Medicaid Estate Recovery in Pennsylvania

What is recovered

55 Pa. Code § 258.1 reaches 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, 1994.¹

Who is subject to recovery

Recipients who were 55 or older when they received the long-term care assistance.^{1, 2}

What counts as the estate

Section 1412 of the Human Services Code directs the Department to recover from the probate estate only.²

Under 55 Pa. Code § 258.3, 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.³

Life insurance payable to the estate, and property paid to family without letters under 20 Pa.C.S. § 3101 (including unclaimed property released under § 3101(e)), remain subject to the claim.³

How the state files its claim

Section 1412(b) requires the executor or administrator of a decedent who reached 55 to find out whether the decedent received Medical Assistance in the five years before death and, if so, to notify the Department and request a statement of claim.²

The Department must submit its claim within 45 days of receiving an accurate and complete notice, or the claim is forfeited.^{2, 4}

When recovery is deferred or barred

55 Pa. Code § 258.7 postpones collection 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, where a sibling with an equity interest lived in the home, the end of that sibling's occupancy.⁵

For a sibling who has an equity interest in the property and lived in the home for at least one year before the decedent died, collection waits until the sibling dies, transfers the property, or vacates it. No interest is charged during the postponement period.⁵

Undue-hardship waiver

55 Pa. Code § 258.10 permanently waives the claim against the decedent's primary residence for a person who lived there continuously for at least 2 years, provided care or support for at least 2 years, and has no other permanent residence.⁶

The Department also permanently waives its claim 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.⁶

Exemptions and protected assets

The Department finds undue hardship and permanently waives its claim for administered estates with a gross value of $2,400 or less, if there is an heir.⁶

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

The Department's statement of claim

within 45 days of receipt of an accurate and complete notice; the claim is forfeited^{2, 4}

1. 1.55 Pa. Code § 258.1
2. 2.Human Services Code § 1412 (62 P.S. 1412), Act of June 13, 1967, P.L. 31, No. 21
3. 3.55 Pa. Code § 258.3
4. 4.Estate Recovery Program Brochure (English), Pennsylvania Department of Human Services
5. 5.55 Pa. Code § 258.7
6. 6.55 Pa. Code § 258.10