks recovery only for nursing facility services, home- and community-based services (HCBS), and the hospital and prescription drug services related to them.^{1, 2}

Recovery is limited to what MaineCare paid, not the value of the whole estate. DHHS gives this example: on a $150,000 estate where MaineCare costs were $20,000, MaineCare would seek to recover $20,000.^{1, 2}

Who is subject to recovery

Members who received MaineCare at age 55 or older and received nursing facility services or HCBS, with no surviving spouse, no child under age 21, and no disabled child of any age at the time the Department seeks recovery.^{1, 3}

MaineCare seeks no recovery from a member who never received nursing facility services or HCBS, or who only received the Medicare Savings Program (Buy-in) benefit.¹

When recovery is deferred or barred

Recovery is not sought while there is a surviving spouse, a child under age 21, or a disabled child of any age at the time the Department seeks recovery.¹

22 M.R.S. 14(2-I)(C) bars the claim until there is no surviving spouse and no surviving child under 21 or blind or permanently and totally disabled.³

Exemptions and protected assets

For members who died on or after September 1, 2019, a $15,000 family allowance is not subject to recovery for estates of $20,000 or less where there is a surviving child of any age.¹

Reasonable funeral expenses, attorneys' fees, probate court costs, upkeep of property, and personal representative fees up to $3,000 are also excluded.¹

What counts as the estate

Under 22 M.R.S. 14(2-I)(F), the estate is not limited to the probate estate: it includes any other property in which the member had a legal interest at death, to the extent of that interest.³

That includes assets passing by tenancy in common, survivorship, life estate, living trust, or joint tenancy in personal property. Joint tenancy in real property is excluded, as is a qualified ABLE account.³

Undue-hardship waiver

A hardship waiver is available to heirs whose combined income and assets are below 180% of the federal poverty level and who lived in the member's home for at least two years before death.¹

A care-given waiver is available to an heir who provided in-home care and has income below 200% of the federal poverty level. $6,000, $12,000, or $32,000 is waived for each of the two years, depending on the level of care.¹

22 M.R.S. 14(2-I)(E) requires the claim to be waived if enforcement would create an undue hardship under criteria developed by the Department.³

When the state does not pursue a claim

22 M.R.S. 14(2-I)(E) also requires the claim to be waived if the costs of collection are likely to exceed the amount recovered.³

How the state files its claim

22 M.R.S. 14(2-I)(C-2) requires the Department to offer heirs an opportunity to pay the claim through a voluntary payment arrangement.³

Long-term care partnership policies

If the member held a qualified Long-Term Care Insurance Partnership Policy, some assets may be protected from estate recovery, usually an amount equal to the benefits paid under the qualifying policy.¹

Governing law: 22 M.R.S. 14(2-I)

Maine DHHS Administrative Hearings Unit

Appeals of estate recovery decisions¹

1. 1.MaineCare Estate Recovery (Maine DHHS Office of MaineCare Services)
2. 2.Estate Recovery Overview (Maine DHHS, Updated December 2021)
3. 3.22 M.R.S. 14, Claims against estates of MaineCare recipients (subsection 2-I)