Medicaid Estate Recovery in Maine

Medicaid Estate Recovery in Maine: key facts

Recovery scope

Effective 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. Recovery is limited to what MaineCare paid, not the value of the whole estate.

Who is subject

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. 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.

Not subject to recovery

For members who died on or after September 1, 2019: a $15,000 family allowance for estates of $20,000 or less where there is a surviving child of any age. Reasonable funeral expenses, attorneys' fees, probate court costs, upkeep of property, and personal representative fees up to $3,000 are also excluded.

Waivers

A hardship waiver (heirs' combined income and assets below 180% of the federal poverty level, with at least two years living in the member's home before death) and a care-given waiver (caregiving heir with income below 200% of the federal poverty level; $6,000, $12,000, or $32,000 waived for each of the two years depending on the level of care) are available.

What counts as the estate

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

Long-term care partnership policy

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.

Contact and appeals

Estate recovery questions go to MaineCare's Estate Recovery Unit at EstateRecoveryUnitQuestion.OMS@maine.gov. MaineCare Member Services at 1-800-977-6740 (TTY: Maine Relay 711) handles all other covered services and benefits. An estate recovery decision may be appealed to the Department's Administrative Hearings Unit.

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

Steps to take when someone dies

1. Determine whether the deceased received MaineCare at age 55 or older AND received nursing facility services or home- and community-based services — recovery reaches only those services and the hospital and prescription drug services related to them.
2. Email MaineCare's Estate Recovery Unit at EstateRecoveryUnitQuestion.OMS@maine.gov to confirm whether a recovery claim applies and request the amount paid — the program page routes estate recovery questions to that mailbox and reserves 1-800-977-6740 for other covered services and benefits.
3. Address the claim as a debt of the estate, after exempt costs such as reasonable funeral expenses, before distributing assets to heirs. Remember the claim can also reach non-probate assets the member had an interest in at death, other than joint tenancy in real property.
4. Request a hardship waiver or care-given waiver from the Department if the heirs meet the income and residency criteria, and ask about the voluntary payment arrangement the Department must offer under 22 M.R.S. §14(2-I)(C-2).
5. Appeal an estate recovery decision to the Department's Administrative Hearings Unit if the claim or a waiver denial is disputed.

Frequently asked questions