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Medicaid Estate Recovery: Improving Policy and Promoting Equity

People who use Medicaid-covered long-term services and supports (LTSS) are a diverse group including people age 65 and older and people with disabilities. To be eligible to receive Medicaid-covered LTSS, they must meet both income and asset limits. Federal law requires that state Medicaid programs seek recovery from the estates of certain deceased beneficiaries for payments for LTSS and other services.

Chapter 3 examines the burden of Medicaid estate recovery, which often falls on those with modest means, and may disproportionally affect people of color and perpetuate intergenerational poverty. This chapter includes recommendations that would ease the burden of estate recovery, making Medicaid estate recovery optional, rather than mandatory, for the populations and services for which it is required under current law. It also would allow states that cover LTSS under managed care arrangements to pursue estate recovery based on the cost of care, and direct the Secretary of the U.S. Department of Health and Human Services to set minimum standards for hardship waivers under the Medicaid estate recovery program.


In the discussion of household wealth held by deceased Medicaid beneficiaries age 65 and older on page 81, the average net wealth should be $46,692 and the average home equity held by the sample should be $27,419.

In Table 3A-1 on page 102, information for the total sample (mean and median) should read as follows:

  • total household income: $19,177 ($13,611);
  • home equity: $27,419 ($0);
  • additional property equity: $782 ($0);
  • total value of financial assets: $16,695 ($1,530); and
  • net value of total wealth: $46,692 ($2,028).
From: March 2021 Report to Congress on Medicaid and CHIP