Medicaid’s estate recovery claim is essentially a creditor’s claim allowing the State to recover medical assistance paid on behalf of recipients of long-term care Medicaid. Authority for the claim is found at 42 U.S.C. § 1396p(b). The claim is limited to the applicant’s estate, although State laws vary regarding what the estate looks like. As shown below, although estate recovery is mandatory, States have the option of limiting estate recovery to the probate estate or expanding it to “any other real and personal property and other assets in which the individual had any legal title or interest at the time of death.” The claim is almost always made against the deceased Medicaid recipient’s home because it is the most valuable exempt resource remaining (countable resources were spent-down prior to becoming eligible for Medicaid). The claim cannot be made until after the Medicaid recipient and his or her spouse are deceased. If you’re concerned about minimizing or avoiding estate recovery, you should consult a Certified Elder Law Attorney.

As of the time of this post (7/28/2022), the federal law provides as follows:

(b) Adjustment or recovery of medical assistance correctly paid under a State plan

(1) No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan may be made, except that the State shall seek adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan in the case of the following individuals:

(A) In the case of an individual described in subsection (a)(1)(B), the State shall seek adjustment or recovery from the individual’s estate or upon sale of the property subject to a lien imposed on account of medical assistance paid on behalf of the individual.
(B) In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of—

(i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or
(ii) at the option of the State, any items or services under the State plan (but not including medical assistance for medicare cost-sharing or for benefits described in section 1396a(a)(10)(E) of this title).

…

(2) Any adjustment or recovery under paragraph (1) may be made only after the death of the individual’s surviving spouse, if any, and only at a time—

(A) when he has no surviving child who is under age 21, or (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or permanently and totally disabled, or (with respect to States which are not eligible to participate in such program) is blind or disabled as defined in section 1382c of this title….

(4) For purposes of this subsection, the term “estate”, with respect to a deceased individual—

(A) shall include all real and personal property and other assets included within the individual’s estate, as defined for purposes of State probate law; and
(B) may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (1)(C)(i) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.