Every state must run a Medicaid Estate Recovery Program (MERP) that seeks repayment from the estate of certain beneficiaries after death. Federal law blocks recovery while a surviving spouse, a child under 21, or a blind or disabled child of any age remains alive. Texas files probate claims but does not place post-death liens, while New York can reach many non-probate assets and record post-death liens on real property. Rules vary by state; this guide explains the federal floor and how Texas and New York execute recovery differently.
MERP is the state program that bills a deceased Medicaid recipient's estate for long-term care the program already paid. Congress added the mandate in the Omnibus Budget Reconciliation Act of 1993, codified at 42 U.S.C. § 1396p. The goal is to return some nursing home and home-and-community-based services dollars to state Medicaid budgets after the beneficiary dies.
MERP is not a pre-death asset test. A widow in San Antonio can qualify for STAR+PLUS with $1,800 in the bank today and still trigger a Texas MERP review years later if she owned a half-interest in a rental duplex at death. The claim targets property that passes through probate or, in expanded-estate states, assets that never enter probate at all.
Every state names its program differently. Texas calls it MERP and contracts with HMS Inc. New York issues "Notice of Claim" letters through county departments of social services. Florida and Ohio follow the same federal floor but write their own notice forms and hardship worksheets. If you are modeling spend-down before an application, start with our guide at what is medicaid spend down and the state tool at calculator hub.
Common mistake:Families often assume MERP only applies while Medicaid checks are still arriving. Texas and most states can file after nursing home discharge if the person was 55 or older when LTSS was paid. Pull MERP notices from the mailbox even when the recipient died at home on regular Medicaid.
Section 1917(b) of the Social Security Act sets the minimum recovery scope. 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. States may optionally recover for other Medicaid services, except Medicare cost-sharing for Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary enrollees.
Recovery runs through the estate, not through heirs personally. Creditors cannot garnish a daughter's paycheck in Cleveland just because her father received Medicaid. Ohio may file against probate assets up to the amount Ohio Medicaid paid, but heirs owe nothing beyond what the estate holds unless they signed personal guarantees elsewhere.
Federal law also authorizes TEFRA liens during life for permanently institutionalized individuals, separate from post-death MERP. A lien recorded while someone lives in a Pennsylvania nursing home is not the same as the post-death lien New York may place after death. Our Pennsylvania calculator at pennsylvania calculator models pre-death countable assets; MERP models what remains after death.
| Category | Federal requirement | Typical example |
|---|---|---|
| Required recovery (age 55+) | Nursing facility, HCBS, related hospital and Rx | Nine months of skilled nursing in Buffalo billed to NY Medicaid |
| Optional recovery (age 55+) | Other Medicaid services state elects | Adult dental or physician visits some states include |
| Excluded | Medicare cost-sharing for QMB/SLMB | Part B premium assistance only |
| Life lien (TEFRA) | Permanently institutionalized, separate statute | Lien recorded while resident lives in facility |
Federal law prohibits estate recovery while certain relatives survive the Medicaid recipient. The list starts with a living spouse. Recovery 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 Queens dies two years after the Medicaid recipient, the New York county Medicaid office 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 Medicaid recipient's death.
Texas adds state-specific 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 dollar caps change rarely; confirm current figures on the Texas HHS MERP FAQ before you rely on them in probate.
Community spouse protections during life come from different statutes than MERP deferral after death. The Community Spouse Resource Allowance that lets Rosa keep $162,660 in El Paso while Marco enters a nursing home is explained in spousal impoverishment rules. MERP deferral only requires that Rosa is still alive when Marco dies; it does not require that she still holds every dollar she protected at application.
A probate claim is a bill presented to the personal representative during estate administration. Texas MERP follows this model exclusively. The 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 under 1 Tex. Admin. Code § 373.205. Class 7 claims rank below mortgages, administration expenses, and most family allowances.
A post-death lien is a recorded interest against real property that secures Medicaid's claim even when title passes outside probate. New York adopted this tool in OHIP/ADM-8 after Chapter 59 of the Laws of 2011 expanded the definition of "estate" beyond probate property. The lien attaches to the decedent's interest at death in joint tenancy, tenancy in common, life estates, and many living trusts.
Post-death liens should not be recorded while federal deferral applies. New York's administrative directive states a lien is improper while recovery is prohibited because a surviving spouse or qualifying child still lives. Once deferral ends, the county may record the lien and still defer forced sale if the heir meets low-income deferral standards on the real property.
California, Florida, and Ohio each blend probate claims with their own lien statutes. A daughter inheriting a Tampa condo through a transfer-on-death deed may face a Florida probate claim against other assets while the deed property follows separate rules. Use the Florida tool at florida calculator for pre-death planning and call the Florida DCF estate recovery unit for post-death notices.
Texas Health and Human Services administers MERP for recipients who were 55 or older when they received covered LTSS. Covered services include nursing facility care and certain home and community-based waiver services. MERP does not bill acute-care-only Medicaid for someone who never received LTSS after 55.
At application, HHSC hands applicants a MERP disclosure. After death, HMS Inc., the MERP contractor, mails a Notice of Intent to File a Claim to the executor, administrator, or family contact on file. The notice includes a questionnaire and an undue hardship waiver request. Families who ignore the 30-day response window still face a probate filing; silence is not a waiver.
Texas does not place liens before or after death. Recovery is strictly a probate claim. Heirs who want to keep a $180,000 Houston bungalow can pay the MERP bill from life insurance instead of selling the house, but they cannot be forced to sell beyond what the estate owns.
Texas hardship relief for the homestead applies when fair market value is under $100,000 and an heir's household income falls below $46,950 for a single person or $63,450 for a family of two in 2025. HHSC adjusts those limits annually. You must submit proof; the state will not grant hardship by default.
Common mistake:Executors pay MERP from the first liquid assets they find, even when a hardship waiver would zero the claim. File the hardship packet before you wire estate funds to HMS. Our Texas calculator at texas calculator helps with the $2,000 asset cap before death, not MERP negotiation after death.
New York Medicaid recovery is governed by Social Services Law § 369 and regulations at 18 NYCRR Part 360. The 2011 expansion means recovery reaches property that passes by operation of law or contract, not only assets listed in a will. A $240,000 Rochester duplex held as joint tenancy with a son can still generate a claim up to the decedent's fractional interest.
County departments of social services send two key mailings: a Notice of Claim to the fiduciary when probate opens, and a Notice of Claim – Non Probate Assets to anyone holding property in which the decedent had a legal interest at death. Attachment II of OHIP/ADM-8 is the non-probate notice families often miss because it does not come from a probate attorney.
New York may record a post-death lien on real property to secure the claim. The lien reflects the decedent's interest at death, not the full market value if others co-owned the parcel. Deferral continues for a surviving spouse, minor child, blind or disabled child, or certain caregivers, but the administrative file may note a secured claim waiting for deferral to end.
New York undue hardship reviews weigh household income below 200% of the federal poverty level and, for deaths on or after January 1, 2023, household assets below $25,000 with CPI adjustments every five years. A surviving heir in the Bronx with $22,000 in total household assets may qualify even when the decedent's Medicaid bill exceeded $400,000.
Texas and New York illustrate the two poles of American estate recovery design. Texas limits collection to probate claims and rejects post-death liens. New York stretches "estate" to most non-probate transfers and records liens when deferral ends. Families moving between states should not assume the prior state's rules follow the decedent.
| Topic | Texas | New York |
|---|---|---|
| Lead agency | Texas HHS / HMS Inc. contractor | County departments of social services |
| Reach of "estate" | Probate estate under Texas Estates Code | Probate plus joint tenancy, TOD, life estate, living trust interests |
| Post-death lien | No; probate claim only | Yes, on real property when deferral ends |
| Filing deadline | 70 days after MERP receives actual notice of death | County notice upon death of recipient or surviving spouse |
| Surviving spouse | No claim while spouse lives | Recovery deferred; may secure claim for later |
| Homestead hardship | FMV under $100,000 plus income test | Undue hardship income and asset tests |
| Claim priority | Class 7 in Texas probate | Governed by SSL § 369 and county practice |
Timing matters because missed notices become default judgments or sold property with unpaid liens. The sequence below reflects Texas MERP practice and New York county notice rules. Other states follow similar patterns with different day counts.
James died March 4 in Austin with a surviving daughter but no spouse. HMS mailed the Notice of Intent on April 2. His executor returned the questionnaire April 20. HMS filed a $118,400 Class 7 claim in Travis County probate court on May 28, day 55 after notice. Distribution to heirs paused until the claim was paid or waived.
Undue hardship is a federal requirement, not a favor. States must publish standards and let families apply. Proof usually includes tax returns, utility bills, appraisals, and affidavits about who lived in the home. Texas and New York deny most unsigned or incomplete packets without prejudice, which lets you refile, but interest and holding costs can accumulate.
Pre-death planning tools differ from MERP defenses. Spending countable assets on exempt items before application, described in medicaid exempt assets, reduces what you hold at approval but does not erase MERP if you rebuild wealth later. Paying off a mortgage, buying a reliable car, or prepaying funeral contracts are common spend-down channels covered in medicaid spend down strategies.
Life estates, lady bird deeds, and irrevocable trusts carry look-back and MERP risk in expanded-estate states. New York explicitly lists life estates and living trusts in its recovery definition. Texas MERP still examines probate assets, so a life estate may shrink the probate claim but will not help if Texas law brings the interest back into the estate.
The California tool at california calculator models a $130,000 individual asset ceiling for many programs, while Ohio's page at ohio calculator reflects a $2,000 cap similar to Texas. None of those widgets project MERP bills; they show whether you qualify today. Pair calculator output with a local elder law consult when home equity exceeds $100,000.
Estate recovery is universal, but execution is local. Texas files probate claims only, skips post-death liens, and caps small estates at $10,000. New York reaches non-probate transfers and records liens after deferral. Florida, Pennsylvania, Ohio, and California each publish their own notice titles and hardship forms.
Before you transfer the house or spend the last countable dollars, run the numbers for the state where the applicant will file, not where the children live. Our hub at calculator hub lists all 51 jurisdictions. Priority states for MERP comparisons on this site include Texas, New York, Florida, Pennsylvania, Ohio, and California because their recovery manuals are public and families relocate among them often.
Common mistake:Using a Michigan spend-down plan for a parent who will apply in Manhattan. New York's expanded estate definition can undo a "probate-free" deed that worked in a probate-only state. Match the tool to the filing state.
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 calculators do not forecast MERP claim amounts, probate priority, or whether a post-death lien will attach. They also do not calculate look-back penalties or income spend-down pathways. Treat output as a planning snapshot, then confirm with the state agency and probate counsel. For post-approval risk, read estate recovery by state, Medicaid lien on home, and does Medicaid take your house.
Medicaid does not seize homes directly. The state files an estate claim or records a post-death lien against your interest in the property. Heirs can sell the house and pay the claim from proceeds, pay from other funds, or seek a hardship waiver. Texas MERP uses probate claims only; New York may record a lien on real estate after deferral ends.
Yes under federal law. States cannot recover while a spouse, a child under 21, or a blind or disabled child of any age survives you. Deferral ends when the last qualifying relative dies, and the state may then pursue assets that were protected only temporarily.
A TEFRA lien is recorded while the Medicaid recipient is alive and permanently institutionalized, subject to homestead exceptions. A post-death lien, used in New York and some other states, secures the recovery claim after death against real property that passed outside probate. Texas MERP does not use post-death liens.
Texas administrative rules require MERP to file its probate claim within 70 days after the program receives actual notice of the death of a Medicaid recipient age 55 or older who received covered LTSS. The contractor usually sends a Notice of Intent within the first 30 days.
New York can assert a claim up to the decedent's interest in joint property, including bank accounts and real estate held with others. OHIP/ADM-8 requires notice to anyone possessing assets in which the decedent held a legal interest at death, even when those assets skip probate.
A gift within the look-back period can delay Medicaid eligibility and may not remove the house from recovery in expanded-estate states. New York explicitly includes certain transfers in its estate definition. Texas still examines probate property. There is no simple deed trick that replaces hardship review or qualified legal planning.
Federal law requires recovery of nursing facility services, HCBS waiver services, and related hospital and prescription drug costs for beneficiaries who were 55 or older when those services were paid. States may add other Medicaid services but cannot recover Medicare cost-sharing for QMB or SLMB enrollees.
Submit the state hardship form with proof of income, assets, and occupancy. Texas provides the form with the Notice of Intent and reviews homestead value under $100,000 plus income limits. New York reviews household income below 200% of the federal poverty level and assets below the statutory ceiling. Deadlines vary by county; respond to the first notice.
