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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

(2) Cost Effectiveness Exception. Effective for dates of death on or after May 14, 2021, in probate estates of members where the probate petition certifies under the penalties of perjury that the total assets in a member’s estate are valued at $25,000 or less, MassHealth has determined that it is not cost effective to pursue recovery. In such estates, MassHealth waives its right to recovery, and will not file a claim or otherwise pursue recovery. MassHealth reserves the right to file a claim and recover in such estates if probate filings do not sufficiently identify the value of the estate or if later probate filings or proceedings or investigation identify or establish that the total assets in the estate exceed $25,000.00.

(C) Deferral of Estate Recovery. Recovery will not be required until after the death of a surviving spouse, if any, or while there is a surviving child who is younger than 21 years old, or a child of any age who is blind or permanently and totally disabled.

(D) Waiver of Estate Recovery Due to Undue Hardship. The MassHealth agency will waive its estate recovery claim if the agency determines that satisfaction of the claim would cause an undue hardship. An undue hardship does not exist solely because recovery will prevent any heir from receiving an anticipated inheritance. The duly court-appointed personal representative or public administrator of the deceased member’s probate estate may apply for a waiver of estate recovery due to undue hardship. The application for a waiver and supporting documents must be received by the MassHealth agency within 60 days of the agency’s notice of claim. The types of waivers of estate recovery due to undue hardship are as follows. (1) Waiver of Estate Recovery Due to Residence and Financial Hardship. (a) For notice of claims presented on or after November 15, 2003, but before May 14, 2021, recovery will be waived if MassHealth determines all of the following conditions have been met. 1. A sale of real property would be required to satisfy a claim against the member's probate estate; and 2. An individual who was using the property as a principal place of residence on the date of the member's death meets all the following conditions: a. the individual lived in the property on a continual basis for two years prior to the member’s admission to an institution, or death, and continued to live in the property at the time the MassHealth agency first presented its claim for recovery against the deceased member’s estate; b. the individual has inherited or received an interest in the property from the deceased member's estate as defined in 130 CMR 501.013(A)(2) and 130 CMR 515.011(A)(2); c. the individual is not being forced to sell the property by other devisees or heirs at law; and d. at the time the MassHealth agency first presented its claim for recovery against the deceased member's estate, the gross annual income of the individual’s family group was less than or equal to 133 % of the applicable federal-poverty- level income standard for the appropriate family size.