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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 251 Rev. 02/13/2026

130 CMR 501.000: HEALTH CARE REFORM: MASSHEALTH: GENERAL POLICIES

501.013: Estate Recovery

(A) Introduction. (1) The MassHealth agency will recover the amount of payment for medical benefits correctly paid from the estate of a deceased member. Recovery is limited to payment for all services provided (a) while the member was 65 years of age or older, except on or after October 1, 1993, while the member was 55 years of age or older; and (b) on or after March 22, 1991, while the member, regardless of age, was institutionalized, and the MassHealth agency determined that the member could not reasonably be expected to return home. (c) Effective for dates of death on or after December 31, 2016, MassHealth will offset the estate recovery claim by the total of any premiums paid to the MassHealth agency on behalf of the member when the member was 55 years of age or older. (2) The estate includes all real and personal property and other assets in the member's probate estate. (3) Notwithstanding 130 CMR 501.013(A)(1) and in accordance with 42 U.S.C. 1396p(b)(B), the MassHealth agency will not recover Medicare cost-sharing benefits described at 42 U.S.C. 1396(a)(10)(E) with dates of payment on or after January 1, 2010, for persons who received such benefits under 130 CMR 505.002: MassHealth Standard, 130 CMR 505.007: Medicare Savings Program (MSP, also called Buy-In), 130 CMR 519.010: Medicare Savings Program (MSP) – Qualified Medicare Beneficiaries (QMB), or 130 CMR 519.011: Medicare Saving Program (MSP) – Specified Low Income Medicare Beneficiaries and Qualifying Individuals. (a) The date of payment for Medicare cost-sharing deductibles, coinsurance, and copayments is the date the MassHealth agency received the claim. (b) The date of payment for premium payments is the date the MassHealth agency paid the premium.

(B) Exceptions. (1) Long-term Care Insurance Exception. No recovery for nursing facility or other long-term care services may be made from the estate of any person who meets the following requirements. (a) The member was institutionalized; and (b) The member notified the MassHealth agency that they had no intent of returning home; and (c) On the date of admission to the long-term care institution, the member had long-term care insurance that, when purchased, or at any time thereafter, met the requirements of 130 CMR 515.014: Long-term-care Insurance Minimum Coverage Requirements for MassHealth Exemptions and the Division of Insurance regulations at 211 CMR 65.09(1)(e)2.