Medicaid Estate Recovery in Massachusetts

What is recovered

For deaths on or after August 1, 2024, M.G.L. c. 118E § 31(b1/2) limits recovery to nursing facility services, home and community-based services, and related hospital and prescription drug services for which estate recovery is mandated under federal law (42 U.S.C. 1396p).^{1, 2}

Who is subject to recovery

Members 55 or older when they received the assistance, and members of any age who were residents of a nursing facility or other medical institution when they received it.¹

What counts as the estate

The estate MassHealth recovers from is the probate estate.³

When recovery is deferred or barred

M.G.L. c. 118E § 31 allows recovery only after the death of a surviving spouse, and only when there is no surviving child who is under 21 or who is blind or has a disability.¹

M.G.L. c. 118E § 31(e) bars recovery of assistance correctly paid to an individual under the CommonHealth program for adults with disabilities or for personal care attendant services, provided the executive office seeks federal authority to implement it where that authority is required.¹

Exemptions and protected assets

MassHealth waives recovery for probate estates valued at $25,000 or less. The personal representative still sends MassHealth a copy of the probate petition and the death certificate.³

The Residence and Financial and the Care Provided Hardship Waivers each waive the entire claim where an heir lived in the home as a principal residence for the two years before the member's institutionalization or death, still lives there, inherited an interest, and the home must be sold to repay MassHealth.⁴

Undue-hardship waiver

The Residence and Financial Hardship Waiver also requires the heir's family group income to be at or below 133% of the federal poverty level when the Notice of Claim was filed. The Care Provided Hardship Waiver requires that the heir's care kept the member out of a nursing home.⁴

The Income-Based Hardship Waiver waives up to $50,000 per qualifying heir, capped at $100,000 per estate, where the heir's family group income was below 400% of the federal poverty level for the two years before the Notice of Claim. An estate cannot receive more than one type of hardship waiver.⁴

How the state files its claim

The personal representative notifies MassHealth that a probate estate is being administered by sending a copy of the probate petition and the death certificate by certified mail, even where the estate is filed as a voluntary administration. A photocopy of the death certificate is accepted.⁴

The Estate Recovery Unit then files a Notice of Claim in the probate court and mails or faxes a copy to the personal representative. Only the court-appointed personal representative can respond to the claim, by written notice sent by certified mail within 60 days of receiving it.⁴

Governing law: M.G.L. c. 118E, s. 31 (as amended by St. 2024, c. 197)

Written notice to challenge the claim, request a deferral, or apply for a hardship waiver

within 60 days of receiving the Notice of Claim⁴

Probate court administering the estate

Receives the Notice of Claim the Estate Recovery Unit files against the estate⁴

1. 1.M.G.L. c. 118E, s. 31
2. 2.EOM 25-09: Updates to the MassHealth Estate Recovery Policy under the LTC Act
3. 3.Massachusetts Medicaid estate recovery (MassHealth)
4. 4.MassHealth Estate Recovery Frequently Asked Questions