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21 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 515.000: MASSHEALTH: GENERAL POLICIES

(2) without a court order or judgment, if all of the following requirements are met: (a) the member is an inpatient receiving long-term or chronic care in a nursing facility or other medical institution; (b) none of the following relatives lives in the property: 1. a spouse; 2. a child younger than 21 years old, or a blind or permanently and totally disabled child; or 3. a sibling who has a legal interest in the property and has been living in the house for at least one year before the member's admission to the medical institution; (c) the MassHealth agency determines that the member cannot reasonably be expected to be discharged from the medical institution and return home; and (d) the member has received notice of the MassHealth determination that the above conditions have been met and that a lien will be placed. The notice includes the member's right to a fair hearing.

(B) Recovery. If property against which the MassHealth agency has placed a lien under 130 CMR 515.012(A) is sold, the MassHealth agency may recover all payment for services provided on or after April 1, 1995. This provision does not limit the MassHealth agency’s ability to recover from the member's estate in accordance with 130 CMR 515.011.

(C) Exception. No recovery for nursing-facility or other long-term-care services may be made under 130 CMR 515.012(B) if the member (1) was institutionalized; (2) notified the MassHealth agency that they had no intention of returning home; and (3) on the date of admission to a long-term-care institution, had long-term-care insurance that, when purchased or at any time thereafter, met the requirements of 130 CMR 515.014 and the Division of Insurance regulations at 211 CMR 65.09(1)(e)2.

(D) Repayment Deferred (1) In the case of a lien on a member's home, repayment under 130 CMR 515.012 is not required while any of the following relatives are still lawfully living in the property: (a) a sibling who has been living in the property for at least one year before the member's admission to the nursing facility or other medical institution; or (b) a son or daughter who 1. has been living in the property for at least two years immediately before the member was admitted to a nursing facility or other medical institution; 2. establishes to the satisfaction of the MassHealth agency that they provided care that permitted the parent to live at home during the two-year period before institutionalization; and 3. has lived lawfully in the property on a continual basis while the parent has been in the institution. (2) Repayment from the estate of a member that would otherwise be recoverable under any regulation is still required even if the relatives described in 130 CMR 515.012(D) are still living in the property.

(E) Dissolution. The MassHealth agency will discharge a lien placed against property under 130 CMR 515.012(A) if the member is released from the medical institution and returns home.