Massachusetts Medicaid Estate Recovery (MassHealth) 2026

Chapter 197 of the Acts of 2024 gave Massachusetts the most significant rollback of Medicaid estate recovery any state has enacted since the program became federally mandatory in 1993. When a resident receives MassHealth long-term-care benefits during life, federal and state law require the Commonwealth to attempt to recover what MassHealth paid out from the deceased member's estate after death, and this is Massachusetts Medicaid estate recovery, a process governed by M.G.L. c. 118E § 31 (as amended by Chapter 197 of the Acts of 2024) and 130 CMR 515.011 of the MassHealth regulations.

What This Guide Covers

When a Massachusetts resident receives MassHealth long-term-care benefits during life, federal and state law require the Commonwealth to attempt to recover what MassHealth paid out from the deceased member's estate after death. This is estate recovery, a process governed by M.G.L. c. 118E § 31 (as amended by Chapter 197 of the Acts of 2024) and 130 CMR 515.011 of the MassHealth regulations.

The Massachusetts estate recovery landscape underwent its most significant transformation in decades in 2024. Chapter 197 of the Acts of 2024 ("An Act to Improve Quality and Oversight of Long-Term Care") was signed by Governor Healey on September 6, 2024, became effective December 5, 2024, and applies retroactively to estates of MassHealth members who died on or after August 1, 2024. The reform narrowed Massachusetts estate recovery from a broad regime that previously sought reimbursement for all MassHealth services received after age 55 to the federal-mandated minimum: nursing facility services, home and community-based services, and related hospital and prescription drug services. CommonHealth (MassHealth's disability program) coverage and Personal Care Attendant (PCA) services were exempted entirely (federal CMS approval pending as of mid-2025).

This narrowing is a major win for Massachusetts families. Under the old regime, a MassHealth member who received MassHealth Standard coverage for general medical services after age 55, even if they never entered a nursing facility, could leave their family facing a substantial post-death claim. Under the new regime, families of members who received only general medical coverage (no LTC) face NO estate recovery at all.

For families whose loved one died before August 1, 2024, the prior broader regime applies, and recovery for general MassHealth services received after age 55 remains in scope. For families whose loved one died on or after August 1, 2024, the new narrower regime applies.

Three additional features of the Massachusetts estate recovery framework distinguish it from peer states and shape what families should expect:

1. Probate-only recovery. Under 130 CMR 515.011, MassHealth recovers from "the member's probate estate" only. Property held jointly with rights of survivorship, in tenancy by the entirety, in a properly drafted irrevocable trust, in a beneficiary-designated account (POD/TOD bank, IRAs, life insurance), or as a life estate remainder is generally NOT subject to MassHealth recovery, because such property does not pass through probate. Massachusetts has explicitly chosen NOT to adopt the federal "expanded estate" option that 42 USC § 1396p(b)(4)(B) permits, a meaningful protection compared to expanded-recovery states like Iowa or Minnesota.

2. The $25,000 small-estate auto-waiver. Effective for deaths on or after May 14, 2021, MassHealth automatically waives recovery for probate estates valued at $25,000 or less under 130 CMR 515.011(B)(2). This is the "cost-not-effective" rule. The threshold is gross probate estate value, self-certified on the probate petition under penalties of perjury, meaning it is largely self-executing.

3. Three SJC decisions reshape practice (2017-2023). The Massachusetts Supreme Judicial Court has handed down three estate-recovery decisions that every family and elder-law practitioner needs to know:

   • Daley v. Secretary of EOHHS / Nadeau v. Director of MassHealth, 477 Mass. 188 (2017), properly drafted irrevocable trusts retaining occupancy or life-estate interests do NOT make trust assets countable for MassHealth eligibility.
   • In the Matter of the Estate of Kendall, 486 Mass. 522 (2020), MassHealth is bound by the Massachusetts Uniform Probate Code's three-year statute of repose under M.G.L. ch. 190B § 3-108. MassHealth cannot pursue claims against estates more than three years after death.
   • In the Matter of the Estate of Mason, 493 Mass. 148 (2023), TEFRA living liens under 130 CMR 515.012 EXPIRE at the member's death if the property was not sold during the member's lifetime.

This guide explains how Massachusetts estate recovery works in 2026, what the 2024 reform changed, what assets are and are not subject to recovery, the three caselaw lessons that shape practice, the three hardship waiver categories, the operational mechanics of the MassHealth Estate Recovery Unit, the realistic timeline from death to claim resolution, and what families can do to plan, respond, and protect inheritance.

In This Guide

• The 60-Second Version
• The 2024 Reform: Chapter 197 of the Acts of 2024 and EOM 25-09
• Pre-Reform vs Post-Reform: What's Recoverable in Each Regime
• Probate-Only Scope: The Asset-by-Asset Walkthrough
• The $25,000 Small-Estate Auto-Waiver
• Three Hardship Waiver Categories Under 130 CMR 515.011(F)
• The Three SJC Decisions That Shape Practice
• The MassHealth Estate Recovery Unit: How It Operates
• The Realistic Timeline: Death to Claim Resolution
• Spousal and Family Protection: Deferral, Not Permanent Waiver
• TEFRA Living Liens Under 130 CMR 515.012
• Settlement and Negotiation Reality
• Worked Example 1: The Robinson Family, $180,000 Probate Estate, Hardship Waiver Granted
• Worked Example 2: The Chen Family, $19,000 Probate Estate, $25,000 Auto-Waiver Applies
• Worked Example 3: The Kowalski Family, Pre-2024 Death With Substantial Non-LTC MassHealth Spend
• Planning Options to Reduce Estate Recovery Exposure
• 10 Common Pitfalls
• Where to Get Help
• Related Reading

The 60-Second Version

• Massachusetts MassHealth estate recovery operates under M.G.L. c. 118E § 31 (as amended by Chapter 197 of the Acts of 2024) and 130 CMR 515.011.
• The 2024 reform applies retroactively to deaths on or after August 1, 2024 and narrows recovery to the federal-mandated minimum: nursing facility services, HCBS, and related hospital/Rx.
• For deaths before August 1, 2024, the prior broader regime applies, recovery for all MassHealth services received after age 55.
• CommonHealth coverage and Personal Care Attendant (PCA) services are exempted from estate recovery under § 31(e); federal CMS approval pending as of mid-2025.
• Probate-only recovery: joint property, tenancy by the entirety, properly drafted irrevocable trusts, beneficiary-designated accounts, and life estate remainders are OUT of scope.
• $25,000 auto-waiver: probate estates valued at $25,000 or less are automatically waived under 130 CMR 515.011(B)(2) (effective for deaths on/after 5/14/2021).
• Three hardship waiver categories under 130 CMR 515.011(F): residence (133% FPL family income), care-provided (heir who provided care delaying LTC admission), income-based (400% FPL with $50K/heir partial waiver up to $100K/estate).
• Hardship waivers must be filed within 60 days of MassHealth's Notice of Claim.
• Mason 2023 (SJC): TEFRA living liens EXPIRE at the member's death if property not sold during lifetime.
• Kendall 2020 (SJC): MassHealth bound by 3-year MUPC statute of repose, cannot pursue claims more than 3 years post-death.
• Daley/Nadeau 2017 (SJC): properly drafted irrevocable trusts with retained occupancy/life estate do NOT defeat MassHealth eligibility.
• MassHealth Estate Recovery Unit: P.O. Box 15205, Worcester, MA 01615-0205 | 617-348-5230 | fax 508-856-7672.
• The 60-day Notice of Claim deadline is the single most consequential family deadline, failure to respond is deemed admission of claim validity.

The 2024 Reform: Chapter 197 of the Acts of 2024 and EOM 25-09

The single most important development in Massachusetts estate recovery in the past two decades is Chapter 197 of the Acts of 2024 ("An Act to Improve Quality and Oversight of Long-Term Care"). The reform's relevant provisions:

Section 20 of Chapter 197 amended M.G.L. c. 118E § 31 to add subsection (b½), limiting estate recovery to:

1. Any-age individuals who were a resident in a nursing facility or medical institution within 42 USC § 1396p(a)(1)(B)(i) when receiving the assistance, with recovery limited to assistance provided on or after March 22, 1991; OR

2. Age 55 or older when the individual received the assistance, where the assistance was provided on or after October 1, 1993, but only for medical assistance consisting of nursing facility services, home and community-based services, and related hospital and prescription drug services for which estate recovery is mandated under 42 USC § 1396p.

Section 21 of Chapter 197 added subsection (e), directing MassHealth to exempt from estate recovery: (a) the costs of CommonHealth coverage, and (b) the costs of Personal Care Attendant (PCA) services. Both exemptions require federal CMS approval (1115 demonstration amendment), which was pending as of MLRI's September 2024 summary; status as of mid-2025 was being implemented through EOM 25-09 with continuing federal approval workstream.

Effective date and retroactive application: Chapter 197 was signed September 6, 2024, and became effective December 5, 2024. It applies retroactively to estates of MassHealth members who died on or after August 1, 2024.

EOM 25-09 ("Updates to the MassHealth Estate Recovery Policy Under the LTC Act") is the MassHealth implementation memo, effective May 27, 2025. EOM 25-09 directs eligibility and Estate Recovery Unit staff on the new rules, the LTC-only scope, the CommonHealth and PCA exemptions, and the operational integration of the changes with existing claim-filing procedures.

What the reform changes in practice:

• A MassHealth Standard member who received only general medical services after age 55 (no nursing facility, no HCBS, no related hospital/Rx) and died on or after August 1, 2024 → no estate recovery.
• A CommonHealth member of any age who died on or after August 1, 2024 → no estate recovery for CommonHealth coverage costs (LTC services, if separately received, may still be recoverable; pending federal approval).
• A PCA recipient of any age → no estate recovery for PCA service costs (other recoverable services may still apply; pending federal approval).
• A MassHealth nursing facility resident who died on or after August 1, 2024 → estate recovery applies as before to NF services and related hospital/Rx.

What the reform does NOT change:

• Probate-only scope (still under 130 CMR 515.011, joint property, trusts, beneficiary-designated accounts remain outside recovery).
• The $25,000 auto-waiver under 130 CMR 515.011(B)(2).
• The three hardship waiver categories under 130 CMR 515.011(F).
• The 60-day Notice of Claim response deadline.
• Spousal and minor-child protection.
• Massachusetts's status as a probate-only-recovery state.
• The pre-2024 SJC caselaw on TEFRA liens, statute of repose, and irrevocable trusts.

Pending regulatory amendments: As of May 2026, MassHealth has not yet finalized amendments to 130 CMR 515.011 to formally codify the LTC Act statutory changes. The amended statute and EOM 25-09 control in the interim. Mass Legal Services has been tracking this regulatory amendment process; readers and elder-law practitioners should monitor mass.gov for final rule publication.

Pre-Reform vs Post-Reform: What's Recoverable in Each Regime

The August 1, 2024 boundary divides Massachusetts estate recovery into two regimes. Families and practitioners must know which regime applies to their case.

Pre-Reform Regime (Deaths Before 8/1/2024)

Massachusetts's pre-reform broader regime put it among the roughly two dozen states that, prior to the 2024 LTC Act, pursued estate recovery beyond the federal mandate. The Commonwealth's choice to recover for all services after age 55, not just LTC, produced years of advocacy by Mass Legal Services, MLRI, AARP MA, Mass Senior Action, the Disability Law Center, NAELA-MA, the Massachusetts Bar Association, and Sen. Jo Comerford and Rep. Christine Barber, who championed the LTC Act reform.

Post-Reform Regime (Deaths On/After 8/1/2024)

The narrowing has dramatic implications for families whose loved one received MassHealth Standard coverage but never entered LTC. Pre-reform, MassHealth could pursue an estate claim for years of general medical coverage (primary care visits, specialist care, hospital stays, prescription drugs) received after age 55. Post-reform, that claim does not exist.

Determining Which Regime Applies

Date of member's death is the controlling fact. If the member died on or after August 1, 2024, the post-reform regime applies, even if MassHealth has not yet filed a Notice of Claim, even if the probate is years from filing, even if the services in question were received decades ago. The reform is retroactive to the date of death, not the date of service.

If the member died on July 31, 2024, or earlier, the pre-reform regime applies, even if probate filing or claim filing happens in 2026.

For families currently navigating an active claim from a pre-2024 death, the new narrower regime does NOT apply. Hardship waivers, the $25,000 auto-waiver, and Kendall/Mason caselaw still apply, but the underlying scope of what's recoverable remains the broader pre-reform list.

Probate-Only Scope: The Asset-by-Asset Walkthrough

The single most important factual claim about Massachusetts estate recovery is this: MassHealth recovers from the probate estate only. This is established in 130 CMR 515.011, which defines the recoverable estate as: "all real and personal property and other assets in the member's probate estate." Massachusetts has explicitly chosen NOT to adopt the federal "expanded estate" option that 42 USC § 1396p(b)(4)(B) permits.

The Boston Bar Association's Practical Guide confirms: "Unlike some other states, DMA currently recovers only from the MassHealth member's probate estate."

Asset-by-Asset Coverage

Important Caveats

Caveat 1, Irrevocable trusts have eligibility implications during life. While properly drafted irrevocable trusts protect assets from post-death recovery (because the assets are not in the probate estate), they can still create eligibility issues during the member's lifetime if MassHealth deems retained interests "countable." The Daley/Nadeau decision in 2017 (discussed below) clarified the boundaries. Improperly drafted trusts that retain too much control can disqualify the member from MassHealth eligibility entirely.

Caveat 2, Asset re-titling near time of death is scrutinized. If a member or their family transfers assets out of probate-vulnerable forms (e.g., adding a joint owner to a bank account) shortly before death, MassHealth or a probate court may scrutinize the transfer for fraudulent conveyance. Genuine, longstanding asset structures held up better.

Caveat 3, Trust assets can be recovered if the trust was set up improperly. The Daley/Nadeau opinion specifically blessed irrevocable trusts retaining occupancy or life-estate interests, but trusts retaining other forms of control or benefit may still be deemed countable. Elder-law counsel matters.

Caveat 4, The 5-year lookback applies separately for ELIGIBILITY purposes. Asset transfers to non-spouse parties within 5 years of MassHealth application can trigger transfer penalties that delay eligibility under 130 CMR 520.019. This is distinct from estate recovery (which operates post-death), but the same underlying asset transfer can have both eligibility and estate-recovery implications.

The Practical Implication

For Massachusetts families planning ahead, the asset-by-asset table is a planning roadmap. Properties held in tenancy by the entirety (between spouses), joint tenancy with rights of survivorship, well-structured irrevocable trusts (with at least 5 years of runway before institutionalization), beneficiary-designated bank accounts, named-beneficiary IRAs and life insurance, all pass outside probate and outside MassHealth's recovery reach.

The single most powerful planning move for married couples is to ensure the marital home is held as tenancy by the entirety (the default Massachusetts marital deed structure) so that the surviving spouse takes the property automatically without probate. This protection has been long-established; the marital home is usually the largest single asset in middle-class Massachusetts estates.

The $25,000 Small-Estate Auto-Waiver

Effective for deaths on or after May 14, 2021, MassHealth automatically waives recovery for probate estates valued at $25,000 or less under 130 CMR 515.011(B)(2). The regulatory text:

"Effective for dates of death on or after May 14, 2021, in probate estates of members where the probate petition certifies under penalties of perjury that the total assets in a member's estate are valued at $25,000 or less, MassHealth has determined that it is not cost effective to pursue recovery."

Mechanics

1. The threshold is gross probate estate value. Not net of debts. If the deceased had a $40,000 home and $20,000 in mortgage debt against it, the gross probate estate value for auto-waiver purposes is $40,000, above the $25,000 threshold. (However, that same $40,000 home with $35,000 in mortgage debt has only $5,000 net equity, and a hardship waiver may apply if other criteria are met.)

2. The threshold applies only to assets in the probate estate. Joint property, trust assets, beneficiary-designated accounts, all OUT of probate, all OUT of the threshold calculation. A family with substantial wealth in joint property and trusts but only $15,000 in the deceased's solely-owned probate estate qualifies for the auto-waiver.

3. It is largely self-executing through probate certification. The probate petition (filed under penalties of perjury) certifies the estate value. MassHealth Estate Recovery Unit, upon receiving notice of probate, declines to file a Notice of Claim if the estate value is at or below $25,000. No separate hardship application is required.

4. Practitioner-recommended best practice. Mass Legal Services and the Boston Bar Association recommend that the personal representative send a copy of the probate petition and death certificate to the MassHealth Estate Recovery Unit (P.O. Box 15205, Worcester, MA 01615-0205) by certified mail. This documents the auto-waiver claim and prevents administrative oversight.

Prior Threshold

Before May 14, 2021, there was no comparable automatic small-estate threshold. Cases below a practical recovery threshold were handled discretionarily by the Estate Recovery Unit, which sometimes declined to pursue but did not have a regulatory bright-line. The $25,000 rule was a wholesale new policy in 2021, not a bump from a prior dollar amount.

Practical Impact

The $25,000 threshold protects a substantial share of Massachusetts middle-class estates. A typical decedent who held the marital home as tenancy by the entirety with their surviving spouse, had an IRA with a named beneficiary, had bank accounts held jointly with rights of survivorship, and held only a modest sole-name checking account at death may well have a gross probate estate below $25,000, qualifying for the auto-waiver.

Statewide implementation data on the auto-waiver is not publicly available, but practitioners report that a meaningful percentage of MassHealth members' estates fall under the threshold once non-probate assets are excluded. This was, in effect, MassHealth's first cost-not-effective rule and a major consumer protection.

Three Hardship Waiver Categories Under 130 CMR 515.011(F)

For estates above the $25,000 auto-waiver threshold, three hardship waiver categories under 130 CMR 515.011(F) provide additional protection. All three were created or expanded effective May 14, 2021, and all three eliminated the previous 2-year conditional waiting period that had operated under prior law.

Category 1: Residence and Financial Hardship Waiver

Criteria (all must apply, claims presented on/after 5/14/2021):

• Sale of real property would be required to satisfy the claim;
• An individual was using the property as a principal place of residence on the date of the member's death;
• That individual lived in the property continuously for two years prior to the member's admission OR for two years prior to the member's death;
• That individual continues to live in the property when MassHealth presents the claim;
• That individual's family group gross annual income is at or below 133% of the federal poverty level (FPL);
• That individual is inheriting an interest in the property.

Effect: Full waiver of MassHealth's claim against the property. The heir keeps the inherited interest in the home.

Practical example: A daughter who had lived in her mother's two-family home for 5 years before her mother entered a nursing facility, continues to live there as her primary residence, has a household income at 130% of the FPL, and inherits the property, qualifies for full waiver.

Category 2: Care Provided Waiver

Criteria (all must apply, created 5/14/2021):

• Heir or devisee is inheriting a legal interest in the deceased member's home;
• That heir resided in the member's home on a continual basis for two years prior to admission/death;
• That heir provided a level of care that avoided or delayed the member's admission to a long-term care facility;
• That heir continues to reside in the home;
• That heir is not being pressured by other heirs to sell;
• Sale of the property would be required to satisfy the claim.

Effect: Full waiver of MassHealth's claim against the property.

Practical example: A son who moved in with his ailing father in 2018, provided daily care that delayed his father's nursing facility admission until 2024, continues to live in the home in 2026, inherits a 50% interest in the home through his father's will, and other heirs are not pressuring sale, qualifies for full waiver. The "level of care that avoided or delayed admission" can be documented through medical records, statements from the member's physician, and family testimony.

Category 3: Income-Based Financial Hardship Waiver

Criteria (created 5/14/2021):

• Heir or devisee is inheriting an interest in the member's estate;
• Heir's "family group" gross income is below 400% of the federal poverty level for the two-year period prior to MassHealth's notice of claim filing.

Effect: Partial waiver equal to the heir's interest in the estate up to $50,000 per qualifying heir, with maximum $100,000 per estate if multiple heirs qualify.

Practical example: A claim of $90,000 against an estate, with two heirs each inheriting 50% ($45,000 each); both heirs have family group incomes below 400% FPL; result: $90,000 × ($50,000 / $45,000 cap) per heir → fully waived because $50,000/heir cap is more than each heir's $45,000 interest. Effective claim: $0.

Practical example 2: A claim of $300,000 against an estate, with one heir inheriting 100%; heir family group income below 400% FPL; result: $50,000 partial waiver (per-heir cap); MassHealth recovers $250,000 from the remaining estate value.

Application Mechanics

Form: "MassHealth Estate Recovery Hardship Waiver Request Form" (no number designation; available at mass.gov/doc/masshealth-estate-recovery-hardship-waiver-request-form-0/download). The form covers all three categories.

Filing party: Court-appointed personal representative or public administrator. Each heir who may qualify under categories 1, 2, or 3 must be separately identified on the form.

Deadline: Within 60 days of MassHealth's notice of claim. This is the single most consequential family deadline in Massachusetts estate recovery, failure to file is deemed admission of the claim's validity.

Determination: MassHealth reviews the application and issues a determination. Approval results in a full or partial waiver as applicable. Denial may be appealed via Board of Hearings.

Multiple-heir scenarios: Each heir applies separately. The estate qualifies for at most one of categories 1 or 2 (full waivers, typically only one heir's residence triggers); category 3 (income-based partial) may apply to multiple heirs simultaneously, subject to the $100,000-per-estate cap.

Reform Context

Before 5/14/2021, the residence waiver required a 2-year conditional waiting period during which the heir's situation was subject to re-review, meaning the property remained encumbered for two years after death. The 2021 reform eliminated this waiting period when the criteria are met at the time of the claim, meaning approved waivers result in a clear release of the claim. This was a meaningful procedural improvement.

Categories 2 (care provided) and 3 (income-based partial) were entirely new in 2021, significant expansions of the prior limited waiver framework.

The Three SJC Decisions That Shape Practice

Massachusetts Supreme Judicial Court decisions in 2017, 2020, and 2023 fundamentally shape the current estate recovery landscape. Every elder-law practitioner and informed family should know these three cases.

Daley v. Secretary of EOHHS / Nadeau v. Director of MassHealth, 477 Mass. 188 (May 30, 2017)

Holding: "Neither the grant in an irrevocable trust of a right of use and occupancy in a primary residence to an applicant nor the retention by an applicant of a life estate in his or her primary residence makes the equity in the home owned by the trust a countable asset for the purpose of determining Medicaid eligibility for long-term care benefits."

Significance: This is the foundational MA case establishing that a properly drafted irrevocable trust holding the family home, retaining the member's right of use and occupancy or a life estate interest, does NOT defeat MassHealth eligibility. The decision blessed the use of "Medicaid asset protection trusts" (irrevocable trusts retaining occupancy rights) in Massachusetts.

Practical implication for estate recovery: Property held in such properly drafted irrevocable trusts is OUTSIDE the probate estate at death, meaning MassHealth cannot recover against the trust assets. Daley/Nadeau is the doctrinal foundation for irrevocable-trust planning as an estate-recovery mitigation strategy.

Caveats: The trust must be drafted carefully to retain only those interests blessed by Daley/Nadeau and not retain other forms of control or benefit that would make the assets countable. Elder-law counsel matters. The trust must be funded at least 5 years before MassHealth application to avoid 5-year lookback transfer penalties under 130 CMR 520.019.

In the Matter of the Estate of Kendall, 486 Mass. 522, SJC-12881 (December 28, 2020)

Holding: MassHealth, like any other creditor, is bound by the Massachusetts Uniform Probate Code's three-year statute of repose under M.G.L. ch. 190B § 3-108. MassHealth may not seek estate recovery against an estate more than three years after the beneficiary's death.

Significance: Kendall imposed the first hard time limit on MassHealth estate recovery claims. Before Kendall, MassHealth could (and sometimes did) pursue claims many years after death, particularly when probate was delayed or when the estate's only asset was real property that the family had been carrying.

Practical implication for families: If MassHealth fails to file a Notice of Claim within three years of the member's death, the claim is barred. Families navigating estate recovery should track the date of death and the three-year mark carefully, a claim filed after the 3-year limit may be unenforceable.

Practical implication for personal representatives: Personal representatives are still required to send probate petition and death certificate to MassHealth Estate Recovery Unit by certified mail under M.G.L. c. 118E § 32, regardless of timing. The Kendall holding does not relieve the PR of statutory notification duties, but it does limit MassHealth's enforcement window.

In the Matter of the Estate of Frances R. Mason, 493 Mass. 148, SJC-13439 (December 13, 2023)

Two holdings:

1. The MUPC three-year statute of repose recognized in Kendall does NOT apply retroactively to bar claims against estates of members who died before Kendall's effective date. The member in Mason had died in 2008; MassHealth filed its claim in 2017; the SJC ruled the pre-Kendall claim was valid because the statute-of-repose rule had not yet been imposed.

2. A TEFRA living lien under 130 CMR 515.012 EXPIRES at the member's death if the property was not sold during the member's lifetime. The lien cannot be enforced against post-death sale proceeds.

Significance of holding 2 (the more impactful for current practice): Before Mason, MassHealth had asserted that TEFRA liens survived death and could be satisfied from post-death property sale proceeds. The SJC's 2023 ruling reversed this expectation. Families should NOT pay a TEFRA lien on real property that was not sold during the member's lifetime, the lien is extinguished at death.

Practical implication: If your loved one had a TEFRA lien on real property and the property was NOT sold during their lifetime, the lien expired at death. Any sale proceeds from a post-death sale are NOT subject to the TEFRA lien. The estate may still face a regular post-death recovery claim against the probate estate, but the TEFRA lien is no longer a separate enforcement vehicle.

Caveat: If the property WAS sold during the member's lifetime (e.g., the member's family sold the home to fund care), MassHealth's TEFRA lien may have been triggered and satisfied at that time. Mason's holding applies specifically to the situation where the property was held until the member's death.

What These Three Cases Mean Together

Daley/Nadeau, Kendall, and Mason combine to make Massachusetts a more family-protective state for estate recovery than its statutory text alone would suggest. The case-by-case takeaway:

• Daley/Nadeau ⇒ properly structured irrevocable trusts with retained occupancy work for asset protection.
• Kendall ⇒ MassHealth has only 3 years from death to file claims.
• Mason ⇒ TEFRA liens expire at death.

Combined with the 2024 LTC Act reform narrowing the recovery scope, these three decisions and one statutory reform represent a substantial swing in family-favorable direction over the 2017-2024 period.

The Massachusetts Medicaid Estate Recovery Unit: How It Operates

The MassHealth Estate Recovery Unit (ERU) is the operational entity that receives probate notifications, files claims, processes hardship waivers, and resolves recovery cases.

Mailing address:

MassHealth Estate Recovery Unit P.O. Box 15205 Worcester, MA 01615-0205

Phone: 617-348-5230 (primary) | 800-754-1864 / 508-856-6381 (alternates)

Fax: 508-856-7672

Online portal: None. All correspondence is paper-driven (mail and fax). Online portals do not currently exist for the ERU.

Workflow:

1. Probate petition filed. Family or attorney files probate petition in the appropriate Massachusetts probate and family court.

2. Personal representative notification to MassHealth. Under M.G.L. c. 118E § 32(a), the personal representative must send the probate petition and death certificate to the ERU by certified mail. Failure to provide this notification within statutory timing creates personal-representative liability.

3. ERU pulls medical billing printout. Upon receiving probate notice, the ERU staff pulls a printout of the deceased member's MassHealth-paid services, applies the LTC Act limitations (for deaths on/after 8/1/2024), excludes Medicare cost-sharing, applies any service-category exemptions, and calculates the proposed claim.

4. ERU files Notice of Claim in probate court. The Notice of Claim must be filed within four months of personal representative appointment under M.G.L. c. 118E § 32. The Notice specifies the dollar amount sought.

5. Family/PR response within 60 days. The PR has 60 days from receipt of the Notice of Claim to:

   • Pay the claim;
   • File a hardship waiver application;
   • Contest the claim (e.g., dispute the billing printout's accuracy, dispute service categorization, raise defenses like Kendall statute of repose);
   • Request an alternative payment structure (case-by-case promissory note + mortgage);
   • Apply for the auto-waiver if estate value at/below $25,000.

6. MassHealth determination and resolution. Hardship waiver determinations issued. Claim disputes resolved through correspondence or, if necessary, through Board of Hearings. Settlements (formal or alternative payment) negotiated case-by-case.

7. Interest accrual. If unpaid, interest at 12% accrues beginning four months and 60 days after the personal representative's bond is approved by the probate court (M.G.L. c. 231 § 6B).

8. Probate distribution. Once the claim is resolved (paid, waived, or compromised), the estate may be distributed to heirs.

Critical practitioner tactic, review the billing printout. Practitioners report that ERU printouts often contain errors, duplications, or services that should be excluded under the post-2024 narrower scope. Always request the underlying billing printout and review carefully before paying or waiving the claim.

Critical practitioner tactic, verify post-2024 service categorization. For deaths on or after 8/1/2024, push back on any non-LTC charges that appear in the printout. CommonHealth coverage costs should be excluded. PCA service costs should be excluded. General medical services for age-55+ members not in LTC should be excluded.

The Realistic Timeline: Death to Claim Resolution

The 60-day Notice of Claim deadline is the single most consequential family deadline. Failure to respond within 60 days is deemed admission of the claim's validity. Even if the family later applies for a hardship waiver or contests the claim, the 60-day window has passed and the procedural posture is much weaker.

The 3-year statute of repose (Kendall) is the outer wall. If MassHealth has not filed a Notice of Claim within 3 years of the member's death, the claim is barred. Families should track the 3-year mark.

Spousal and Family Protection: Deferral, Not Permanent Waiver

Federal and state law defer estate recovery during the life of certain protected family members.

130 CMR 515.011(C): "Recovery will not be required until after the death of a surviving spouse, if any, or while there is a surviving child who is younger than 21 years old, or a child of any age who is blind or permanently and totally disabled."

Federal authority: 42 USC § 1396p(b)(2), federal mandate that states must defer recovery during life of surviving spouse and minor/disabled children.

What This Means in Practice

1. Spousal deferral is NOT a forever-waiver, it is a deferral. When the surviving spouse dies, MassHealth's recovery right against the original member's estate technically reactivates. However, in practice, the original member's probate estate has typically been distributed to the surviving spouse and others by the time of the spouse's death, meaning there is often nothing left in the original member's estate to recover from.

2. Asset re-titling during the spouse's lifetime is critical. If the surviving spouse re-titled assets that came from the deceased member into their own sole name (or into joint property with new persons), those assets are now in the surviving spouse's estate, NOT the original member's estate, and are typically beyond MassHealth's reach when the spouse dies.

3. Minor or disabled child protection ends when triggered. When a protected child reaches 21 (for the under-21 protection) or loses disability status (for the disabled-child protection), MassHealth's recovery right reactivates. But again, the same practical reality applies, the original member's estate may have been distributed by then.

4. The protections do NOT preclude TEFRA living lien filing during life. A TEFRA lien may still be filed during the member's lifetime against real property even if a surviving spouse or protected child exists, but the lien would have to await the death of the spouse/protected child to be enforced. (And under Mason 2023, if the property is held until the member's death rather than sold during life, the TEFRA lien expires at death anyway.)

Practical Planning

For couples planning ahead, the spousal deferral combined with probate-only scope and tenancy by the entirety produces a strong protection: when the institutionalized spouse dies, the marital home held as tenancy by the entirety passes automatically to the surviving spouse outside probate; spousal deferral protects against any direct recovery; when the surviving spouse later dies, the home is in the surviving spouse's estate (not the original member's), so MassHealth has no recovery target. This sequence eliminates estate-recovery exposure for the marital home in the typical Massachusetts middle-class scenario.

TEFRA Living Liens Under 130 CMR 515.012

Federal law (42 USC § 1396p(a)(1)(B)) authorizes states to file pre-death "TEFRA liens" on real property of permanently institutionalized Medicaid members. Massachusetts implements this authority under 130 CMR 515.012.

When MassHealth May File a TEFRA Lien

All four conditions must be met:

1. Member is "an inpatient receiving long-term or chronic care in a nursing facility or other medical institution."

2. None of the following protected family members reside in the property:

   • A spouse;
   • A child younger than 21;
   • A blind or permanently and totally disabled child of any age;
   • A sibling who has a legal interest in the property and has lived in the home for at least one year before the member's institutionalization.

3. MassHealth determines "the member cannot reasonably be expected to be discharged from the medical institution and return home", the formal "no intent to return home" or "permanent institutionalization" finding.

4. Member has received notice of the determination, including the right to a fair hearing.

TEFRA Lien Filing Procedure

The lien is recorded against the property at the registry of deeds. The member receives notice and has the right to appeal the underlying "permanent institutionalization" determination via fair hearing.

Lien Release

Under 130 CMR 515.012, "The MassHealth agency will discharge a lien placed against property under 130 CMR 515.012(A) if the member is released from the medical institution and returns home." This means the TEFRA lien is conditional, it is released if the member returns to the home.

Lien Expiration at Death (Mason 2023)

The most important development for current practice: In re Estate of Mason, 493 Mass. 148 (2023) held that TEFRA living liens EXPIRE at the member's death if the property was not sold during the member's lifetime. This means:

• If the member died and the property was NOT sold during life, the TEFRA lien is extinguished. Post-death sale proceeds are NOT subject to the lien.
• If the member died AFTER the property was sold during life, the TEFRA lien may have already been satisfied from the sale proceeds at that time.
• If the member is still alive but the property is being sold, the TEFRA lien must be satisfied from the sale proceeds.

The post-death lien expiration in Mason was a major shift in MA practice. Before 2023, some MassHealth practitioners and families had assumed TEFRA liens carried over and could be satisfied from estate sale proceeds. Post-Mason, this is no longer the case.

Practical Tactics for Families With TEFRA Liens

1. Verify the lien is current. Check the registry of deeds for the recorded TEFRA lien.

2. If the member is alive and family is contemplating sale. Engage elder-law counsel before sale. The TEFRA lien must be addressed, either through MassHealth release (if the member would return home) or through claim satisfaction from sale proceeds.

3. If the member has died and the property was held until death. Per Mason, the TEFRA lien is extinguished. The estate may still face a regular post-death claim against the probate estate, but the TEFRA lien is no longer a separate enforcement vehicle. Engage elder-law counsel to formally release the lien at the registry of deeds.

4. If the member has died and property is in the probate estate. Standard post-death recovery rules apply. The auto-waiver, hardship waiver, or other protections may apply depending on facts.

Settlement and Negotiation Reality

The MassHealth Estate Recovery Unit operates under regulatory and statutory frameworks that constrain what it can negotiate.

Direct dollar reductions outside the regulatory waiver framework: NOT generally negotiable. Practitioners report that the ERU does not formally negotiate dollar-amount reductions. Margolis Bloom and Avvo legal answers practitioners agree on this.

Alternative payment structures: case-by-case. Per the Boston Bar Association's Practical Guide, the ERU "may accept alternative payment solutions, such as a promissory note secured by a mortgage deed" on a case-by-case basis. This typically arises when the estate's only asset is real property and forced sale would be impractical. Result: family signs a note + mortgage allowing them to retain the property, paying off the MassHealth claim over time.

Compromise via partial waiver: pursue all available regulatory waivers first. The income-based hardship waiver (Category 3) up to $50,000/heir / $100,000/estate functions effectively as a settlement-by-regulation. Always pursue available waivers before considering alternative payment structures.

Insufficient estate caps recovery. Per mass.gov FAQ: "If the MassHealth claim exceeds the value of the remaining amount in the estate, MassHealth will recover the remaining amount from the estate and will not pursue any unsatisfied claim amount." The probate-only scope is a hard wall.

Settlement leverage points for families:

1. Validity challenges to specific charges. Review the medical billing printout. Practitioners report ERU printouts often contain errors. Disputed charges should be removed from the claim.

2. Service categorization, especially post-2024 (deaths on/after 8/1/2024). Push back on any non-LTC charges in the printout. CommonHealth costs should be excluded under § 31(e). PCA service costs should be excluded.

3. Apply for all three hardship waivers if any is plausible.

4. Strong probate-creditor priority defense. MassHealth is a general unsecured creditor in the probate priority scheme, funeral and burial expenses, administration costs, and certain other priority claims come ahead of MassHealth.

5. Kendall statute-of-repose defense. If the claim was filed more than 3 years after death (and the death was after Kendall's effective date), the claim is barred.

Worked Example 1: The Robinson Family, $180,000 Probate Estate, Hardship Waiver Granted

Eleanor Robinson, 84, lived in her two-family home in Brockton for 47 years. She entered a nursing facility in 2023 with advanced dementia. She received MassHealth nursing facility coverage from 2023 until her death on October 15, 2024 (post-LTC Act effective date). Her daughter Lisa, 56, had moved in with her in 2018 to provide care, and Lisa's care delayed Eleanor's nursing facility admission by approximately 3 years.

Eleanor's assets at death:

• Two-family home in Brockton: $480,000 fair market value, held in Eleanor's sole name (no co-tenancy with Lisa)
• Bank accounts in Eleanor's sole name: $14,000
• IRA with Lisa as named beneficiary: $42,000 (passes outside probate)
• Personal property: $6,000

Probate estate value: $480,000 (home) + $14,000 (bank) + $6,000 (personal property) = $500,000.

(IRA passes outside probate via beneficiary designation.)

MassHealth claim: Approximately $180,000 in nursing facility services for the period 2023-2024.

Initial position: The estate owes MassHealth $180,000.

Hardship waiver analysis (Category 2, Care Provided):

• Lisa is inheriting an interest in Eleanor's home (50% interest under Eleanor's will).
• Lisa resided in the home continuously from 2018 to 2024 (6 years before Eleanor's death), exceeds 2-year requirement.
• Lisa provided care that delayed Eleanor's admission to a long-term care facility (documented by Eleanor's primary care physician's medical records and a statement from Eleanor's social worker).
• Lisa continues to reside in the home after Eleanor's death.
• Lisa's brother (the other heir) is not pressuring sale.
• Sale of the property would be required to satisfy the $180,000 claim, since the estate's liquid assets are only $14,000 + $6,000 = $20,000.

Result: Lisa applies within 60 days of the Notice of Claim using the MassHealth Estate Recovery Hardship Waiver Request Form, supported by:

• Eleanor's primary care physician's letter confirming Lisa's caregiving delayed nursing facility admission.
• Lisa's drivers' license, voter registration, and utility bills documenting 2018-2024 continuous residence.
• Lisa's brother's notarized statement that he is not pressuring sale.
• Eleanor's will showing 50/50 inheritance.

The hardship waiver is granted (Category 2). The $180,000 claim is fully waived. Lisa retains her 50% interest in the home; Lisa's brother takes his 50% interest; the home is not sold to satisfy MassHealth.

Outcome: The Robinson family preserves the home and the inheritance. The 2024 LTC Act narrowing (deaths on/after 8/1/2024) didn't change the math here, since all of Eleanor's services were nursing facility (recoverable under federal mandate). But the Care Provided Waiver, created in 2021, was the lifeline.

Worked Example 2: The Chen Family, $19,000 Probate Estate, $25,000 Auto-Waiver Applies

Henry Chen, 78, lived in Lowell with his wife Mei in their home held as tenancy by the entirety. Henry entered a nursing facility in 2023 with end-stage Parkinson's. He received MassHealth nursing facility coverage from 2023 until his death on March 8, 2025 (post-LTC Act).

Henry's assets at death:

• Home in Lowell: $385,000 fair market value, held as tenancy by the entirety with Mei (passes to Mei automatically outside probate)
• Joint checking account with Mei: $24,000 (passes to Mei outside probate)
• IRA with Mei as named beneficiary: $58,000 (passes outside probate)
• Sole-name checking account: $14,000
• 2018 Honda Accord: $5,000
• Personal property: $0 (Henry kept few solely-owned belongings)

Probate estate value: $14,000 (sole checking) + $5,000 (Honda) = $19,000.

(Home, joint checking, IRA all pass outside probate.)

MassHealth claim: Approximately $145,000 in nursing facility services, 2023-2025.

Initial analysis: The probate estate value is $19,000, below the $25,000 auto-waiver threshold under 130 CMR 515.011(B)(2).

Spousal deferral: Mei is the surviving spouse, so under 130 CMR 515.011(C), recovery is deferred during her lifetime in any event.

Auto-waiver application: The personal representative (Mei, as nominated executor under Henry's will) certifies on the probate petition (under penalties of perjury) that the gross probate estate is $19,000. MassHealth Estate Recovery Unit, upon receiving notice, declines to file a Notice of Claim because the estate falls below the $25,000 auto-waiver threshold.

Outcome: Mei keeps the home, the joint checking, the IRA, the sole checking, and the Honda. There is no MassHealth recovery. The combination of (a) tenancy by the entirety home structure passing outside probate, (b) joint checking and beneficiary-designated IRA passing outside probate, (c) the probate estate falling below $25,000, and (d) spousal deferral if needed, all converge to fully protect the family.

Worked Example 3: The Kowalski Family, Pre-2024 Death With Substantial Non-LTC MassHealth Spend

Stanislaw Kowalski, 79, lived alone in his Worcester home after his wife's death in 2018. He received MassHealth Standard coverage from 2019 (when he turned 73 and qualified) until his death on June 12, 2024 (PRE-LTC Act effective date, pre-reform regime applies). He never entered a nursing facility, but his MassHealth Standard coverage paid for primary care visits, specialist care, hospital stays, and prescription drugs over 5 years.

Stanislaw's assets at death:

• Home in Worcester: $310,000 fair market value, held in Stanislaw's sole name (no co-tenants)
• Bank accounts in sole name: $52,000
• IRA with no named beneficiary: $35,000 (passes through probate by default)
• Personal property: $8,000

Probate estate value: $310,000 + $52,000 + $35,000 + $8,000 = $405,000.

MassHealth claim: Pre-LTC Act regime. MassHealth pulls a billing printout for Stanislaw's services from 2019-2024. Under the pre-reform regime, MassHealth recovers for ALL services received after age 55, including primary care, specialists, hospital stays, prescription drugs, and Medicare cost-sharing wraparound.

Approximate claim: ~$95,000 over 5 years (general medical Standard coverage with periodic high-cost hospital admissions).

Hardship waiver analysis: Stanislaw's heirs are his three adult children, none of whom lived in the home or provided live-in care. None qualifies for Category 1 (residence) or Category 2 (care provided). The income-based partial waiver (Category 3) might apply if any heir's family group income falls below 400% FPL for the prior 2 years, providing up to $50,000/heir partial waiver.

Counterfactual under post-reform regime: If Stanislaw had died on August 1, 2024, or later (post-reform regime), MassHealth would only be able to recover for nursing facility services, HCBS, related hospital/Rx, and similar federally mandated LTC categories. Since Stanislaw never received LTC, MassHealth would have ZERO claim. The dramatic difference between $95,000 (pre-reform) and $0 (post-reform) for the same fact pattern, separated by less than 7 weeks of timing, illustrates the magnitude of the 2024 LTC Act reform.

Outcome (under pre-reform regime that actually applies): The estate pays the claim from the probate estate value. Hardship waivers may reduce the claim. The home may be sold to satisfy the claim, with the residual distributed to heirs. The Kowalski family experiences the full pre-reform broader regime.

Lesson: The August 1, 2024 boundary date is consequential. Families with loved ones currently in MassHealth Standard coverage who have not entered LTC should understand that under the post-reform regime, MassHealth has no estate-recovery claim for non-LTC services after 8/1/2024. This is a meaningful policy improvement for families.

Planning Options to Reduce Massachusetts Medicaid Estate Recovery Exposure

For Massachusetts families thinking ahead, several planning options can reduce or eliminate estate recovery exposure. All require execution well before institutionalization or death.

1. Tenancy by the Entirety (Married Couples)

The default Massachusetts marital deed structure for married couples. The marital home held as tenancy by the entirety passes to the surviving spouse automatically outside probate. Combined with spousal deferral, this is the strongest single protection for the marital home.

Cost: Typically built into the original deed at home purchase; if the home is currently held differently, a deed amendment can transfer to tenancy by the entirety (consult counsel, there may be assessment, gift, or eligibility implications).

2. Joint Tenancy With Rights of Survivorship (JTWROS), Other Than Marital Home

Bank accounts, brokerage accounts, real property held jointly with a designated co-owner (often an adult child) pass automatically to the surviving co-owner outside probate. This protects the asset from MassHealth recovery.

Caveat: Adding a co-owner to an asset can be considered a transfer for the 5-year lookback period under 130 CMR 520.019, potentially triggering eligibility issues if the member applies for MassHealth within 5 years. Time these structures well in advance of any potential MassHealth application.

3. Properly Drafted Irrevocable Trusts (Daley/Nadeau)

An irrevocable trust holding the family home or other significant assets, retaining the member's right of use and occupancy or a life-estate interest, can protect the assets from both eligibility countability (under Daley/Nadeau) and post-death recovery (because the assets are not in the probate estate at death).

Critical requirements:

• The trust must be irrevocable.
• The trust must be properly drafted by experienced elder-law counsel.
• The trust must be funded at least 5 years before MassHealth application.
• Retained interests must be limited to those Daley/Nadeau blessed (occupancy, life estate) and not extend to other forms of control or benefit.

Cost: Typically several thousand dollars in elder-law legal fees for drafting; ongoing trust administration may have modest costs. Get a written engagement quote before retaining counsel.

4. Beneficiary-Designated Accounts

IRAs, 401(k) accounts, life insurance, brokerage accounts (with TOD designations), and bank accounts (with POD designations) all pass outside probate to the named beneficiary. This is essentially free protection that requires only filling out beneficiary forms with each institution.

Best practice: Periodically review beneficiary designations on every account. Outdated designations (e.g., a deceased spouse still listed as primary beneficiary) can defeat the protection.

5. Life Estate Deeds

A deed transfer with retained life estate to the original owner and remainder to designated heirs (typically adult children) creates a vested remainder interest that passes automatically at death outside probate. Useful when the family wants to preserve some lifetime control while protecting the asset from post-death recovery.

Caveats: Same 5-year lookback consideration as JTWROS. Tax implications differ (carryover vs stepped-up basis). Consult elder-law counsel.

6. Long-Term-Care Insurance

Private LTC insurance pre-funds nursing facility or HCBS care, reducing or eliminating reliance on MassHealth and thus reducing or eliminating estate recovery exposure entirely. The Massachusetts Long-Term Care Insurance Partnership Program also provides asset-protection benefits for partnership-qualified policies.

Caveats: LTC insurance is expensive and underwriting-restricted. Most appropriate for middle-class families with planning runway who can afford premiums.

7. Spend-Down with Care Strategy

For families who anticipate institutionalization within 5 years, structured spend-down on the member's own care, household repairs, replacement vehicle, prepaid funeral and burial (under 130 CMR 520.008), or modest gifts to family within transfer-penalty constraints can reduce countable assets and post-death exposure simultaneously.

Combined Planning

The strongest planning combines multiple approaches: tenancy by the entirety on the marital home, beneficiary-designated retirement accounts, joint accounts with adult children for liquid assets, and an irrevocable trust executed at least 5 years before MassHealth application. This combination can result in a probate estate well below the $25,000 auto-waiver threshold, fully eliminating estate recovery exposure.

10 Common Pitfalls

1. Missing the 60-Day Notice of Claim Deadline. Failure to respond is deemed admission of claim validity. Calendar this date the moment the Notice of Claim arrives. Engage counsel within 7-10 days of receipt.

2. Assuming the Pre-2024 Broader Regime Still Applies. For deaths on or after August 1, 2024, the post-reform narrower regime applies. Confirm the date of death and apply the correct regime.

3. Failing to Verify the Billing Printout. Practitioners report ERU printouts often contain errors, duplicate charges, or services that should be excluded. Always request and review the underlying billing printout.

4. Failing to Apply for All Relevant Hardship Waivers. The three categories under 130 CMR 515.011(F) cover different scenarios. Apply for any plausible waiver.

5. Treating MassHealth Recovery as Negotiable for Dollar Reductions. It generally is NOT. The negotiable space is alternative payment structures and regulatory waivers, not direct dollar discounts.

6. Paying a TEFRA Lien on Real Property Held Until Death. Per Mason 2023, the TEFRA lien expired at death. Don't pay a lien that no longer exists. Engage counsel to formally release the lien at the registry of deeds.

7. Failing to Track the 3-Year Statute of Repose (Kendall). If MassHealth has not filed a Notice of Claim within 3 years of death, the claim is barred. Calendar the 3-year mark.

8. Not Sending the Probate Petition and Death Certificate to the ERU. PR is statutorily required to provide notification under M.G.L. c. 118E § 32. Send by certified mail to P.O. Box 15205, Worcester, MA 01615-0205.

9. Ignoring Spousal Protection. Surviving spouse triggers automatic deferral. Use this protected period to re-title assets out of the deceased's name and into the surviving spouse's name (or into joint names with new persons), reducing the original member's estate to nothing if possible.

10. Setting Up Asset Protection Trusts Too Late. A 5-year lookback applies. Trusts must be funded at least 5 years before MassHealth application. Retroactive trust drafting after admission cannot defeat the lookback.

Where to Get Help

If you have questions about Massachusetts Medicaid estate recovery, hardship waivers, TEFRA liens, or planning options:

• MassHealth Estate Recovery Unit, 617-348-5230 | mailing P.O. Box 15205, Worcester, MA 01615-0205 | fax 508-856-7672. Direct contact for claim questions, hardship waiver applications, and lien matters.
• MassHealth Customer Service Center, 1-800-841-2900 (TTY 711). General eligibility and policy questions.
• Massachusetts Long-Term Care Ombudsman Program (Executive Office of Elder Affairs), 617-727-7750 (main EOEA line) or 617-222-7495 (local-rep referral). 1 Ashburton Place, 10th Floor, Boston, MA 02108.
• Mass. Executive Office of Elder Affairs (EOEA), 1-800-AGE-INFO (1-800-243-4636).
• Disability Law Center (DLC), 617-723-8455 or toll-free 1-800-872-9992. 11 Beacon Street, Suite 925, Boston, MA 02108. Massachusetts Protection & Advocacy agency.
• Greater Boston Legal Services, Elder, Health and Disability Unit, 617-371-1234. Represents low-income seniors on MassHealth and estate recovery.
• MetroWest Legal Services / Justice Center of Southeast Massachusetts / Community Legal Aid (Worcester), Regional legal-aid organizations covering elder-law and MassHealth issues.
• Mass Legal Reform Institute (MLRI), Statewide policy advocacy and litigation support.
• NAELA-Massachusetts, National Academy of Elder Law Attorneys, MA chapter; specialized elder-law referrals for trust planning and estate recovery.
• Massachusetts Bar Association Lawyer Referral Service, 617-654-0400 or 866-MASS-LRS.
• Boston Bar Association, A Practical Guide to MassHealth Estate Recovery available at bostonbar.org/journal.
• Mass Legal Services, Massachusetts statewide legal-aid hub at masslegalservices.org/content/masshealth-estate-recovery.
• Blue Cross MA Foundation, Estate Recovery Issues Brief "Holding on to Home" (Feb 2024).

Learn More

• MassHealth Programs Overview
• MassHealth Eligibility & Income Limits
• MassHealth Spousal Impoverishment
• MassHealth Personal Needs Allowance
• MassHealth Medically-Needy Spend-Down
• Medicaid Estate Recovery Explained

Find personalized help navigating Massachusetts 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.