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18 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 255 Rev. 02/13/26

130 CMR 515.000: MASSHEALTH: GENERAL POLICIES

(b) For claims presented on or after May 14, 2021, and upon application of a waiver of estate recovery due to residence and undue hardship by the personal representative or public administrator of the estate, MassHealth will waive recovery without a conditional two-year waiting period provided the personal representative or public administrator establishes to the satisfaction of the MassHealth agency that all the criteria for a residence and undue hardship waiver in 130 CMR 515.011(D)(1)(a)1. and 2. are currently met. (c) Any waivers arising out of notice of claims presented before May 14, 2021, that did not become permanent and binding pursuant to the two-year conditional requirements set forth in 130 CMR 515.011(D)(1)(a)3., and that had not been satisfied and were still subject to the two-year conditional requirements of 130 CMR 515.011(D)(1)(a)3 as of May 14, 2021, will become permanent and binding. (2) Waiver of Estate Recovery Based on Care Provided. For claims presented on or after May 14, 2021, for an heir or devisee inheriting a legal interest in the deceased member’s home, the MassHealth agency will waive estate recovery if the agency determines to its satisfaction that all of the following conditions have been met. (a) the heir or devisee resided in the member’s home on a continual basis for two years prior to the member’s death or admission to an institution; (b) during that time, the member needed, and the heir or devisee provided, a level of care that avoided the member’s admission to a facility; (c) the heir or devisee continues to live in the property at the time the notice of claim is filed; (d) the heir or devisee was left an interest in the home under the member’s will or inherited the property under the laws of intestacy; (e) the heir is not being forced to sell the property by other devisees or heirs; and (f) the property would have to be sold to satisfy the claim. (3) Waiver of Estate Recovery Due to Financial Hardship Based on Income (a) For claims presented on or after May 14, 2021, the personal representative or public administrator of a member’s estate may apply for a waiver of estate recovery due to financial hardship based on the income of an heir or heirs or devisee or devisees. If there are multiple heirs or devisees, the personal representative or public administrator must apply for an income-based waiver separately on behalf of each individual. To be 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 shall be limited to a total of $100,000.