Medicaid Estate Recovery in Massachusetts

Medicaid Estate Recovery in Massachusetts: key facts

Recovery scope (deaths on or after Aug. 1, 2024)

Only 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), plus recovery from anyone who was a resident of a nursing facility or other medical institution when assistance was received.

Who is subject

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.

Small-estate waiver

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.

Recovery deferred

Recovery may be made 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. The "estate" reached is the probate estate.

CommonHealth and personal care attendant services

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

How to notify MassHealth

The personal representative sends a copy of the probate petition and the death certificate by certified mail to the MassHealth Estate Recovery Unit, P.O. Box 15205, Worcester, MA 01615-0205 (fax 508-856-7803). A photocopy of the death certificate is accepted. Notice is required even where the estate is filed as a voluntary administration. The Unit then files a Notice of Claim in the probate court and mails or faxes a copy to the personal representative.

Deadline to respond to a Notice of Claim

Only the court-appointed personal representative can respond. To challenge the claim, request a deferral, or apply for a hardship waiver, the personal representative sends written notice by certified mail to the MassHealth Estate Recovery Unit within 60 days of receiving the Notice of Claim.

Hardship waivers

Three: the Residence and Financial Hardship Waiver (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, the home must be sold to repay MassHealth, and the heir's family group income was at or below 133% of the federal poverty level when the Notice of Claim was filed — entire claim waived); the Care Provided Hardship Waiver (same residency and sale conditions, where the heir's care kept the member out of a nursing home — entire claim waived); and the Income-Based Hardship Waiver (heir's family group income below 400% of the federal poverty level for the two years before the Notice of Claim — up to $50,000 waived per qualifying heir, capped at $100,000 per estate). An estate cannot receive more than one type.

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

Steps to take when someone dies

1. Determine whether the deceased received MassHealth at age 55 or older, or as a resident of a nursing facility or other medical institution.
2. Send the MassHealth Estate Recovery Unit a copy of the probate petition and the death certificate by certified mail (P.O. Box 15205, Worcester, MA 01615-0205) — required even where the estate is filed as a voluntary administration. If the probate estate is $25,000 or less, recovery is waived.
3. Wait for the Estate Recovery Unit to file its Notice of Claim in the probate court; a copy is mailed or faxed to the personal representative.
4. Within 60 days of receiving the Notice of Claim, send written notice by certified mail to the Estate Recovery Unit to challenge the claim, request a deferral, or apply for a hardship waiver. Only the court-appointed personal representative can do this, using the Hardship Waiver Application Form on the MassHealth estate recovery page.
5. Address any valid claim as a debt of the estate before distributing assets to heirs.

Frequently asked questions