Medicaid does not usually take your house while you are alive. The agency cannot force a sale to meet the $2,000-style asset test when your home qualifies as an exempt homestead. After you die, the state Medicaid Estate Recovery Program may file a claim against your estate for nursing home and waiver costs paid after age 55. A surviving spouse, a child under 21, or a blind or disabled child can block recovery while they live. The house that was exempt at application is often the same asset recovery targets later.
The short answer is no in most cases. Medicaid agencies use a low countable asset limit, often $2,000 for a single nursing-home applicant. Your primary residence would exceed that cap in days if every dollar of equity counted. Federal law exempts the homestead when you live there, state intent to return from a facility, or a protected relative occupies the property.
Medicaid workers do not show up with a moving truck. They review bank statements, deeds, and facility records. The house stays off the resource worksheet when exemption rules pass. That treatment answers eligibility today, not what happens after death.
Harold in Akron entered a Summit County nursing home after a stroke. His wife Betty still lived in their $195,000 bungalow. Ohio Department of Medicaid kept the deed off Harold's countable sheet because Betty qualified as a protected spouse resident. Ohio did not demand a sale or place a TEFRA lien because Betty occupied the home.
Two narrow exceptions can touch the house during life. A TEFRA lien may attach when you are permanently institutionalized and no spouse, minor child, blind or disabled child, or equity-holding sibling lives in the home. Some states also test home equity against a 2026 cap between $713,000 and $1,130,000 when no protected resident lives there. Our is your home exempt from Medicaid post walks through those application-time rules with equity math.
Common mistake:Believing a caseworker who exempted the house also waived estate recovery. Exemption and recovery follow different statutes. Ask for the state MERP brochure at application and read it before you promise the property to grandchildren.
Congress required state Medicaid Estate Recovery Programs in the 1993 Omnibus Budget Reconciliation Act. The mandate sits at 42 U.S.C. § 1396p. States must seek repayment from the estate of anyone who was 55 or older when Medicaid paid for nursing facility services, home and community-based waiver services, and related hospital and prescription drug costs.
Recovery runs through the estate, not through heirs personally. A daughter in Philadelphia cannot have her paycheck garnished because her father received Medicaid. Pennsylvania may file against probate assets or, under Pennsylvania's expanded definition, property that passes outside a will. The claim is limited to what Medicaid paid for covered services, not the full market value of the house.
Ruth in Jacksonville received eight years of Florida nursing-home Medicaid after her husband died. Her $240,000 St. Johns County home stayed exempt on every annual renewal because she signed intent to return and never rented it out. When Ruth died at 82, Florida's Agency for Health Care Administration referred the file to its estate recovery contractor. Her son received a notice that the state sought $186,000 from the probate estate. The exempt homestead became the main asset on the bill.
Many families first hear about recovery at death, not at application. The MERP disclosure on the Medicaid form warns that coverage is not a gift. Pair this article with our Medicaid estate recovery explained guide for probate timelines, hardship forms, and state-by-state execution differences.
Federal law blocks estate recovery while certain relatives survive the Medicaid recipient. Recovery cannot run while a living spouse remains. It also stops while a child under 21 survives, or while a blind or permanently disabled child of any age survives under Social Security definitions.
Deferral is not forgiveness. When a surviving spouse in Harris County dies two years after the Medicaid recipient, Texas MERP can resume collection against assets that were protected only while the spouse lived. The clock restarts on the survivor's death, not on the original recipient's death.
Texas adds state-specific bars. MERP will not file when an unmarried adult child lived in the homestead at least one year before death, when the estate is worth $10,000 or less, or when total Medicaid LTSS costs are $3,000 or less. Confirm current dollar caps on the Texas HHS MERP FAQ before you rely on them in probate.
Maria in the Bronx cared for her mother Elena for six years before Elena entered a facility. Elena's Medicaid file noted Maria as the live-in daughter. When Elena died, New York deferred recovery while Maria, age 58 and not disabled, still lived in the house. Maria later moved to Florida. The county Department of Social Services mailed a non-probate notice because deferral had ended and the expanded estate rules reached Elena's fractional interest in the Queens row house.
Common mistake:Selling the homestead while a protected spouse still lives, then distributing proceeds without checking whether a deferred claim will attach when the spouse dies. Talk to probate counsel before closing a sale from a deferred-recovery estate.
Three different tools can touch your house, and families mix them up constantly. A TEFRA lien records during life when you are permanently institutionalized and no protected relative lives in the home. The lien must be removed if you return home. That tool is separate from estate recovery after death.
A probate claim is a bill presented to the personal representative during estate administration. Texas MERP uses this model exclusively. HMS Inc., the Texas contractor, sends a Notice of Intent to File a Claim within 30 days of learning of the death, then files a Class 7 claim in probate court within 70 days of actual notice. Class 7 claims rank below mortgages, administration expenses, and most family allowances.
A post-death lien records against real property to secure Medicaid's claim even when title passes outside probate. New York adopted this tool after expanding its definition of estate beyond probate property. Pennsylvania and Ohio blend probate claims with their own lien statutes. Read our Medicaid lien on home article for TEFRA timing, hardship waivers, and how each lien type differs from the resource test at application.
George in Pittsburgh spent four years in a Beaver County nursing home. Pennsylvania DHS placed a TEFRA lien on his Monroeville house while he lived in the facility because no spouse or dependent child occupied it. After George died, the lien converted to a recovery claim against his estate. His executor paid $94,000 from life insurance so the daughter could keep the deed without a forced sale.
| Tool | When it applies | Typical state example |
|---|---|---|
| TEFRA life lien | Permanently institutionalized, no protected resident in home | Pennsylvania records lien while resident lives in facility |
| Probate claim (MERP) | After death, assets pass through estate administration | Texas Class 7 claim filed within 70 days of notice |
| Post-death lien | After death, secures claim on real property outside probate | New York records lien when federal deferral ends |
| Homestead exemption | During life, resource test at application | Florida exempts primary home when intent-to-return rules pass |
Estate recovery is universal, but execution is local. Texas limits collection to probate claims, skips post-death liens, and publishes homestead hardship rules when fair market value sits under $100,000. Florida AHCA contracts with a recovery vendor that files probate claims and follows federal deferral for surviving spouses and qualifying children.
New York stretches estate to joint tenancy, life estates, living trusts, and transfer-on-death deeds. County departments of social services send Notice of Claim letters and may record post-death liens when deferral ends. A Rochester duplex held as joint tenancy with a son can still generate a claim up to the decedent's fractional interest.
Pennsylvania DHS uses daily penalty divisors for look-back math and enforces recovery through probate plus lien tools on real property. Ohio Department of Medicaid files MERP claims through county Job and Family Services offices and follows the $713,000 home equity cap on long-term care applications when no protected resident lives in the house.
Carlos in San Antonio qualified for STAR+PLUS with $1,400 in the bank and a $320,000 homestead he still owned outright. Texas HHSC exempted the house on the resource worksheet. After Carlos died at 79, MERP filed a $142,000 Class 7 probate claim. His nephew paid the bill from Carlos's $150,000 IRA so the nephew could inherit the deed free of MERP. Pre-death spend-down through the Texas Medicaid spend down calculator helped Carlos qualify. MERP billed what remained titled in his name at death.
Texas MERP files probate claims only and rejects post-death liens on homesteads. Hardship relief for the homestead applies when fair market value is under $100,000 and an heir's household income falls below published limits. HHSC adjusts those figures annually. Run the Texas calculator for the $2,000 asset cap before death, then call HMS Inc. after death for claim notices.
Florida AHCA sends estate recovery notices through its contractor after nursing home or waiver Medicaid ends. Florida follows federal deferral for surviving spouses and qualifying children. A couple in Naples with a $600,000 homestead and $90,000 in IRAs may spend down retirement balances while the deed stays off the count at application. Recovery still targets probate assets after death. Use the Florida calculator for ICP resource math.
New York elected the $1,130,000 home equity cap for 2026 and runs expanded estate recovery that reaches non-probate transfers. County DSS offices mail non-probate notices families often miss because they do not come from a probate attorney. The New York calculator models community spouse thresholds and resource limits separate from MERP bills.
Pennsylvania DHS recovery reaches real property through probate and lien statutes. The 2026 daily penalty divisor of $421.20 affects gift math, not MERP claim size. A widow in Allegheny County with a $280,000 home and a $95,000 IRA faces countable retirement treatment plus post-death recovery risk on the deed. Open the Pennsylvania calculator for both tests.
Ohio Department of Medicaid mirrors the $713,000 equity cap for institutional cases filed through county Job and Family Services. Ohio MERP follows federal deferral and files probate claims after death. A Parma bungalow below the cap does not help if a $120,000 IRA sits in the same packet. The Ohio calculator totals countable assets after you flag exempt homestead property.
Common mistake:Filing in the state where your daughter lives instead of the state where you receive care. Medicaid financial eligibility and recovery follow the certifying facility's state. Open the calculator for the admission state, not the family guest room zip code.
Spend Down Calculator tools estimate countable assets and community spouse allowances before Medicaid approval. They apply published state caps, such as Texas HHSC's $2,000 individual limit or New York's higher community spouse thresholds, using 2026 figures where verified.
The widgets do not forecast MERP claim amounts, probate priority, or whether a post-death lien will attach. They also do not calculate look-back penalties. Treat output as a planning snapshot for today's eligibility, then confirm recovery exposure with the state agency and probate counsel.
Start with the Texas, Florida, New York, Pennsylvania, or Ohio page for your filing state. Cross-check homestead treatment with our Medicaid exempt assets guide before you assume the house is invisible to every Medicaid rule.
Medicaid generally cannot force a sale or seize your homestead during life to meet the resource test when federal exemption rules are met. Some states place TEFRA liens when you are permanently institutionalized and no protected relative lives in the home. Estate recovery after death is a separate process from the application-time exemption.
If you received nursing home or waiver Medicaid after age 55, your state must seek recovery from your estate for those costs. The claim often targets the family home because it was exempt during life and may be the largest remaining asset. Surviving spouses, minor children, and blind or disabled children can defer recovery while they live.
Yes. Federal law prohibits estate recovery while a surviving spouse lives. Recovery can resume after the spouse dies against assets that were protected only during deferral. The community spouse may also keep a Community Spouse Resource Allowance during life under separate spousal impoverishment rules.
A TEFRA lien records during life when you are permanently institutionalized and no protected resident occupies the home. Estate recovery bills your estate after death for LTSS paid after age 55. Some states also record post-death liens to secure recovery claims on real property that passes outside probate.
Living trusts do not automatically block recovery. New York and other expanded-estate states explicitly include living trust interests in recovery. Transfers into trusts during the five-year look-back can also trigger penalty periods. Review both recovery rules and transfer penalties with qualified counsel before you retitle the deed.
States must offer undue hardship procedures. Texas mails a waiver form with the Notice of Intent to File a Claim; hardship requests must be made within 60 days in many cases. New York weighs household income below 200% of the federal poverty level and household assets below $25,000 for deaths on or after January 1, 2023. Submit income, occupancy, and appraisal proof with the first notice.
