Can MassHealth Take Your Home? Liens, Recovery, and Waivers

Yes, MassHealth can take your home in two situations: it can place a lien on the property while you are living in a nursing facility and not expected to return, and it can file a claim against your estate after you die to recover what it paid for your long-term care. Whether it actually collects depends on who else lives in the home, how the property is titled, and what your family does in the weeks after your death. Federal law requires every state Medicaid program to attempt recovery of long-term care costs from a deceased member’s estate, and Massachusetts uses both tools.¹ Strong protections exist for spouses, certain children, live-in siblings, and caregiving family members.

Liens Placed While You Are Still Alive

MassHealth can put what it calls a living lien on your home if you are a patient in a nursing facility or similar institution and the agency determines you cannot reasonably be expected to return home.² There is no age requirement. The “age 55” figure people often cite belongs to estate recovery, which is a separate process.

A living lien does not force you out of the home or trigger a sale. It attaches to the property so that if it is sold during your lifetime, MassHealth can be paid back from the proceeds. If you are discharged and return home, the lien dissolves. In Massachusetts, these liens are only enforceable while you are alive; once you die, estate recovery takes over as a distinct process.³

MassHealth cannot place a living lien at all if any of the following people lawfully live in the home:⁴

Your spouse.
Your child who is under 21, blind, or permanently and totally disabled.
Your sibling who has an ownership interest in the home and has lived there for at least one year before your admission to the institution.

Before placing a lien, MassHealth must notify you and give you the chance for a fair hearing to contest the finding that you will not return home.⁴ If there is a realistic path back home, that hearing is the moment to make the case.

What Happens to Your Home After You Die

The more common route to your house is the Estate Recovery Program, which begins only after a MassHealth member dies. The state files a claim in probate court against the deceased member’s estate for what it spent on covered care.⁵

For members who died on or after August 1, 2024, Massachusetts narrowed what it can recover. MassHealth now pursues only the cost of long-term services and supports: nursing facility care, home and community-based waiver services, and the hospital and prescription drug costs incurred while the member was receiving those long-term services.⁶ For deaths before that date, the older, broader rule still applies: MassHealth could recover the cost of virtually any medical care it paid for a member aged 55 or older, including routine doctor visits and prescriptions unrelated to long-term care.⁷

MassHealth can only reach assets that are part of the probate estate, meaning assets titled solely in the deceased member’s name. A home held in joint tenancy with right of survivorship, property in certain trusts, and accounts with named beneficiaries generally pass outside probate and are beyond MassHealth’s reach under current Massachusetts law.⁷ If the home was in the member’s sole name, it falls into the probate estate and is fair game for a claim.

MassHealth waives estate recovery entirely for probate estates valued at $25,000 or less. Even for those small estates, the personal representative still has to send a copy of the probate petition and death certificate to MassHealth.⁷

Family Members Who Block or Delay a Claim

Federal law prevents MassHealth from recovering when certain family members survive the deceased. Some protections block recovery from any asset. Others specifically prevent enforcement against the home.

Survivors Who Block All Recovery

As long as the deceased member’s spouse is alive, MassHealth cannot pursue any estate recovery. The claim is deferred until after the surviving spouse also dies. The same rule applies when the deceased is survived by a child who is under 21, blind, or permanently and totally disabled.² For a minor child, protection lasts until age 21. For a blind or disabled child, it lasts indefinitely. Families in this situation should still notify MassHealth and assert the deferral rather than assume the state will figure it out on its own.

Survivors Who Protect the Home Specifically

Two additional protections stop MassHealth from forcing the sale of the home when a qualifying family member is still living there, provided that person has continuously resided in the home since the member entered the institution.²

A caregiver child qualifies if they lived in the parent’s home for at least two years immediately before the parent entered a nursing facility and provided care that allowed the parent to delay entering the facility. This is one of the most commonly claimed protections and one of the hardest to prove. You have to show that the care you gave actually kept your parent out of a nursing home. A physician letter documenting the level of care and its impact is the minimum. Detailed records of daily caregiving tasks and medical needs strengthen the claim considerably.⁴

A sibling qualifies if they were living in the home for at least one year immediately before the member’s admission to the institution and have continued living there without interruption since.²

Transferring the Home Before Applying

Some families try to protect the home by transferring it to a child before applying for MassHealth. That strategy often backfires. MassHealth reviews every asset transfer made in the 60 months before a long-term care application. Any transfer for less than fair market value during that window triggers a penalty period during which MassHealth will not pay for nursing facility care.⁸

For transfers made on or after February 8, 2006, the penalty starts on the later of the transfer date or the date you become otherwise eligible for MassHealth long-term care, which typically means the date you have spent down your other assets and are already in a facility.² That timing produces the worst-case scenario: your money is gone, you need care, and MassHealth refuses to pay because of a transfer you made years earlier.

Some home transfers are exempt from the look-back penalty entirely. You can transfer your home without any period of ineligibility if the recipient is:⁸

Your spouse.
A child under 21, or a child who is blind or permanently disabled.
A sibling with an equity interest in the home who has lived there for at least one year before your admission to an institution.
A caregiver child who has lived in your home for at least two years before your admission and whose care allowed you to stay home rather than enter a facility.

These exemptions mirror the estate recovery protections but do a different job. The look-back exemptions let you transfer the home without losing MassHealth eligibility. The estate recovery exemptions stop MassHealth from claiming the home after your death. Good planning usually addresses both.

Undue Hardship Waivers

If none of the standard exemptions fit, heirs can apply for an undue hardship waiver to reduce or eliminate the estate recovery claim. Massachusetts offers three types. Each has a cap of $50,000 per qualifying heir, with a maximum of $100,000 waived across all heirs in a single estate.⁹

The residence and financial hardship waiver applies when paying the claim would force sale of the property. The heir must have lived in the property continuously for at least two years before the member’s admission or death, inherited an interest in it, not be forced to sell by other heirs, and have had household income at or below 133% of the federal poverty level when MassHealth first presented its claim.⁹

The care-provided waiver mirrors the caregiver child exemption but is used in the estate recovery context. The heir must have lived in the home for two years before the member’s admission, provided care that delayed institutionalization, still live in the home when the claim is filed, and have inherited an interest in the property.⁹

The income-based hardship waiver is the broadest. If the heir’s household income was below 400% of the federal poverty level for two years before MassHealth filed its claim, the heir may qualify for a partial waiver.⁹ It is easier to qualify for, but the $50,000 per-heir cap may not cover the full claim on a valuable property.

The Deadlines That Decide the Outcome

After a MassHealth member dies, the personal representative is required under Massachusetts law to send a copy of the probate petition and death certificate to MassHealth. The agency then pulls the member’s billing history and calculates the recoverable total.⁵

MassHealth must file its formal claim in probate court within four months after the personal representative is appointed. Once presented, the estate has 60 days to respond. Miss that window and the claim is allowed as a matter of law: the full amount is approved without further review. Within those 60 days, the personal representative can request an undue hardship waiver, request a deferral, or assert one of the statutory exemptions.⁵ Delay past the 60-day mark is where most families lose leverage they otherwise would have had.

1
Medicaid.gov. Estate Recovery
2
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
3
U.S. Department of Health and Human Services. Medicaid Liens and Estate Recovery in Massachusetts
4
Mass.gov. 130 CMR 515.012 Real Estate Liens
5
Mass.gov. Overview of the Office of Medicaid (MassHealth) – Review of Estate Recovery
6
Mass.gov. Eligibility Operations Memo 25-09 – Updates to the MassHealth Estate Recovery Policy Under the LTC Act
7
Mass.gov. Massachusetts Medicaid Estate Recovery
8
Mass.gov. Eligibility Letter 174 – Revisions to Look-Back Periods for Transfers Into or From Trusts
9
Mass.gov. MassHealth Estate Recovery Hardship Waiver Request Form