REPORT: Holding on to Home: A Primer on MassHealth Estate Recovery and Options for Reducing its Impact on Members and Families

February 2024

Medicaid is a key source of coverage for long-term services and supports (LTSS) for older adults and individuals with disabilities. Under federal law, states are required to seek reimbursement from certain Medicaid members’ estates after death for LTSS-related services they received. States also have the option to recover the cost of all Medicaid-covered services provided. In Massachusetts, state law requires that MassHealth recover for all services provided for those 55 and older, not just LTSS. To resolve the state’s claim against an estate, surviving family members are often forced to sell assets such as the deceased member’s home, which is typically the most valuable asset inherited

Medicaid estate recovery has the potential to perpetuate wealth disparities and inter-generational poverty among Medicaid beneficiaries’ heirs. The Massachusetts Medicaid Policy Institute (MMPI), a program of the Blue Cross Blue Shield of Massachusetts Foundation, contracted with Aurrera Health to identify policy options to reduce the burden of Medicaid estate recovery on communities that are economically, racially, culturally, or socially marginalized. Aurrera Health Group’s Kristal Vardaman, Elizabeth Stein, and Mallika Mahalingham developed an issue brief that assesses Massachusetts’ current Medicaid estate recovery policy and practices, how their policies compare to those of peer states, and how estate recovery affects marginalized communities. Their key findings and suggested policy option are also outlined in an executive summary and blog post, Reducing the Burden of Medicaid Estate Recovery: Policy Options for Massachusetts.

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Authors

Kristal Vardaman [Managing Principal]

Liz Stein [Senior Policy Consultant]

Mallika Mahalingam [Senior Policy Consultant]