Medicaid Estate Recovery by State 2026: $733.4 Million Collected in FY 2019, Five States 38.5% of It

Who this page is for, and what is different about it

The reader is a retiree, a spouse, or an heir whose parent or relative has needed, or may need, nursing-home care paid by Medicaid, and who holds a home plus retirement accounts or other property. Our page on the 60-month look-back, trusts and rentals covers eligibility and the transfer penalty. This page covers the other end: what a state can claim after death, state by state, using the one national dataset of recoveries (MACPAC) and the text of the statutes we could read. It does not tell you what to do with your property.

Two warnings about data. First, the national recovery figures are for FY 2019, because MACPAC’s FY 2015 to FY 2019 table, built from CMS-64 collections, is the latest all-state dataset we found; KFF repeated it in September 2024 as the most recent year for which data are publicly available about all states’ collections. Second, MACPAC states that the amounts “reflect amounts reported as probate collections”, so recoveries from non-probate assets in expanded states may be reported differently or not captured in that line (our reading: the note does not say).

What federal law requires, and what it leaves to each state

MACPAC’s summary of the federal minimum is that states must attempt to recover “all property and assets that pass to heirs under state probate laws”, and that “both the definition of an estate and the priority of Medicaid’s claims against an estate’s other creditors vary by state”. That second point matters: a claim ranks behind secured debts and some other creditors, and an estate emptied by higher-priority claims pays Medicaid little.

Which states reach past probate: the nine states whose text we read

No single federal document lists each state’s definition. MACPAC’s tables record liens, services and hardship criteria but not the estate definition, so we went to the statutes. Nine are below (eight statutes and one Department of Health notice); for the other 42 jurisdictions the census table marks the definition “Not verified”, because we would not take it from a secondary website.

Two of these changed recently. Massachusetts narrowed its recovery rule for deaths from August 1, 2024, and California’s 2017 amendment states its purpose as to “limit the definition of ‘estate’ to include only the real and personal property and other assets required to be collected under federal law” (14009.5(a)(2)). A statute can be changed again, and the recovery law in effect on the date services were received can matter: Washington, for one, directs the department to apply “the medical assistance estate recovery law as it existed on the date that benefits were received” (RCW 43.20B.080(4)).

The 51-jurisdiction census: recoveries, liens, partnership and what we verified

The recovery and spending columns come from MACPAC’s Table 3E-1 (FY 2019, thousands of dollars, CMS-64); the lien and partnership columns come from MACPAC’s review of state plans in 2020 (Tables 3C-1 and 3C-2). The share column is our arithmetic: recoveries divided by fee-for-service LTSS spending. Where a state delivers most long-term care through managed care, its fee-for-service base is small, so a high share (Iowa, Kansas) says little about how aggressive recovery is. MACPAC makes the same point: managed care LTSS is not in the data, and including it would lower the percentages.

What the census shows (our arithmetic on the table above): the eight states that recovered more than 1.0 percent of fee-for-service LTSS spending are Idaho, Iowa, Kansas, Massachusetts, Oregon, Tennessee, Wisconsin and Wyoming, matching MACPAC’s count of eight. Massachusetts alone collected $83.1 million, 11.3 percent of the national total; the five largest states sum to $282.1 million. Tables 3C-1 and 3C-2 mark a few cells with an asterisk where a state plan copy did not give the information; we show those as “Not in plan copy” and have not filled them in.

The legal tools that are in the statute

These are descriptions of what the federal and state texts provide, not recommendations. Each depends on facts (who survives, how the property is titled, what the state elected) that only a lawyer licensed in your state can apply.

• Deferral and exemption for family. No recovery while a surviving spouse lives, or while a child under 21, or a blind or disabled child, survives (1396p(b)(2)(A)). That is a deferral for a spouse (recovery can follow the spouse’s death) and a bar in the child case for as long as the child qualifies. California’s statute goes further: under its age-55 paragraph the department may not claim while a spouse or registered domestic partner survives (14009.5(b)(2)(B)(i)); Florida’s likewise says the debt is not enforced if the recipient is survived by a spouse (409.9101(6)).
• The home carve-outs. A sibling with an equity interest who lived in the home a year, or an adult child who lived there two years and provided care that kept the parent out of an institution, protects the home from the lien-based recovery while that person lives there (1396p(b)(2)(B)). The state must be satisfied that the care was given.
• Hardship waivers. Every state must have a procedure; KFF’s March 2024 survey found 49 states reporting at least one of the three CMS examples (sole income-producing asset of survivors, home of modest value, other compelling circumstances), with 35 using the income-producing asset test and 15 a modest-value test. MACPAC’s 2020 review of state plans found 8 with a home-of-modest-value criterion: Alaska, California, Florida, Michigan, Mississippi, New Mexico, New York and South Carolina. The two counts differ because the sources and years differ. Approval rates vary: of the 10 states in MACPAC’s survey, the share of hardship applications granted in 2019 ranged from 29 percent in New York to 95 percent in Iowa (as reported by KFF).
• TEFRA liens and their limits. A state may put a lien on the real property of a person in a nursing facility who, after notice and a hearing, “cannot reasonably be expected to be discharged from the medical institution and to return home” (1396p(a)(1)(B)); it dissolves if the person returns home (1396p(a)(3)) and cannot be imposed on the home while a spouse, a minor or disabled child, or a qualifying sibling lawfully lives there (1396p(a)(2)). Where a lien exists, recovery may come “upon sale of the property subject to a lien” (1396p(b)(1)(A)), so a recorded lien can matter even when the property later passes outside probate (our reading). 26 state plans in 2020 imposed TEFRA liens; 19 imposed post-death liens.
• Assets outside probate. In a state that has not used the option in 1396p(b)(4)(B), the mandatory estate is the probate estate, so an asset that passes by beneficiary designation, a transfer on death deed or a living trust is outside the claim unless the state’s own text says otherwise. In Ohio, Minnesota, Washington and Oregon the texts above reach those assets. Our guides to transfer on death deeds by state, life estate deeds and Florida’s enhanced life estate (Lady Bird) deed cover the deed mechanics.
• Partnership policies. Where a state has a qualified partnership, the amount of insurance benefits disregarded for eligibility is not recovered from the estate (1396p(b)(1)(C)(ii)); 35 state plans say they do not seek recovery for these policyholders. See the partnership and reciprocity guide.
• Timing matters for transfers. Giving property away is a separate question governed by the 60-month look-back and a penalty period, not by estate recovery; a gift made to avoid recovery can create a period of ineligibility (1396p(c)). Our look-back page works through that formula, and the home equity and divisor table shows the state numbers.

Worked example: a $380,000 house and a $90,000 IRA (our arithmetic)

A mother received $210,000 of nursing-home Medicaid after age 55 and dies unmarried, with no child under 21 or disabled. She leaves a house worth $380,000 and a $90,000 IRA with her daughter named as beneficiary. We assume the state’s claim equals what it paid, $210,000, ignoring administration costs, the funeral, higher-priority creditors and income tax on the IRA.

The $210,000 difference between B1 and B2 comes entirely from the state’s choice under 1396p(b)(4)(B). In scenario A the titling does not matter. Three things can change B1: a TEFRA lien recorded during life (recovery “upon sale of the property”), a state whose plan or statute reaches the asset for another reason, and the 60-month look-back if the deed was a transfer for less than fair market value. If the mother had a surviving spouse, recovery would be deferred in every scenario.

What a reader can do with this

• Find your state’s row. Look up the FY 2019 recoveries and the lien and partnership flags above, then read your state’s actual statute and Medicaid agency estate recovery page; for 42 jurisdictions we did not verify the estate definition.
• Ask the agency for the number. California’s statute lets a current or former member request a statement of recoverable Medi-Cal expenses once a year for a fee of not more than five dollars (14009.5(e)); other states may give an estimate on request (not verified).
• List what would be in the “estate.” In a probate-only state: the home if titled in the person’s name alone, accounts without a beneficiary. In an expanded state: also joint accounts, life estates, living trust assets and beneficiary-designated property, per the state’s text.
• Check who survives and who lives in the home against the federal deferral and carve-out rules before assuming anything is claimable.
• Bring the statute to an elder law attorney licensed in your state. The attorney drafts deeds and trusts and answers recovery and hardship questions; the match below connects you with fee-only or fee-based financial advisers who can look at the whole balance sheet, including how much must stay liquid to pay for care and the tax on any sale or retirement-account inheritance. An adviser does not decide Medicaid eligibility.

This is analysis of public documents, not investment, legal or tax advice.

FAQ

Sources, read and saved on November 8, 2026: 42 U.S.C. 1396p, Legal Information Institute, Cornell Law School; Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP, March 2021, chapter 3 and appendices 3C, 3E and 3F (macpac.gov); KFF, “What is Medicaid Estate Recovery?” by Burns, Mohamed and O’Malley Watts, September 13, 2024; California Welfare and Institutions Code 14009.5 (Legislative Counsel, via the Internet Archive); Massachusetts General Laws c. 118E, section 31 (malegislature.gov, via the Internet Archive); New York State Department of Health 11 OHIP/ADM-8 and GIS 11 MA/028; Texas Government Code 531.077 and 546.0403, Estates Code 114.106 and 1 Texas Administrative Code 373.103 and 373.105 (public.law and Legal Information Institute mirrors); Florida Statutes 409.9101 (leg.state.fl.us); Ohio Revised Code 5162.21 (Internet Archive copy of codes.ohio.gov); Minnesota Statutes 256B.15 (revisor.mn.gov); RCW 43.20B.080 (app.leg.wa.gov); ORS 416.350 (Oregon Laws mirror). The CMS State Medicaid Manual section 3810 was not retrievable and is not quoted. State-level recovery data are from FY 2019; plan policies are from 2020 and may have changed.