Every state and Washington, D.C. operate a Medicaid Estate Recovery Program (MERP) required by federal law. States must bill the estate for nursing home, HCBS waiver, and related hospital and drug costs paid after age 55. About half the states limit recovery to probate assets; the rest use an expanded definition that can reach joint tenancy, life estates, and living trusts. Texas and Florida file probate claims. New York, Pennsylvania, and Ohio can pursue assets outside probate. Hardship waivers exist in every state but deadlines and income tests differ.
Congress added the Medicaid estate recovery mandate in 1993. Section 1917(b) of the Social Security Act, codified at 42 U.S.C. § 1396p, tells every state Medicaid agency to bill the estate after death for long-term care already paid. The floor covers nursing facility services, home and community-based waiver services, and related hospital and prescription drug costs for anyone who was 55 or older when Medicaid paid.
States may go further. KFF's 2024 survey found 32 states recover for all Medicaid services after age 55, not only the federally required LTSS categories. Thirty-six states recover beyond the federal minimum in some form, according to Justice in Aging. None of that changes the core rule: recovery runs through the estate, not through heirs personally.
Dorothy in Erie received $118,000 in Pennsylvania nursing-home Medicaid between ages 78 and 81. Her daughter assumed Pennsylvania could not bill the family because Dorothy died with only $4,200 in a checking account. Pennsylvania DHS mailed a notice seeking recovery from Dorothy's half-interest in a $210,000 duplex held as joint tenancy with her son. The expanded estate rules reached property that never entered probate.
MERP is separate from the $2,000 asset test at application. A house exempt on the resource worksheet today can still appear on the recovery bill after death. Our Medicaid estate recovery explained guide walks through federal deferrals, lien types, and notice timelines in more depth.
Common mistake:Assuming estate recovery only applies in nursing home states. HCBS waiver costs trigger the same federal mandate. A Medicaid recipient who never slept a night in a facility can still face MERP if waiver services were paid after age 55.
The biggest state split is how each jurisdiction defines "estate." Probate-only states limit recovery to assets that pass through estate administration: property titled solely in the decedent's name with no beneficiary designation, no joint survivorship, and no trust transfer. Expanded-estate states stretch the definition to joint tenancy, tenancy in common, transfer-on-death deeds, life estates, and many revocable living trusts.
A son in Dallas who inherits his mother's house through a transfer-on-death deed may keep the property free of Texas MERP because Texas limits recovery to probate assets. The same TOD deed in Columbus, Ohio does not automatically block Ohio Department of Medicaid from asserting a claim against the decedent's fractional interest.
Roughly 27 states use an expanded definition and about 24 limit recovery to probate property, though state legislatures amend these lists. Always confirm current rules on your state Medicaid agency website before you retitle a deed based on a national chart.
Probate-only status does not mean zero risk. A single-owner homestead with no TOD beneficiary still lands in probate and becomes MERP's primary target. Pair this section with our is your home exempt from Medicaid article for the application-time homestead test.
Five large states illustrate the full range of MERP execution. Texas and Florida sit on the probate-only side. New York, Pennsylvania, and Ohio stretch recovery beyond the probate court file. Agency names, notice forms, and hardship worksheets differ, but the federal deferral list is identical in each state.
James in Tampa died at 84 after six years of Florida ICP nursing-home Medicaid. His $265,000 Hillsborough County home stayed exempt during life because he signed intent to return. Florida AHCA referred the file to its estate recovery contractor, which filed a probate claim for $198,000. His daughter paid from a brokerage account because the homestead was the only probate asset.
In contrast, Helen in Pittsburgh held her Lawrenceville row house in joint tenancy with her daughter. Pennsylvania DHS sent a non-probate notice after Helen's death because Pennsylvania treats joint interests as recoverable. The claim capped at Helen's one-half interest, not the full fair market value.
Use the comparison table below as a planning snapshot, then call the state MERP unit for your county before you distribute estate assets. Dollar caps and income limits change on agency schedules, not on blog publish dates.
| State | Estate definition | Post-death lien on home | MERP administrator | Notable state-specific rules |
|---|---|---|---|---|
| Texas | Probate only | No post-death lien | HHSC / HMS Inc. contractor | Class 7 probate claim within 70 days of notice; skips recovery when LTSS costs are $3,000 or less or estate is $10,000 or less |
| Florida | Probate only | No routine post-death homestead lien | AHCA estate recovery contractor | Probate claim after ICP or waiver LTSS; federal deferral for surviving spouse and qualifying children |
| New York | Expanded (joint tenancy, life estates, trusts) | Yes, when federal deferral ends | County departments of social services | Non-probate Notice of Claim; hardship tests include 200% FPL income and $25,000 asset limits for deaths on or after January 1, 2023 |
| Pennsylvania | Expanded | TEFRA life lien possible; post-death recovery on real property | Pennsylvania DHS | Probate and non-probate notices; daily penalty divisor $421.20 affects gifts, not MERP claim size |
| Ohio | Expanded | Probate claims plus lien tools on real property | Ohio Department of Medicaid / county Job and Family Services | $713,000 home equity cap at application; MERP may waive when recovery would make heir Medicaid-eligible |
MERP begins when the state learns a Medicaid recipient died. Hospital discharge systems, nursing home billing offices, and Social Security death files feed county workers within days. The agency checks whether federal deferral still blocks collection.
If no surviving spouse, minor child, or blind or disabled child remains, the state sends a notice. Texas HMS Inc. mails a Notice of Intent to File a Claim with a hardship questionnaire. New York counties mail separate probate and non-probate notices under OHIP/ADM-8. Pennsylvania DHS contacts the personal representative and joint property owners.
Executors who ignore the first envelope still face a filing. Texas MERP can enter a Class 7 probate claim within 70 days of actual notice under 1 Tex. Admin. Code § 373.205. New York may record a post-death lien when deferral ends, even if no one opened probate.
Carlos in San Antonio qualified for STAR+PLUS with $1,400 in the bank and a $320,000 homestead he 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 from Carlos's $150,000 IRA so the nephew could inherit the deed free of MERP.
Common mistake:Waiting for a probate attorney to call you. MERP contractors learn of deaths from eligibility systems before heirs hire counsel. Respond to the first notice even when you have not filed probate paperwork.
Federal deferral rules are uniform. Recovery cannot run while a surviving spouse lives. 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 temporary. When a surviving spouse in Queens dies two years after the Medicaid recipient, the New York county Department of Social Services can resume collection against assets protected only during the spouse's lifetime. The clock restarts on the survivor's death.
Texas adds state bars beyond federal law. 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. Those figures appear on the Texas HHS MERP FAQ. A live-in caregiver child may qualify under rules similar to the federal caregiver child exemption for transfers, but occupancy alone does not replace a hardship filing after death.
Ruth in Jacksonville received eight years of Florida nursing-home Medicaid after her husband died. Her St. Johns County home stayed exempt on every renewal because she signed intent to return. When Ruth died at 82, Florida deferred recovery while her blind adult son still lived in the house. After he moved to an assisted living facility, the contractor mailed a new notice.
Federal law requires every state to establish undue hardship procedures. States define hardship differently. Justice in Aging notes that Missouri and North Dakota historically offered no hardship waivers, which conflicts with federal requirements. Most states publish forms heirs must file within tight windows.
Texas hardship relief for the homestead applies when fair market value sits under $100,000 and an heir's household income falls below published limits ($46,950 for a single person and $63,450 for a family of two in 2025 per HHSC materials). You must submit appraisals and tax returns. The state will not grant relief by default.
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. Ohio may waive recovery when collection would make a survivor eligible for Medicaid or other public assistance, per KFF survey responses. Pennsylvania and Florida publish their own undue hardship worksheets on DHS and AHCA sites.
Linda in Rochester inherited her mother's half-interest in a $92,000 bungalow. Monroe County DSS mailed a non-probate notice for $74,000 in LTSS. Linda filed a hardship packet with pay stubs showing $28,400 in annual wages for a household of one. The county reduced the claim because her income sat below the 200% FPL threshold.
Three tools can touch a house: TEFRA life liens during permanent institutionalization, probate MERP claims after death, and post-death liens in expanded-estate states. Families mix them up constantly.
A TEFRA lien records while the recipient lives in a nursing home and no protected relative occupies the home. Pennsylvania DHS uses this tool. The lien must dissolve if the recipient returns home. That is separate from the MERP bill that arrives after death.
Texas and Florida do not record post-death liens on homesteads under current agency practice. Recovery runs as a probate claim. New York records post-death liens when federal deferral ends. Ohio blends probate claims with lien statutes on real property.
Read our Medicaid lien on home article for TEFRA timing and title-search steps. A homestead exempt under Medicaid homestead rules during life remains the asset MERP targets most often after death because equity survived the resource test.
Texas MERP files probate claims only through HMS Inc. Hardship relief for the homestead applies when fair market value is under $100,000 and heir income falls below HHSC limits. Run the Texas calculator for the $2,000 asset cap before death, then respond to HMS notices within 30 days.
Florida AHCA sends estate recovery notices through its contractor after ICP or waiver LTSS ends. Florida follows federal deferral and limits recovery to probate assets. A Naples couple with a $600,000 homestead and $90,000 in IRAs may spend down IRAs while the deed stays off the count. 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. County DSS offices mail non-probate notices families often miss. The New York calculator models community spouse thresholds separate from MERP bills.
Pennsylvania DHS recovery reaches real property through probate and expanded-estate notices. The 2026 daily penalty divisor of $421.20 affects gift math, not MERP claim size. Open the Pennsylvania calculator for countable asset totals.
Ohio Department of Medicaid files MERP claims through county Job and Family Services and may waive recovery when an heir would become Medicaid-eligible. The $713,000 equity cap applies at application. 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 received LTSS. Medicaid financial eligibility and recovery follow the certifying facility's state. Open the calculator for the admission state.
Spend Down Calculator tools estimate countable assets and community spouse allowances before Medicaid approval. They apply published state caps 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.
No state opts out. Federal law requires every state and Washington, D.C. to run a Medicaid Estate Recovery Program. States differ in how they define estate, whether they record post-death liens, and how generous hardship waivers are. Texas and Florida limit recovery to probate assets; New York, Pennsylvania, and Ohio reach many non-probate transfers.
After a Medicaid recipient dies, the state checks whether federal deferral still applies for a surviving spouse, minor child, or blind or disabled child. If not, the agency mails a notice and files a probate claim or asserts a non-probate claim. The bill is limited to LTSS and related costs Medicaid paid after age 55, not the full value of the house. Heirs are not personally liable beyond estate assets.
A hardship waiver asks the state to reduce or cancel a MERP claim when collection would cause undue hardship. Texas grants homestead relief when value is under $100,000 and heir income falls below published limits. New York weighs income below 200% FPL and assets below $25,000 for recent deaths. Every state must offer a process, but forms and deadlines differ.
Post-death liens are common in expanded-estate states like New York and are separate from TEFRA life liens recorded during permanent institutionalization. Texas and Florida do not record post-death liens on homesteads under current practice. Pennsylvania may record TEFRA liens during life and pursue real property through expanded-estate rules after death.
Yes. Federal law prohibits estate recovery while a surviving spouse lives, regardless of state. Recovery can resume after the spouse dies against assets that were protected only during deferral. Community spouse resource allowances during life come from separate spousal impoverishment statutes.
Not automatically. New York, Pennsylvania, and Ohio include many trust and non-probate interests in expanded estate definitions. A revocable living trust may still hold recoverable assets. Transfers into trusts during the five-year look-back can also trigger penalty periods. Review both recovery and transfer rules with qualified counsel before retitling property.
