Maryland Medicaid estate recovery applies after death to recipients 55 or older who received long-term care. 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). After a qualifying recipient of Maryland Medical Assistance dies, MDH may seek repayment for certain long-term care costs from the estate, starting with the assets that pass through probate. Federal law builds in several mandatory protections (for a surviving spouse, a minor child, and a blind or permanently disabled child) that block recovery in many family situations. A hardship waiver is also available when recovery would impose genuine financial burden.

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. OBRA-93 (Pub. L. 103-66, Section 13612) 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. The implementing regulation sits at 42 CFR 433.36, and CMS operational guidance is in State Medicaid Manual Section 3810.

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. Whether Maryland recovers anything beyond that federal minimum is not something MDH's published materials settle, so an estate that received Medical Assistance but no LTSS is worth a call to MDH rather than an assumption.

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. Estate recovery keys on the long-term-care services Medicaid paid for and the recipient's age when they received them, so someone who qualified through the medically needy pathway faces the same potential recovery claim at death as anyone else.

One federal carve-out is relevant here: Medicaid payments made solely for Medicare premiums and cost-sharing through the Medicare Savings Programs (QMB, SLMB, QI) are excluded from estate recovery under an Affordable Care Act (ACA) provision effective January 1, 2010. A person whose only Medicaid enrollment was through a Medicare Savings Program and who never received Medicaid LTSS would not have a recovery claim against their estate.

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. 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.

Asset In the probate estate? Inside the federal recovery floor?
Real estate titled solely in the deceased's name (no joint owner, no transfer-on-death deed) Yes Yes
Bank account in the deceased's name alone, no payable-on-death (POD) beneficiary Yes Yes
Investment account in the deceased's name alone, no transfer-on-death (TOD) designation Yes Yes
Personal property (vehicles, jewelry, household goods) owned individually Yes Yes
Business interest held solely in the deceased's name Yes Yes
Jointly-held account with right of survivorship No Outside the floor
Account with a POD or TOD beneficiary No Outside the floor
Life insurance or retirement account with a named beneficiary No Outside the floor

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. 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. Federal law contemplates a lien imposed on the home of a permanently institutionalized recipient under 42 USC Section 1396p(a)(1)(B), and where one 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. A lien of that kind is a security interest rather than a sale: it encumbers the property and appears on a title search. Whether MDH actually files pre-death liens, and in what circumstances, is not something we can establish from its published materials. MDH's own fact sheet on the subject is written for property liens and estate recovery together and lists TEFRA 1982 among its legal bases, which is a reason to ask rather than an answer. If anything resembling a lien notice has reached you, call the Estates, Liens and Trust Section at (410) 767-6613 and ask what was filed and under what authority.

Who Is Protected from Maryland Medicaid Estate Recovery?

Federal law at 42 USC Section 1396p(b)(2) creates categorical protections that block Maryland Medicaid estate recovery in specific family situations. These are mandatory, not discretionary.

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. Recovery may later be sought from the spouse's estate if property inherited from the Medicaid recipient is still identifiable. 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 is alive. Recovery is completely blocked until the child turns 21.
  • A child of any age who is blind or permanently and totally disabled (using the SSI disability standard at 42 USC Section 1382c) is alive.

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.
  • 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.

These protections must be asserted and documented by the estate administrator during the recovery process. They don't apply automatically. The estate administrator should communicate the relevant facts to 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 Maryland to maintain procedures for waiving estate recovery when it would cause undue hardship. The CMS State Medicaid Manual Section 3810.C identifies three recognized hardship categories:

  1. The asset is the sole income-producing asset. If the primary estate asset is a family farm, family business, or other asset that represents the surviving household's sole income source, recovery can be waived to protect that livelihood.
  2. The asset is a homestead of modest value. Where the home is modest in value and the family would face genuine hardship from losing it, a waiver may apply.
  3. Other compelling circumstances. Maryland may recognize additional situations beyond these two baseline categories.

To apply, the estate administrator should contact MDH in writing, describe the specific hardship circumstances, and include supporting documentation (proof of income dependency, property appraisals, family circumstances). MDH will review and issue a determination. If MDH denies the waiver, the estate administrator has the right to a fair hearing.

A well-documented application makes a difference. An elder-law attorney can help the administrator build a complete hardship waiver submission, particularly in cases involving a family business or farm, or when the home has been the primary caregiver household's residence.

How to Respond If You Receive a Claim

When a Maryland Medical Assistance recipient dies, MDH will typically learn of the death through the state's vital records system. The estate administrator or executor should contact MDH proactively to understand whether a recovery claim applies, rather than waiting for a notice to arrive. Within MDH, estate recovery is handled by the Division of Recoveries and Financial Services (DRAFS), specifically its Estates, Liens, and Trust Section, not the general Medicaid eligibility office.

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. Phone: (410) 767-6613. 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. That fact sheet is an older MDH publication, so confirm the phone line is still in service when you call, and use the mailing address for anything you need on the record.
  • MDH Long Term Care: health.maryland.gov/mmcp/longtermcare
  • Direct estate recovery correspondence to that division rather than to the eligibility office that handled the original application. They are separate offices, and a letter sent to the wrong one can sit unanswered while probate deadlines run.

Steps for the estate administrator:

1
Step 1

Notify the Maryland Department of Health

Write to the Maryland Department of Health's Recoveries and Financial Services Division, ATTN: Estates, Liens and Trust Section, P.O. Box 13045, Baltimore, MD 21203, or call (410) 767-6613, to report the recipient's death and request information on any outstanding recovery claim. Reaching out proactively is better than waiting for a notice to arrive.

2
Step 2

Compile an estate inventory

Assemble a list of the probate estate's assets and their values so you can see what MDH could reach and what passes outside probate.

3
Step 3

Document any mandatory protection

If a surviving spouse, a child under 21, or a blind or disabled child of any age is alive, document the relationship and communicate it to MDH in writing, since these protections must be asserted, not applied automatically.

4
Step 4

Document any sibling or caregiver-child protection

If a sibling with an equity interest or a caregiver child qualifies, gather the residency history and evidence of care provided.

5
Step 5

File a hardship waiver if it applies

Where recovery would cause genuine financial hardship, prepare and submit a written waiver application with supporting documentation.

6
Step 6

Verify the claim's scope

Review any claim MDH asserts to confirm it reflects only LTSS costs for services received at age 55 or older, not Medicare Savings Program cost-sharing.

7
Step 7

Request a fair hearing if you disagree

If you contest the claim or a waiver denial, request a fair hearing within the deadline stated in the notice.

Probate should not close until MDH's recovery position is fully resolved. Making distributions to heirs before the claim is settled can create personal liability for the estate administrator. An estate attorney and an elder-law attorney working together can help sequence probate proceedings appropriately.

Frequently Asked Questions

Will Maryland Medicaid take my parent's house after they die?

It depends on how the home is held and whether any protections apply. If the home is titled solely in the deceased's name and passes through probate, MDH may include it in a recovery claim. But recovery is completely blocked if a surviving spouse is alive, a child under 21 is alive, or a blind or permanently disabled child of any age is alive. The caregiver child and sibling protections can also shield the home in specific circumstances. If none of these apply and the home passes through probate, MDH may pursue recovery up to the amount of Medicaid LTSS benefits paid.

What if my parent received Medicaid home care through a waiver instead of nursing home care?

HCBS services delivered through Maryland Medical Assistance waivers, including the Community Options Waiver, qualify as LTSS subject to estate recovery on the same terms as nursing facility care. The relevant question is whether qualifying long-term services and supports were received at age 55 or older, regardless of whether the setting was a nursing facility or the recipient's own home.

Does Maryland Medicaid estate recovery apply if my parent went through the medically needy spend-down?

Yes. Maryland's medically needy spend-down pathway is an eligibility mechanism: it determines how a person with income above the standard limit can qualify for coverage. Once qualified, the LTSS services they receive are paid by Medicaid and become the basis for a potential recovery claim after death. The eligibility pathway does not affect the recovery obligation.

Can MDH put a lien on the house while my parent is still alive in a nursing home?

Federal law contemplates a pre-death lien on the home of a permanently institutionalized recipient under 42 USC Section 1396p(a)(1)(B). Whether MDH actually files them, and in what circumstances, is not something we can establish from its published materials, so treat it as a question for the Estates, Liens and Trust Section at (410) 767-6613 rather than a settled yes or no. Where such a lien has been imposed, recovery is barred while a qualifying sibling or caregiver child is lawfully living in the home and has lived there continuously since the admission. A lien is a security interest rather than a sale, but it encumbers the property and appears on a title search, so if you believe one was filed and a protection applies, contact MDH and consider legal assistance.

How does Maryland Medicaid estate recovery interact with the five-year look-back?

These are two separate rules. The look-back (at 42 USC Section 1396p(c)) applies before and during a Medicaid LTSS application: it examines asset transfers in the 60 months before the application and can create a penalty period delaying eligibility. Estate recovery applies after death: it seeks repayment from the probate estate for LTSS costs Medicaid paid. Planning tools that reduce look-back exposure, like irrevocable trusts executed more than five years before application, can also reduce what remains in the probate estate available for recovery. But each rule requires separate legal analysis.

What is Maryland's hardship waiver and how does the family apply?

The hardship waiver allows MDH to forgo or reduce recovery when it would cause genuine financial hardship for the surviving household. The core qualifying situations are when the primary estate asset is the family's sole income source, or when recovery against a modest family home would cause real hardship. To apply, contact MDH in writing with a description of the hardship circumstances and supporting documentation. MDH issues a determination, and the administrator can request a fair hearing if the waiver is denied.

Maryland Medicaid estate recovery has clear rules and real protections. Brevy's care navigator can help you understand what applies to your family's situation and connect you with an elder-law attorney in Maryland.

Learn More

MedicaidMaryland Medicaid Eligibility and Income LimitsMaryland Medicaid has two income limits: $1,835/mo for adults under 65, with no asset test, and a $350 medically needy level plus spend-down for seniors. MedicaidHow to Apply for Maryland MedicaidLearn how to apply for Maryland Medicaid through Maryland Health Connection or your local DSS. Covers spend-down, documents, timelines, and appeals. MedicaidMaryland Medicaid: A Guide for Seniors and FamiliesMaryland Medicaid covers long-term care in 2026: the $2,500 medically needy asset limit, $106 PNA, spend-down, HCBS waivers, and how to apply through MDH. MedicaidMaryland Medicaid Spousal Impoverishment RulesMaryland Medicaid spousal impoverishment 2026: CSRA protects up to $162,660 in assets; MMMNA protects income. No Miller Trust required (medically needy state). MedicaidMedicaid Estate Recovery ExplainedMedicaid estate recovery explained: federal law, 51-state matrix, categorical protections, hardship waivers, and 2025-2026 reform updates. Verify before acting.

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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.