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Audit  Audit of the Office of Medicaid (MassHealth)—Review of Estate Recovery

Audit called on MassHealth to enhance measures to prevent individuals and families from incurring unnecessary financial hardship during its estate recovery process, which is used to recoup funds from the deceased for Medicaid expenses paid on their behalf. The audit examined July 1, 2016 through December 31, 2018.

Organization: Office of the State Auditor
Date published: June 28, 2021

Executive Summary

The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the Commonwealth’s Medicaid program. This program, known as MassHealth, is administered under Chapter 118E of the Massachusetts General Laws by the Executive Office of Health and Human Services, through the Division of Medical Assistance. Medicaid is a joint federal-state program created by Congress in 1965 as Title XIX of the Social Security Act. At the federal level, the Centers for Medicare & Medicaid Services, within the United States Department of Health and Human Services, administer the Medicare program and work with state governments to administer state Medicaid programs.

OSA has conducted a performance audit of MassHealth claims for estate recovery for the period July 1, 2016 through December 31, 2018. During this period, MassHealth recovered $96,618,866 for Medicaid expenses paid by 3,440 estates. The average estate recovery was approximately $28,087. The purpose of this audit was to determine whether MassHealth ensures that estate recovery does not create undue financial hardships for low- and middle-income families.

The audit was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program. As with any government program, public confidence is essential to this program’s success and continued support.

Below is a summary of our findings and recommendations, with links to each page listed.

Finding 1

MassHealth’s estate recovery may cause some families to incur undue financial hardship.


  1. MassHealth should establish a cost-effectiveness threshold to prevent undue financial hardship for members’ survivors.
  2. MassHealth should better promote its undue-hardship waiver process for members’ survivors.


A PDF copy of the audit of the Office of Medicaid (MassHealth)—Review of Estate Recovery is available here.


Post-Audit Action

By the end of our audit fieldwork, MassHealth had put in place the following estate recovery policy reforms:

  • expanded criteria for members’ heirs to qualify for undue-hardship waivers
  • an expanded number of low-income individuals and families eligible for waivers
  • new waivers, permanent immediately upon qualification
  • two new waivers: the Care Provided Hardship Waiver and the Income-Based Hardship Waiver.






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Boston, MA 02133

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