Federal law requires all states to recover assets from the estates of two groups of Medicaid beneficiaries after their deaths: those who were age 55 or older when they received Medicaid benefits, and those who received Medicaid nursing facility or ICF/ID benefits regardless of age. At a minimum, states must use the same definition of estate used under their probate laws. They are permitted to use a broader, state-established definition that captures additional assets.
States are mandated to recover any amounts they have paid on the individuals behalf for any type of long-term care services, as well as any hospital costs and prescription drug benefits related to the condition requiring long-term care services. They also have the option of recovering all amounts spent on other Medicaid benefits. But state recovery actions must be delayed if there is a surviving spouse or, in certain cases, a child or sibling living in the home. States have the option of not pursuing recovery in the case of very small estates, if the cost of doing so is likely to exceed the amount that can be recovered. (See the Resources section of this chapter for links to several publications about states estate recovery policies.)