Maryland Medicaid Estate Recovery 2026: Will They Take the House?

After a Maryland Medicaid recipient dies, the state can seek repayment from the estate for benefits paid at 55 or older, but family protections often delay or prevent it. If you are the executor or an adult child sorting this out in the weeks after a parent's death, here is how Maryland's rules work and what protections apply to your family.

Every state must operate a Medicaid estate recovery program under federal law, and Maryland carries out that obligation through the Maryland Department of Health (MDH). Maryland's regulation directs MDH to seek recovery of Medical Assistance correctly paid for anyone who was 55 or older when they received it, and that reaches beyond long-term care costs.1 Recovery waits until after a surviving spouse has died, can't proceed while a child under 21 or a blind or disabled son or daughter survives, and is off the table when MDH finds substantial hardship, a term Maryland defines narrowly.1

This guide covers who is subject to Maryland Medicaid estate recovery, what assets MDH can reach, who is protected, how to claim a hardship waiver, and how to respond when an estate receives a recovery notice.

Who Does Maryland Medicaid Estate Recovery Apply To?

Maryland Medicaid estate recovery is grounded in federal law. The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) enacted Section 1917(b) of the Social Security Act, now codified at 42 USC Section 1396p(b). This provision requires every state Medicaid program to recover certain long-term care costs from the estates of deceased recipients.2 The implementing federal regulation is 42 CFR 433.36.1

Under the federal mandatory floor, Maryland must seek recovery from the estates of residents who were:

• Age 55 or older at the time they received services, AND
• Receiving nursing facility care, HCBS, or related hospital and prescription drug services paid by Medicaid.

The federal mandate is focused on long-term services and supports (LTSS) rather than the general range of Medicaid benefits, and it keys on age at the time of service: care received before age 55 does not create a recovery basis under it, even if more care followed after 55.2 Federal law also lets a state recover for nearly any service its Medicaid plan paid for, and Maryland goes past the minimum: its regulation directs MDH to seek recovery of Medical Assistance correctly paid from the estate of anyone who was 55 or older when they received it, not only long-term care costs.2,3,1 So an estate whose owner received Medical Assistance after 55 but never used long-term care can still face a claim.

Maryland Medical Assistance, administered by MDH, covers long-term care through nursing facility benefits and HCBS waivers including the Maryland Community Options Waiver. Maryland is a medically needy state, meaning applicants who exceed the standard income limits can still qualify for long-term care coverage by spending down excess income on incurred medical costs. The medically needy income level as of February 1, 2026 is $350 per month for an individual.3 Maryland's recovery rule keys on the recipient's age when they received Medical Assistance, not on how they qualified, so someone who qualified through the medically needy pathway faces the same potential recovery claim at death as anyone else.3

Maryland's regulation carves out two kinds of payment. MDH may not recover Medical Assistance payments of Medicare premiums, copayments or deductibles, and it may not recover to the extent of the value of long-term-care partnership policy benefits paid to the person before death.1 So if Medical Assistance only covered your parent's Medicare premiums and cost-sharing, for example through one of the Medicare Savings Programs, those payments are not part of a recovery claim.

What Assets Can Be Recovered?

Every state's estate definition must include the probate estate, so that is the floor a Maryland recovery claim reaches at a minimum.2 The probate estate includes assets that the deceased owned in their sole name, without a beneficiary designation, joint tenancy, or other mechanism that would cause them to pass automatically outside of probate. Assets that pass outside probate sit outside that floor, which is not the same as being out of reach.

That distinction is the one families most often get wrong. "Outside the floor" means only that federal law does not compel Maryland to reach the asset; it does not mean the asset is safe. Federal law at 42 USC Section 1396p(b)(4)(B) gives states the option to expand the definition of "estate" beyond probate assets.2 The extent to which Maryland uses that option is not definitively stated in a single public document, so whether MDH pursues non-probate assets is a question for an elder-law attorney with current knowledge of MDH practice. Families with significant non-probate assets, particularly jointly-held real estate, should get legal advice before assuming those assets are beyond MDH's reach.

Liens filed before death. Maryland's regulation provides for a lien on the home of an institutionalized recipient and limits it. No such lien may be placed on the home while the recipient's spouse, child, blind or disabled son or daughter, or a sibling who has an equity interest in the home and lived there for at least 1 year before the recipient's admission to a long-term care facility lawfully lives in it, and the lien dissolves if the recipient is discharged and returns home.1 Where a lien has been imposed, no recovery may be made while a qualifying sibling or caregiver child is lawfully living in the home and has lived there continuously since the recipient's admission.2 A lien is a security interest rather than a sale: it encumbers the property and appears on a title search. How often MDH files these liens in practice is not something its published materials tell us. If anything resembling a lien notice has reached you, write to the Estates, Liens and Trust Section at the address below and ask what was filed and under what authority.1

Who Is Protected from Maryland Medicaid Estate Recovery?

Federal law at 42 USC Section 1396p(b)(2), and the Maryland regulation that carries it out, limit when Maryland Medicaid estate recovery can happen. These limits are mandatory, not discretionary, and most of them delay recovery rather than cancel it.2,1

Recovery cannot proceed while any of the following are true:

• A surviving spouse is alive. Recovery is deferred until after the surviving spouse's death; it is a delay, not a permanent bar.1 Families where the surviving spouse has significant assets or a valuable home may want to discuss planning options with an elder-law attorney during the spouse's lifetime.
• A child under age 21 survives. Maryland's regulation defines a child as an unmarried person younger than 21.3
• A son or daughter of any age who is blind or disabled survives.1

Two further federal protections attach to the home where a lien has been imposed on it under 42 USC Section 1396p(a)(1)(B):

• A sibling who lived in the home for at least one year immediately before the recipient was admitted to a medical institution, is lawfully living there now, and has lived there continuously since that admission.2
• A caregiver child (any age) who lived in the home for at least two years immediately before that admission, establishes to the state's satisfaction that they provided care that let the recipient stay at home rather than in an institution, is lawfully living there now, and has lived there continuously since the admission.2

Don't count on MDH already knowing who is in the family or living in the home. The estate administrator should set out the relevant facts for MDH in writing, with supporting documentation, when notifying MDH of the recipient's death.

The caregiver child protection for estate recovery is related to but legally separate from the caregiver child transfer exception under 42 USC Section 1396p(c)(2)(A)(iv), which applies to the eligibility-period look-back rule rather than post-death recovery.

How to Claim a Hardship Waiver

Federal law at 42 USC Section 1396p(b)(3) requires every state to have procedures for waiving recovery when it would work an undue hardship.2 Maryland's version is narrow. MDH may not seek recovery when, in its judgment, substantial hardship exists, and the regulation defines that as a claim that would force the sale or transfer of the deceased person's real property and so remove a dependent who:

1. lived in the property on the date of death,
2. had lived there continuously for at least 2 years before the death, and
3. can't provide another place to live.1

If not every condition is met, MDH's fact sheet says Medicaid may instead let the dependent keep living in the property and place a non-interest-bearing mortgage on it, with monthly payments set by ability to pay.1

To ask for either, the estate administrator should write to MDH, describe the dependent's situation, and include documentation such as proof of where the dependent has lived and their income. If MDH says no, ask in writing how to contest the decision and by what date.

A well-documented request makes a difference. An elder-law attorney can help the administrator build it, particularly when the home has been the main caregiver household's residence.

How to Respond If You Receive a Claim

When a Maryland Medical Assistance recipient dies, the estate administrator or executor should contact MDH proactively to understand whether a recovery claim applies, rather than waiting for a notice to arrive. MDH's estate recovery fact sheet sends questions about estate and property lien recovery to its Recoveries and Financial Services Division, Estates, Liens and Trust Section, or to your caseworker at the local department of social services. The Maryland People's Law Library calls the same unit the Division of Recoveries & Financial Services, once known as the Division of Medical Assistance Recoveries.1

Where to reach MDH about estate recovery:

• MDH Recoveries and Financial Services Division, ATTN: Estates, Liens and Trust Section: P.O. Box 13045, Baltimore, MD 21203. MDH's property liens and estate recovery fact sheet cites Article 15-120 of the Annotated Code of Maryland, COMAR 10.09.24.15, and TEFRA 1982 as the legal basis for the program.1 That fact sheet dates from November 2006, when MDH was still the Department of Health and Mental Hygiene, so put anything you need on the record in writing and keep a copy.
• MDH Long Term Care: health.maryland.gov/mmcp/longtermcare
• Your local department of social services caseworker: the fact sheet's other route for estate and lien questions, useful if you're unsure where to start.1 For a notice of death or anything else you want on the record, write to the Recoveries and Financial Services Division directly.

Steps for the estate administrator:

On timing, the Maryland People's Law Library's guide to small estates says MDH has 6 months after publication of notice of the first personal representative's appointment, not 6 months from the date of death, to present its claim, and the personal representative can shorten that by sending the Division a notice that the claim will be barred unless presented within 2 months of receipt.1 That guide is written for small estates, so confirm the timing with the estate's attorney. MDH's fact sheet adds that Medicaid is usually a general creditor, paid after priority claims such as court fees, estate administration costs, funeral expenses, attorney's fees and taxes.1

Don't close probate or distribute to heirs until MDH's position is resolved. An estate attorney and an elder-law attorney working together can help sequence probate proceedings appropriately.

Learn More

Find personalized help understanding Maryland Medicaid estate recovery at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.