Medicaid Estate Recovery in Maryland

Medicaid Estate Recovery in Maryland: key facts

Recovery scope

Only money Medicaid paid for medical services rendered on or after the recipient's 55th birthday. All medical services are subject to repayment — nursing home care, hospital services, home and community-based waiver services, personal care, physician and pharmacy services.

Who is subject

The estate of any individual who was 55 or older when they received Medical Assistance benefits. Recovery also reaches the estate, or the sale proceeds, of real property on which the Department imposed a lien because the owner was in a long-term care facility with no reasonable expectation of returning home.

Recovery deferred

The Department may seek recovery only after the death of the recipient's surviving spouse, and only when there is no surviving child (an unmarried person younger than 21) and no surviving son or daughter who is blind or disabled. Where the Department imposed a lien on the home, recovery is deferred further while a sibling who lived in the home for at least 1 year before the recipient entered long-term care still lawfully resides there, or a son or daughter who lived there for at least 2 years before that admission still lawfully resides there and can establish that they provided the care that allowed the recipient to stay at home instead of in the facility.

Hardship waiver

The claim is waived where substantial hardship exists — meaning the claim would force the sale or transfer of the decedent's real property and remove a dependent who lived in the property on the date of death, lived there continuously for at least 2 years before the death, and cannot provide an alternate residence. A "dependent" is a child or descendant, a sibling, or a parent or ancestor of the decedent.

Not recoverable

Medical Assistance payments of Medicare premiums, copayments, or deductibles. Recovery is also barred up to the value of long-term care partnership policy benefits furnished to the recipient before death.

Claim priority in the estate

Medicaid is usually a general creditor, paid after priority claims such as court fees, estate administration fees, funeral expenses, attorney's fees, and taxes.

Governing law: Md. Code, Health-General 15-121; COMAR 10.09.24.15

Steps to take when someone dies

1. Determine whether the deceased received Maryland Medical Assistance benefits at age 55 or older, or owned real property on which the Department imposed a lien.
2. Contact the Recoveries and Financial Services Division (410-767-6613) to confirm whether a recovery claim applies and to request the amount paid on the recipient's behalf.
3. Address the claim as a general creditor claim of the estate — after court fees, administration expenses, funeral expenses, attorney's fees, and taxes — before distributing assets to heirs.
4. Ask the Department for a substantial-hardship waiver if the claim would force the sale of the property and remove a qualifying dependent who lived there for at least 2 years before the death.

Frequently asked questions