Page 21

21

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

considered a qualifying heir or devisee, the personal representative or public administrator of the estate must establish the following: 1. the qualifying heir or devisee is inheriting an interest in the member’s estate under the member’s probate estate; and, 2. the family group of a qualifying heir or devisee has a gross income below 400% of the federal poverty level for the two-year period prior to the date the notice of claim is filed. If MassHealth determines that both conditions have been met, the heir is considered a qualifying heir. (b) MassHealth will waive recovery in an amount equal to the value of the qualifying heir’s or devisee’s interest in the estate up to a maximum of $50,000 per qualifying heir or devisee. If there is more than one qualifying heir or devisee in an estate, the total amount of the agency’s estate recovery claim waived for qualifying heirs or devisees must be limited to $100,000. (c) An estate with qualifying heirs or devisees, regardless of whether there are non- qualifying heirs, will be subject to estate recovery based on the lesser of the following: 1. the value of the estate remaining after deducting the amount waived from the total value of the estate for qualifying heirs and devisees; or 2. the amount of the MassHealth claim remaining after deducting the amount waived from the total value of the MassHealth claim. (d) Example 1. The value of the estate is $400,000 and the MassHealth claim is $60,000. There are two heirs who qualify for the waiver, each with an interest in the estate of $50,000 or greater. There are also two heirs who do not qualify. In this example, the waived amount is $100,000 (50,000 + 50,000). After deducting the $100,000 waived amount from the estate there is $300,000 left in the estate, but after deducting the $100,000 waived amount from the $60,000 MassHealth claim there is nothing left in the MassHealth claim. The result is no estate recovery. (e) Example 2. The value of the estate is $350,000 and the MassHealth claim is $500,000. There are two qualifying heirs, each with an interest in the estate of $50,000 or greater. There are also two non-qualifying heirs. In this example, the waived amount is $100,000 (50,000 + 50,000). After deducting the $100,000 waived amount from the estate there is $250,000 left in the estate, and after deducting the $100,000 waived amount from the $500,000 MassHealth claim there is $400,000 remaining in the MassHealth claim. In this example, MassHealth would recover $250,000, since it is less than $400,000.

(E) Outstanding Claims. (1) For claims presented between April 1, 1995 and November 15, 2003, that are still outstanding, recovery will be waived if all requirements under the then-existing MassHealth regulations were met. (2) For claims presented before April 1, 1995, a waiver for hardship did not exist.

(F) Fair Market Value and Equity Value. If there will be insufficient proceeds from the sale or