What is Medicaid Estate Recovery in Massachusetts?

If your loved one is receiving long-term care through Medicaid in Massachusetts—or you’re planning ahead—you’ve probably heard the term “estate recovery.” It’s not just legal jargon. Estate recovery directly affects what happens to someone’s home, savings, and other assets after they pass away. And for many families, it comes as a surprise.

You’ve worked hard to build a life, raise a family, and set something aside for your future. The thought of losing that to nursing home bills or government repayment claims can raise serious concerns about how to protect what you’ve built. But understanding how Medicaid estate recovery works in Massachusetts gives you a chance to protect your hard-earned savings while staying within the law.

What Is Medicaid Estate Recovery?

Medicaid estate recovery refers to the process where the state seeks reimbursement for Medicaid benefits paid on behalf of a deceased Medicaid recipient. In Massachusetts, the Office of Medicaid (MassHealth) can pursue recovery from the estate of a person who:

• Was 55 or older when they received Medicaid coverage, or
• Received long-term care services, regardless of age.

MassHealth may try to collect repayment for the cost of a nursing home stay, community based services, hospital care, prescription drugs, and other covered benefits.

This process is required by federal law under 42 U.S. Code § 1396p. Massachusetts follows this mandate through its regulations at 130 CMR 515.011.

What Assets Are at Risk?

In Massachusetts, an “estate” includes:

• Homes and other real estate
• Bank accounts and investment portfolios
• Vehicles and personal property
• Certain jointly held assets

Even if your property is not listed in a will, it may still be included in the probate estate, which is what MassHealth typically recovers against, if the Medicaid applicant owned it at death.

Are There Exceptions to Recovery?

Yes—MassHealth cannot pursue estate recovery if the deceased has:

• A surviving spouse
• A child under 21
• A child of any age who is blind or permanently disabled

In these cases, estate recovery is delayed or waived. There’s also an undue hardship provision that allows someone to apply for relief if recovery would threaten the family’s income or force the sale of a small business or family home.

How Medicaid Planning Can Minimize the Impact

If your loved one receives care through nursing home Medicaid or a skilled nursing facility, the cost can quickly exceed thousands per month. Without proper Medicaid Planning, the state may later try to recover those expenses from their estate.

That’s where long-term care planning and financial planning come in. With the right strategy, you may be able to:

• Transfer countable assets outside the look-back period (5 years)
• Convert funds into a protected income stream
• Meet the income limit using a qualified income trust
• Pay legitimate expenses like nursing home costs or burial arrangements
• Protect the community spouse from asset depletion
• Avoid triggering a penalty period that delays coverage

These strategies only work when handled properly, and early planning often leads to more cost-effective outcomes. Since state law and Medicaid rules are complex, many families turn to a trusted Medicaid Planning lawyer for guidance. Keep in mind that any transfers made within five years of applying for Medicaid may trigger a penalty period and delay eligibility.

What About the Family Home?

The home is often a person’s most valuable asset—and one that families work hardest to keep. During the Medicaid application process, a primary residence may not count as an asset if a community spouse or qualifying child still lives there. But once the Medicaid recipient passes, the home may become vulnerable.

MassHealth may recover against the home unless:

• It was transferred out of the recipient’s name before the look-back period
• It was placed in an irrevocable trust outside of probate
• A hardship waiver is granted
• A Medicaid beneficiary’s exempt relative still lives there

If your goal is to pass the home down to children or keep a private room in the family, early estate planning becomes essential.

How the Recovery Process Works

Once the Medicaid recipient dies, MassHealth begins the estate recovery process:

1. Notification: The estate’s representative notifies MassHealth of the death.
2. Claim Filing: MassHealth files a formal claim with the probate court for reimbursement.
3. Valuation: Assets in the estate are identified and valued.
4. Repayment: The state recovers costs from the estate before assets can be distributed.

This can delay the probate process and reduce what heirs receive. Even after just a short nursing home stay, the nursing home bill could add up to tens or hundreds of thousands of dollars.

Can You Avoid Medicaid Estate Recovery?

Estate recovery isn’t always avoidable—but you can often reduce its impact. A few strategies that may protect assets include:

• Setting up an irrevocable trust five years in advance
• Using a qualified income trust to meet eligibility
• Spending down on allowable expenses such as home repairs, burial arrangements, or durable medical equipment
• Gifting assets early enough to avoid a penalty period
• Coordinating with a tax planning professional or financial advisor
• Aligning your estate planning documents with Medicaid assistance goals

These strategies often require working with an elder law attorney who understands both the legal and financial side of planning. In some cases, they may also collaborate with other professionals to create a plan tailored to your family’s needs.

Planning Matters—Now More Than Ever

You might assume that Medicaid is just another government benefit—but if you don’t take action, it could cost your estate more than you expect. If your loved one has many assets or receives care in an assisted living facility, the potential for recovery is high.

You may not be able to predict every outcome, but you can control how much your decisions today affect your future. With the right planning, you may reduce the state’s ability to take from your estate and preserve more for your family members.

Talk with a Professional Who Knows Massachusetts Law

Massachusetts has its own version of Medicaid rules, which may differ from what you’ve read about in other states. If you’re unsure whether your current plan might impact Medicaid, it’s time to review your options.

A local elder law attorney can walk you through the legal issues, look at your assets, and implement strategies to protect what matters most—your family, your home, and your legacy.

Preserve What Matters Most—Your Family, Your Home, Your Legacy

MassHealth’s estate recovery process can catch families off guard, especially after years of careful saving. You don’t have to leave your home or other assets unprotected. With proactive planning, it’s possible to qualify for Medicaid benefits without putting your estate at risk later.

For over 20 years, The Law Office of Polly Tatum has guided Massachusetts families through the legal and financial challenges of long-term care. Our team takes a thoughtful and personalized approach to Medicaid Planning, long-term care strategy, and estate protection—always with respect, clarity, and compassion.

Whether you’re planning ahead or responding to a recent diagnosis, we’ll walk you through your options and develop a plan that supports your loved ones both now and in the future.

Your online search for a “Medicaid Planning attorney” or “Medicaid lawyers near me” brought you to this blog. Take the next step and call (508) 795-1557(508) 795-1557 or complete our confidential online form to schedule your strategy session. Virtual and in-person meetings are available for your convenience.

PROTECT WHAT MATTERS MOST—Take Control of Your Medicaid Planning Today.

Copyright © 2025. The Law Office of Polly Tatum. All rights reserved.

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.

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