Mississippi Medicaid Estate Recovery (DOM) 2026

Mississippi Medicaid estate recovery applies after the death of a recipient who was 55 or older and received long-term care, and it reaches only the probate estate.1 The Mississippi Division of Medicaid (DOM) administers the program. If a parent or spouse received Medicaid long-term care in Mississippi, this guide explains exactly what DOM can and cannot claim, who is protected, and what to do after a death.

What This Guide Covers

Medicaid estate recovery is a federal requirement, not a Mississippi invention. The Omnibus Budget Reconciliation Act of 1993 (OBRA-93) added the estate recovery mandate to federal law at 42 U.S.C. 1396p(b), requiring every state to recover from the estate of a deceased Medicaid recipient who was 55 or older when they received nursing facility services, home and community-based services (HCBS), and related hospital and prescription drug services, and from a recipient of any age who was permanently institutionalized.2

In Mississippi, the program is administered by the Mississippi Division of Medicaid (DOM) under Miss. Code Ann. § 43-13-317 and 23 Miss. Code R. 306-1.8, effective July 1, 1994. Mississippi operates at the federal mandatory floor. It has not adopted the optional expansion that lets a state reach non-probate assets, so § 43-13-317 does not expand the definition of estate, and only the recipient's probate estate is subject to recovery.1 This guide explains who is affected, what DOM can reach, who is protected, the undue-hardship waiver, and the step-by-step response after a loved one on Mississippi Medicaid dies.

The 60-Second Version

• Mississippi Medicaid estate recovery operates under Miss. Code Ann. § 43-13-317 and 23 Miss. Code R. 306-1.8, effective July 1, 1994.1
• Recovery applies only to recipients who were 55 or older when they received nursing facility services, HCBS, or related long-term care, and who have died.1
• DOM recovers from the probate estate only. The regulation defines the estate as property the recipient owned outright or by shared ownership, and it excludes life-estate interests and property transferred into a trust.1
• Recovery is waived while a surviving spouse is alive, or while a surviving child is under 21 or blind or disabled.2
• An undue-hardship waiver is available, including for a relative who lived in and provided care in the home, and where the property is the family's source of income, such as a family farm.1
• Medicaid paid for Medicare cost-sharing under a Medicare Savings Program (premiums, deductibles, coinsurance, copays) is carved out of estate recovery by federal law.3
• DOM is handled as a creditor in probate. Its main contact is 1-800-421-2408, medicaid.ms.gov.1

Who Is Subject to Mississippi Medicaid Estate Recovery

Recovery applies when all three of the following are true:1

• The person was 55 or older when they received the relevant Medicaid service.
• The service was nursing facility care, HCBS waiver services, or related hospital and prescription drug services, not routine medical coverage.
• The person has died and left assets in the probate estate.

Recovery does not apply to:1

• Recipients who received Medicaid only for routine medical care, doctor visits, or prescriptions without long-term care services.
• Long-term care services received before age 55.
• Mississippi's children's Medicaid populations.
• Medicaid payments for Medicare cost-sharing made for Medicare Savings Program (MSP) enrollees (premiums, deductibles, coinsurance, and copayments for Qualified Medicare Beneficiaries and related groups), which federal law at 42 U.S.C. 1396p(b)(1)(B)(ii) carves out of estate recovery.3

The population that may later face recovery is the long-term care Medicaid population. Mississippi covers nursing facility and HCBS-waiver services for aged, blind, and disabled residents who meet the financial rules: a countable-resource limit of $4,000 for a single applicant ($6,000 for a couple where both apply), an income limit of $2,982 per month (300% of the 2026 Supplemental Security Income (SSI) Federal Benefit Rate), and a home-equity limit of $752,000 for an exempt primary residence. Mississippi is an income-cap state and does not operate a medically needy spend-down for this population, so an applicant over the income cap must establish a Qualified Income Trust.4 These eligibility rules define who qualifies for coverage; the estate recovery rules below define what DOM can recoup after death.

What Mississippi Can and Cannot Recover

Mississippi recovers from the recipient's probate estate. Under 23 Miss. Code R. 306-1.8, the recoverable estate is "any real or personal property owned by the recipient in its entirety or by shared ownership," and the regulation expressly excludes life-estate interests and property that has been transferred into a trust.1 Because Mississippi has not adopted the optional federal expansion to non-probate assets, property that passes outside the probate estate is generally beyond DOM's reach, with one important nuance: the recipient's own shared ownership interest in co-owned property can be included.

The two regulation-confirmed exclusions are worth emphasizing. A life-estate interest (the recipient keeps the right to live in the home for life, with the remainder passing automatically to named heirs) and property held in a trust are both excluded from the recoverable estate by 23 Miss. Code R. 306-1.8.1 Survivorship and beneficiary-designated assets pass outside probate and are generally out of reach, but because the regulation reaches shared-ownership interests, how a specific co-owned asset is titled matters; confirm any particular property with DOM or an elder-law attorney rather than assuming it is automatically safe.

A word on transfers and the look-back period. Retitling property or adding a POD beneficiary is a transfer, and under federal law uncompensated transfers within the 60-month (five-year) look-back before a Medicaid long-term care application can create a transfer penalty that delays eligibility.5 Mississippi applies the 60-month look-back.4 Estate-recovery planning and eligibility planning have to be analyzed together, which is why an elder-law attorney with Mississippi Medicaid experience is the right resource before changing any title or beneficiary designation.

Why Mississippi Is a Probate-Estate State

Federal law gives every state a choice. It must recover from at least the probate estate, and it may, at the state's option, expand the definition of estate to reach non-probate property such as jointly held accounts, life estates, and living trusts.2 Mississippi has not taken the expansion. Section 43-13-317 does not enlarge the estate beyond what state probate law defines, and the implementing regulation excludes life-estate interests and trust property outright.1

The practical consequence is that planning instruments that move property out of the probate estate (a properly drafted irrevocable trust, a life-estate deed, beneficiary designations) are more effective in Mississippi than in an expanded-estate state, because Mississippi does not pursue those assets after they leave probate. The same instruments still interact with the look-back period during life, so timing is what determines whether they also work for eligibility.

Who Is Protected from Recovery

Federal law at 42 U.S.C. 1396p(b)(2) establishes categorical protections that block recovery regardless of how much Medicaid spent, and Mississippi's statute waives the claim on the same grounds.2,1

DOM cannot pursue recovery while any of the following is true:

• A surviving spouse is alive, at any age and regardless of where the spouse lives.2
• A surviving child under age 21 is alive.2
• A surviving child of any age who is blind or permanently and totally disabled (under the SSI standard) is alive.2

These three protections apply to the full estate. While the qualifying relationship persists, DOM cannot pursue any recovery at all. The protection is a deferral, not a permanent waiver. After the surviving spouse or protected child dies, the state may in theory seek a deferred claim against traceable assets, though in practice the property has often been retitled, consumed, or otherwise passed in ways that limit a deferred recovery.2

Two additional protections apply to the home specifically. A sibling with an equity interest in the home who lived there for at least one year before the recipient was institutionalized, and a caregiver child (a son or daughter who lived in the home for at least two years before institutionalization and provided care that delayed it), are protected while they continue to live in the home.2 The related federal caregiver-child rule also lets a parent transfer the home during life to such an adult child without a transfer penalty.3

The Undue-Hardship Waiver

Federal law requires every state to maintain an undue-hardship waiver, and Mississippi provides one through DOM.2 The state regulation identifies the situations that qualify.1

1. A relative provided care in the home. Where a relative lived in the home continuously for at least one year before the recipient was institutionalized, provided care that delayed or avoided facility placement, and has no other residence, recovery against the home would impose undue hardship.1

2. The property is the family's source of income. Where the main estate asset is a family farm or similar property the surviving family depends on for income, recovery would remove the family's livelihood.1

3. Other compelling circumstances under the federal standard, which leaves room for situations outside the named categories when the facts warrant relief.2

To request a waiver, contact DOM after the recipient's death and before the estate closes, and submit a written request with documentation of the hardship. DOM reviews the request and issues a determination, and a denial can be appealed through the agency's fair-hearing process.1

Liens on the Home Before Death (TEFRA Liens)

Federal law (TEFRA, 42 U.S.C. 1396p(a)) permits states to file a lien on the home of a permanently institutionalized Medicaid recipient before death.2 Whether Mississippi files TEFRA liens in a given case should be confirmed directly with DOM or an elder-law attorney, because the operative recovery in Mississippi runs through the probate claim after death rather than a pre-death lien. If a lien is filed, federal law requires it to be lifted when a surviving spouse, minor child, blind or disabled child, sibling with an equity interest, or qualifying caregiver child is present.2 A lien before death and the post-death probate claim are two different mechanisms; confirm which, if either, applies to your situation.

How to Respond to a Mississippi Medicaid Estate Recovery Claim

When a Mississippi Medicaid recipient 55 or older who received long-term care dies, follow this sequence:1

An elder-law attorney familiar with Mississippi probate and Medicaid practice can help navigate these steps, particularly when the estate has significant value or a hardship waiver is being sought.

Planning Options to Reduce Exposure

Because Mississippi recovers only from the probate estate, the most effective planning moves property out of probate well before any Medicaid application. All of these interact with the 60-month look-back, so timing is decisive.5

• Life-estate deed. A deed that retains a life estate for the owner and passes the remainder to heirs keeps the home out of the probate estate; the regulation expressly excludes life-estate interests from recovery.1
• Properly drafted irrevocable trust. Property transferred into a trust is excluded from the recoverable estate by the regulation; the trust must be drafted by elder-law counsel and funded ahead of the look-back.1
• Beneficiary designations. POD and TOD designations on accounts, and named beneficiaries on retirement accounts and life insurance, pass outside probate and are generally out of reach.1
• Caregiver-child transfer. A parent may transfer the home to an adult child who lived there for at least two years and provided care that delayed institutionalization, without a transfer penalty.3

Each of these should be analyzed for both estate-recovery and eligibility effects together, with an elder-law attorney, before any title or beneficiary change is made.

Worked Example: The Probate-Only Outcome

This is an illustrative scenario. Mary, 81, lived in her Hattiesburg home, held solely in her name. She entered a nursing facility in 2023 and received Mississippi Medicaid nursing facility coverage until her death in 2026. Her husband predeceased her, and her two adult children live out of state.1

At death, Mary's home is in her sole name (a probate asset), a bank account with a POD beneficiary passes to her daughter outside probate, and her car is titled in her name alone. DOM is noticed as a creditor in the probate estate. Because there is no surviving spouse and no minor or disabled child, no categorical waiver applies, so DOM may claim against the home and the car (the probate assets), up to the amount Medicaid paid; the POD account is generally out of reach because it passed outside probate.1 Had Mary instead deeded the home with a retained life estate to her children years earlier, the home would have been excluded from the recoverable estate under 23 Miss. Code R. 306-1.8, and only the car would remain exposed.1 The example shows why how property is titled, and when, is the deciding factor in Mississippi.

Where to Get Help

Learn More

Find personalized help understanding Mississippi 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.