Medicaid Estate Recovery in Pennsylvania

Medicaid Estate Recovery in Pennsylvania: key facts

Recovery scope

Medical Assistance paid for nursing facility care, home and community-based services (HCBS), and related hospital and prescription services, provided on or after August 15, 1994.

Who is subject

Recipients who were 55 or older when they received the long-term care assistance. Recovery is made from the probate estate only.

Outside the claim

Survivorship property (joint tenancy with right of survivorship, tenancy by the entireties), life insurance payable directly to a named beneficiary, and assets placed in trust before death that are not payable to the estate are not subject to the claim. Property paid to family without letters under 20 Pa.C.S. § 3101 — including unclaimed property released under § 3101(e) — remains subject to it.

Notice and 45-day claim deadline

The executor or administrator of a decedent who reached 55 must find out whether the decedent received Medical Assistance in the five years before death and, if so, must notify the Department and request a statement of claim. The Department must submit its claim within 45 days of receiving an accurate and complete notice, or the claim is forfeited.

Recovery deferred

Collection is postponed until the last of: the death of a surviving spouse; the death of a child who is blind or totally and permanently disabled; the date a surviving child turns 21; or the death of, transfer by, or vacating of the property by a sibling who has an equity interest in the property and lived in the home for at least one year before the decedent died. No interest is charged during the postponement period.

Undue hardship waiver

The Department permanently waives its claim against the decedent's primary residence for a person who lived there continuously for at least 2 years and provided care or support for at least 2 years and has no other permanent residence; against an income-producing asset that is the household's primary income source where gross family income would otherwise fall below 250% of the Federal poverty guideline; and for administered estates with a gross value of $2,400 or less if there is an heir. DHS publishes an Undue Hardship Waiver Request Form and a separate form for income-producing property; requests go to the Estate Recovery Program, P.O. Box 8486, Harrisburg, PA 17105-8486.

Governing law: 62 P.S. 1412; 55 Pa. Code Chapter 258

Steps to take when someone dies

1. Determine whether the deceased received Pennsylvania Medical Assistance for long-term care at age 55 or older in the five years before death.
2. Send notice of the death to the Department of Human Services Estate Recovery Program — by certified mail return receipt or fax — with the decedent's name, last known address, Social Security number, date of birth, date of death, and the gross value of the estate, and request a statement of claim.
3. Expect the Department's statement of claim within 45 days of an accurate and complete notice; the claim is forfeited if it is not submitted in that window.
4. Address the recovery claim as a debt of the probate estate before distributing assets to heirs.
5. Request an undue-hardship waiver from the Department if recovery would cause undue hardship to the heirs.

Frequently asked questions