About Estate Recovery
Federal and state Medicaid law requires MassHealth to recover assets from the estates of certain MassHealth members after their death. This process is called “estate recovery.” The assets are used to reimburse (pay back) the state for the cost of care that MassHealth paid for the member.
In some cases, MassHealth may delay this process or “waive” this requirement (not recover assets).
More information about this process and how to request a waiver or delay can be found below and in the Frequently Asked Questions (FAQ) section.
Who does estate recovery apply to?
According to federal and state law, MassHealth must seek to recover from the probate estates of MassHealth members who
- were 55 or older when they received medical assistance paid by MassHealth for nursing facility services, home and community-based services, and related hospital and prescription drug services (also known as long-term services and supports); and
- were of any age when they received medical assistance paid by MassHealth for long-term care in a nursing home, Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID), or an Institution for Mental Disease (IMD).
Please note: For former MassHealth members with a date of death before August 1, 2024, MassHealth estate recovery applies to any members aged 55 or older for any care paid for by MassHealth, not just certain long-term services and supports.
What are long-term services and supports?
For the purposes of estate recovery, as defined by federal and state law, long-term services and supports (LTSS) include the following:
- Nursing home services
- Services provided in an Intermediate Care Facility for Persons with an Intellectual Disability (ICF/ID)
- 1915(c) Home and Community Based Services (HCBS). These are services covered under one of the following MassHealth 1915(c) HCBS waivers that serve adult MassHealth members:
- The Frail Elder Waiver (FEW)
- The Acquired Brain Injury – Residential Habilitation (ABI-RH) waiver
- The Acquired Brain Injury – Non-residential Habilitation (ABI-N) waiver
- The Traumatic Brain Injury (TBI) waiver
- The Moving Forward Plan – Residential Supports (MFP-RS) waiver
- The Moving Forward Plan – Community Living (MFP-CL) waiver
- The Adult Supports (DDS-AS) waiver for persons with an Intellectual Disability
- The Community Living waiver (DDS-CL) waiver for persons with an Intellectual Disability
- The Intensive Supports (DDS-IS) waiver for persons with an Intellectual Disability
- Hospital and prescription drug services received during the time the member was admitted to a nursing facility or enrolled in a 1915(c) HCBS Waiver.
What kind of assets does the law require MassHealth to seek recovery from?
Federal and state law require MassHealth to seek recovery from anything that is part of the member’s probate estate. A probate estate includes assets that were owned solely by the individual at their time of death.
Any property or assets that are part of the MassHealth member’s probate estate are subject to estate recovery. This can include real property (homes) and personal property (cars, funds in bank accounts, and other assets). MassHealth cannot recover from assets that are outside of a member’s probate estate.
Assets collected during estate recovery are put into the Massachusetts general fund.
How much of the member’s estate does the law require MassHealth to recover?
According to federal and state law, MassHealth is required to seek recovery:
- For individuals 55 or older, medical assistance paid by MassHealth for nursing facility services, home and community-based services, and related hospital and prescription drug services (also known as long-term services and supports); and
- For individuals of any age, medical assistance paid by MassHealth for long-term care in a nursing home, Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID), or an Institution for Mental Disease (IMD). For former MassHealth members with a date of death before August 1, 2024, MassHealth is required to recover the total cost of care it paid for members after they turned 55.
If the MassHealth claim exceeds the value of the remaining amount in the estate, MassHealth will recover the remaining amount from the estate and will not pursue any unsatisfied claim amount from the estate.
Is managed care subject to estate recovery?
Estate recovery may apply to MassHealth members whether they were enrolled in a MassHealth health plan or MassHealth paid for their care directly (Fee for Service).
If a member enrolled in a MassHealth health plan (like an Accountable Care Organization (ACO) or a One Care plan) and received LTSS services after age 55, MassHealth is required to seek recovery for the amount it paid to the health plan that MassHealth’s actuary has determined were for LTSS services in the month that the member received LTSS services.
Please note: For members of any age who are permanently institutionalized and for former MassHealth members with a date of death before August 1, 2024, MassHealth is required to seek recovery for the total amount it paid to the health plan for the member’s care, regardless of what services the member received.
The amount MassHealth pays to the plan is also known as the premium payment or capitation rate. The premium payment or capitation rate may be more or less than the actual cost of services the member received. A member’s estate will never have to repay more than the amount MassHealth paid.
Are there exceptions to the estate recovery requirement?
Yes, MassHealth may not enforce all or part of its estate recovery claim in certain situations.
- MassHealth will waive estate recovery for all probate estates valued at $25,000 or less. The personal representative still needs to send a copy of the petition and death certificate to MassHealth.
- If the MassHealth member had certain long-term-care insurance and met the other requirements under the rules to qualify for this exception on the date of admission to a long-term-care facility, the estate may not have to repay MassHealth for nursing facility and other long-term-care services. The long-term-care insurance must meet the rules of the Division of Insurance under 211 CMR 65.09, and MassHealth regulations at 130 CMR 515.000. The member must also have been living in a long-term-care facility and told MassHealth that they did not intend to return home.
- If the MassHealth member was eligible for both MassHealth and Medicare, MassHealth will not recover Medicare cost-sharing benefits (premiums, deductibles, and copayments) paid on or after January 1, 2010, for members who got these benefits while they were 55 or older. This includes Medicare Savings Programs.
- If the MassHealth member was enrolled in a MassHealth plan that included member premiums paid to MassHealth on their behalf when the member was 55 or older, MassHealth will not recover on the amount that the member paid in premiums during that time period.
- Certain income, resources, and property of American Indian and Alaska Natives are exempt from estate recovery.
- Estate recovery may be temporarily delayed if the MassHealth member leaves behind a surviving spouse, a child who is blind, a child who is permanently and totally disabled, or a child younger than 21 years old. This is called a deferral. Once the conditions allowing for a deferral are no longer met, MassHealth will seek to recover its claim amount against the member’s probate estate.
- If MassHealth determines that the estate qualifies for an undue hardship waiver, MassHealth will waive all or part of its estate recovery claim. The types of undue hardship waivers are described below.
There are other situations in which MassHealth may grant a waiver. The FAQs below will give you more information about who may qualify for a delay or waiver and how to apply for a waiver.
What is an estate?
An “estate” includes all real property (land or buildings) and personal property (mobile homes, vehicles, savings, other assets) that the individual on MassHealth owned or had an interest in when they died.
What is probate?
Probate is the formal court process for distributing your property after you die. Whether an estate is probated depends on how the property is owned when you die. In general, assets that you designate for people to inherit through your will are probate assets. If you die without a will, state law will determine which of your assets are probated and who will inherit them.
Estate Recovery Frequently Asked Questions
These Frequently Asked Questions (FAQs) provide general information about MassHealth’s estate recovery program requirements, process, hardship waivers, and deferrals. Please note that the information in these FAQs may not apply to every individual situation.
Additional Resources
Estate Recovery Fact Sheet
The Fact Sheet gives members general information about estate recovery. It includes the most commonly asked questions regarding a MassHealth member notice called “Important Information about MassHealth Estate Recovery Requirement.”
Additional Resources
Hardship Waiver Application
To apply for an estate recovery hardship waiver, please review and complete the appropriate application form for your circumstances.
Additional Resources
Estate Recovery Policy Updates
See below for documents and related links regarding reforms to MassHealth's estate recovery program.