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The Federal government mandates that if you receive Medicaid benefits after age 55, or if Medicaid pays for nursing home care for you at any time during your life, Medicaid/MassHealth must attempt to recover the cost of benefits paid on your behalf from your estate at your death. In Massachusetts, MassHealth can only recover from assets that pass through your probate estate. Probate assets are those assets you owned individually prior to your death and that did not have a named beneficiary. At your death if your estate needs to be probated to pass your home and/or other assets to your heirs, it is then that MassHealth will make a claim against your Probate Estate in the probate court; that claim must then be paid prior to any distribution of your assets to your heirs.
During the last few years, the use of Senior Care Options and PACE programs began expanding. These are programs designed to provide complete healthcare to seniors in the community. The goal is to allow healthy seniors to continue living at home longer. MassHealth pays premiums to private companies to provide these programs, making the programs much more affordable. However, seniors that are enrolled in these programs were often unaware that their estate may have to payback MassHealth upon the senior’s death. The premiums can total as much as $3,000 per month. Many seniors and their families were not notified about potential probate estate recovery when they enrolled in the program. Upon the senior’s death, the probate estate could receive a large bill for the premiums paid by MassHealth.
Elder Law firms in Massachusetts filed appeals in the Courts on behalf of several clients who received these unexpected bills. A ruling was obtained that stated MassHealth can only recover premiums from a decedent’s estate if MassHealth mailed written Notice to the senior and their families at the time of enrolling in these Senior Care Options and PACE programs. The advance written notice must state that MassHealth has the right to recover premiums paid on behalf of the person enrolled in the program at the person’s death. Once this court ruling was obtained, MassHealth began mailing written notices to people beginning enrollment into these programs, thus allowing MassHealth the right to recover from a person’s probate estate at the person’s death. You may have received such a notice. If you did this means that you (or a loved one) are receiving or have received MassHealth benefits.
A Bill, crafted by Elder Law attorneys and advocates, is pending in the Massachusetts legislature proposing changes to make Estate Recovery fairer and limit Estate Recovery to only those assets that the Federal government mandates. As a result of this advocacy, MassHealth made revisions to the Estate Recovery rules. Those revisions expanded exemptions and waivers allowing more people to avoid Estate Recovery. Therefore, presently no probate estate under $25,000 is subject to Estate Recovery. There are also expanded waivers of estate recovery for low-income heirs, heirs who cared for the ill person at home and financial hardship waivers. If during the probate of a loved one’s estate, the Personal Representative (Executor) receives a MassHealth claim for estate recovery, you should check with an Elder Law Attorney immediately to see if any of the new waivers apply. There may be a very limited time to file for a waiver.
If you or a loved one need or are receiving MassHealth benefits directly, or MassHealth is paying your premiums for the Senior Care Options program or the PACE program, you may want to consult an Elder Law Attorney to see how Estate Recovery impacts your family. If you ae considering to apply for Senior Care Options program or the PACE program, there may be things that can be done in advance to avoid Estate Recovery. You should also find out if any of the recently developed waivers apply in your situation. This article highlights the complexity of MassHealth benefits and why it can be beneficial to work with an Elder Law Attorney to apply for and manage such benefits.
DO NOT make decisions based upon information in this article. Every family is unique and legal advice can only be given after an individual consultation with an elder law attorney. Any decisions made without proper legal advice may cause significant legal and financial problems.