Medicaid Estate Recovery in Maryland

What is recovered

The Department recovers only money Medicaid paid for medical services rendered on or after the recipient's 55th birthday.¹

All medical services are subject to repayment, including nursing home care, hospital services, home and community-based waiver services, personal care, and physician and pharmacy services.¹

Who is subject to recovery

COMAR 10.09.24.15 reaches the estate of any individual who was 55 or older when they received Medical Assistance benefits.²

Liens on real property

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.²

Where the Department imposed a lien on the home, recovery is deferred while a son or daughter who lived there for at least 2 years before the recipient entered long-term care still lawfully resides there and can establish to the Department's satisfaction that they provided the care that let the recipient stay home.²

When recovery is deferred or barred

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.²

Where the Department imposed a lien on the home, recovery is deferred while a sibling who has lived there for at least 1 year before the recipient's admission to a long-term care facility still lawfully resides there.²

Undue-hardship waiver

Md. Code, Health-General 15-121(b) requires the Department to waive the claim where enforcement would cause substantial hardship.³

COMAR 10.09.24.15 defines substantial hardship as a claim that would force the sale or transfer of the decedent's real property and remove a dependent who lived there on the date of death, lived there continuously for at least 2 years before the death, and cannot provide an alternate residence.²

A dependent is a child or descendant, a sibling, or a parent or ancestor of the decedent.²

Exemptions and protected assets

COMAR 10.09.24.15 bars recovery of Medical Assistance payments of Medicare premiums, copayments, or deductibles.²

Long-term care partnership policies

Recovery is barred up to the value of long-term care partnership policy benefits furnished to the recipient before death.²

How the state files its claim

Medicaid is usually a general creditor, paid after priority claims such as court fees, estate administration fees, funeral expenses, attorney's fees, and taxes.¹

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

1. 1.Medical Assistance (Medicaid) Property Liens & Estate Recovery Fact Sheet (Maryland Department of Health)
2. 2.COMAR 10.09.24.15
3. 3.Md. Code, Health-General 15-121