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19 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 515.000: MASSHEALTH: GENERAL POLICIES

(c) An estate with qualifying heirs or devisees, regardless of whether there are nonqualifying 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 nonqualifying 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 transfer of the property to satisfy the MassHealth agency’s claim in full from a property on which MassHealth has recorded a lien, the fair market value and equity value of all real property that is part of the deceased member’s probate estate must be verified prior to the sale or transfer of said property. (1) The personal representative or public administrator of the probate estate must verify the fair market value by sending to the MassHealth agency a copy of the most recent tax bill or the property tax assessment that was most recently issued by the taxing jurisdiction, provided that this assessment is not one of the following: (a) a special-purpose tax assessment; (b) based on a fixed-rate-per-acre method; or (c) based on an assessment ratio or providing only a range. (2) The personal representative or public administrator of the probate estate must also provide a comparable market analysis or a written appraisal of the property value from a knowledgeable source. Knowledgeable sources include the following: a licensed real-estate agent or broker; a real-estate appraiser; or an official of a bank, savings and loan association, or similar lending organization. The knowledgeable source must not have any real or apparent conflict-of-interest relationship with the estate. (3) The MassHealth agency may also obtain an assessment from a knowledgeable source.