Medicaid Estate Recovery Collections. NOTES


  1. The mandate was imposed by Section 13612 of P.L. 103-66 (OBRA 93), which amended Section 1917 of the Social Security Act, accessible at: Detailed federal guidance to states is in the State Medicaid Manual, Chapter 3, Section 3810 at:

  2. Data on state Medicaid spending, including "probate collections," reported by the Centers for Medicare and Medicaid Services (CMS), appear in the MEDSTAT analysis of the CMS-64. Earlier years are accessible at: The accuracy of state reported numbers has not been systematically examined or verified.

  3. Nursing home spending during this time period was artificially increased by changes in state use of Upper Payment Level (UPL) programs to generate additional federal matching dollars.

  4. The estate recovery mandate is described in greater detail in Medicaid Estate Recovery, a policy brief prepared for the HHS Office of the Assistant Secretary for Planning and Evaluation, at: For a survey of state practices, see Karp, N., Sabatino, C.P. and Wood, E.F. (June 2005). Medicaid Estate Recovery: A 2004 Survey of State Programs and Practices. The AARP Public Policy Institute, Washington, D.C. #2005-06, accessible at:

  5. The hardship exemption is described in greater detail in Medicaid Estate Recovery, a policy brief prepared for the HHS Office of the Assistant Secretary for Planning and Evaluation, at: See also Section 3810.C. of the State Medicaid Manual.

  6. See for a description of the Partnership Program and links to individual state programs and data. For overviews of current program activities in the four Partnership states (California, Connecticut, Indiana and New York), as well as actions taken by states wishing to participate in the program, see

  7. For example, see The Heartland Model for Long-Term Care Reform: The Nebraska Model (December 2003). The Center for Long-Term Care Financing, available at:

  8. FMAPs are based on a matching formula that takes into account each state's average per capita income relative to the national average. States with lower average per capita income have a higher matching rate and receive a higher proportion of their Medicaid financing from the Federal Government. Further information about FMAPs is available at: subcategory=Medicaid+Spending&topic=Federal+Matching+Rate+%28FMAP%29.

  9. For example, see the criticism of estate recovery practices and advice for potential Medicaid recipients on how to protect their assets from estate recovery provided by the West Virginia Attorney General: McGraw, D.V., Jr. (March 2005). Medicaid Estate Recovery. What Seniors Should Know, available at: For an in-depth examination of how estate recovery works in one state, see Medicaid Liens and Estate Recovery in Massachusetts, an issue brief commissioned by the HHS Office of the Assistant Secretary for Planning and Evaluation, available at:

  10. Florida provides broad protection for the homestead against creditors' claims. See Article X, Section 4 of the Constitution of the State of Florida at: Texas probate law (section 322 of the Texas Probate Code) protects the homestead from Medicaid claims. See Texas estate recovery guidelines proposed on January 26, 2004 at:

  11. See Medicaid Liens and Estate Recovery in Massachusetts, at:

  12. See Schwartz, R.A. and Sabatino, C.P. (November 1994). Medicaid Estate Recovery Under OBRA '93: Picking the Bones of the Poor? For the Commission on Legal Problems of the Elderly, the American Bar Association.

  13. Recipients may own $2,000 in general savings ($3,000 for a couple), limited amounts of life insurance, burial funds, household and personal effects, and certain other types of assets. Medicaid rules generally mirror those of the Supplemental Security Income program (SSI). SSI rules on assets ("resources") are available in the Code of Federal Regulations, Title 20, Part 416, Subpart L at:

  14. The earliest and most detailed evidence is indirect and relates to recipients' attempts to transfer assets before death. See Medicaid Estate Planning. Letter from U.S. General Accounting Office to U.S. Senate, Committees on Finance and Aging. GAO/HRD-93-29R. July 1993.

  15. The home retains an exemption from estate recovery only if the recipient is survived by a spouse, a minor or disabled child or, in limited instances, certain siblings or adult children living in the home. In all other cases, the deceased recipient's equity interest in the home may be subject to estate recovery.

  16. Data on home ownership rates or the value of homes belonging to Medicaid recipients have not been collected systematically. The fact that the Medicaid program typically serves low-income individual means that few recipients can afford to own valuable real estate. However, recipients in nursing homes are not typical of the Medicaid population in general. They may qualify for Medicaid despite having incomes far above the poverty level, which may have enabled them to accumulate significant equity in a home.

  17. 2002 Medicaid Estate Recovery Work Group Report to the Pennsylvania Intra-Governmental Council on Long-Term Care. See data tables 1 and 2. The results of this study were compromised because the number of states that responded fully was limited and the report failed to address the number of properties involved or the amount collected per property.

  18. Karp, Sabatino, and Wood (May 2005). Medicaid Estate Recovery: A 2004 Survey of State Programs and Practices, accessible at:

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