Can MassHealth Take Your Home? Liens, Claims, and Waivers

Yes, MassHealth can take your home, but only in specific circumstances and almost never while someone the law protects is still living in it. The question of whether MassHealth can take your home has two answers because the state uses two different tools: a lien placed on the property while you are alive and in long-term care, and a claim filed against your probate estate after you die. A surviving spouse, a minor or disabled child, an adult child who moved in to care for you, or a sibling with an ownership interest who lived with you can each stop or delay that recovery. How your home is titled when you die, and what your family does in the weeks after, often matters more than the size of the MassHealth bill.

When MassHealth Can Put a Lien on Your Home While You’re Alive

Federal law has allowed states to place what MassHealth calls a “living lien” since 1982. It applies when you are a patient in a nursing facility or similar institution and MassHealth determines you cannot reasonably be expected to return home.¹ There is no age requirement. The widely cited “age 55” rule belongs to estate recovery, which is a separate process that only starts after death.

A living lien doesn’t push you out of the house or force a sale. It attaches to the property so that if the home is sold while you are alive, MassHealth gets paid back from the proceeds. In Massachusetts these liens end at death; estate recovery takes over as its own process at that point.² If you are discharged and return home, the lien dissolves.¹

MassHealth cannot place a living lien at all if any of these people lawfully live in the home:³

Your spouse
Your child who is under 21, blind, or permanently and totally disabled
Your sibling who has an ownership interest in the home and who has lived there for at least a year before your admission

Before placing a lien, MassHealth has to notify you and give you a chance at a fair hearing to contest the finding that you won’t return home.³ If there is a credible plan for discharge, that hearing is worth taking seriously.

What Happens to Your Home After You Die

The more common way MassHealth gets paid back is through its Estate Recovery Program, which starts only after a member dies. The state files a claim in probate court for what it spent on that person’s care.⁴

For members who died on or after August 1, 2024, Massachusetts narrowed what counts. MassHealth now recovers only the cost of long-term services and supports: nursing facility care, home and community-based waiver services, and related hospital and prescription drug costs that were incurred while the member was receiving those long-term services.⁵ For deaths before that date, the older, broader rule still applies: MassHealth could recover for essentially any medical care paid on behalf of a member age 55 or older.⁶

Here’s the piece that drives most planning. MassHealth can only reach assets that are part of the probate estate, meaning assets titled solely in the deceased member’s name at death. A home held in joint tenancy with right of survivorship, inside certain trusts, or passing through a beneficiary designation generally sits outside probate and outside MassHealth’s reach under current Massachusetts law.⁶ A home titled solely in the member’s name is the classic case where estate recovery hits.

MassHealth waives estate recovery entirely for probate estates valued at $25,000 or less, though the personal representative still has to send the probate petition and death certificate to MassHealth.⁶

Family Members Who Stop or Delay a Claim

Federal law blocks MassHealth from recovering against the estate at all as long as the deceased member’s spouse is still alive. Recovery is deferred until after the surviving spouse dies. The same protection applies when the member is survived by a child who is under 21, blind, or permanently and totally disabled; for a minor child the shield lasts until age 21, and for a blind or disabled child it is permanent.¹

Two more protections apply specifically to the home when the right family member is still living there, as long as that person has lived in the home continuously since the member went into the institution:¹

A caregiver child: an adult child who lived in the parent’s home for at least two years immediately before the parent entered a nursing facility, and whose care allowed the parent to delay entering that facility. This is one of the most commonly used protections and also where families stumble. You have to show that the care you provided actually kept your parent out of a nursing home. A letter from the parent’s physician documenting the level of care is the floor; detailed records of the daily caregiving and medical needs make the claim much stronger.³
A sibling with an equity interest in the home who was living there for at least one year immediately before the member’s admission and has stayed there without interruption since.¹

If one of these situations fits yours, the protection is not automatic in the sense of happening without paperwork. You still have to assert it in response to MassHealth’s claim.

Why Giving the House to Your Kids Usually Backfires

The common instinct, transferring the home to a child before applying, almost always makes things worse. MassHealth looks at every asset transfer made within the 60 months before a long-term care application. Any transfer for less than fair market value in that window triggers a penalty period during which MassHealth will not pay for nursing facility care.⁷

The penalty is calculated by dividing the uncompensated value of what you transferred by the average monthly cost of nursing facility care in Massachusetts at the time you apply.⁷ A $500,000 home divided by a roughly $14,000 monthly care cost yields a penalty of more than three years. The timing is what makes this painful: for transfers on or after February 8, 2006, the penalty clock doesn’t start on the day you transfer. It starts on the later of the transfer date or the date you would otherwise qualify for MassHealth long-term care, which usually means the day you’ve spent down your other assets and are already in a facility.¹ So you can end up in the facility, broke, with MassHealth refusing to pay because of a gift you made four years ago.

Some home transfers don’t trigger the penalty at all. You can transfer the home without any period of ineligibility if the recipient is:⁷

Your spouse
A child under 21, or a child who is blind or permanently disabled
A sibling with an equity interest in the home who has lived there for at least a year before your admission
A caregiver child who lived with you for at least two years before your admission and whose care kept you out of a facility

These mirror the estate recovery exemptions but do a different job. The look-back exemptions let you transfer the home now without losing MassHealth eligibility. The estate recovery exemptions keep MassHealth from claiming the home after you die. Planning that works usually accounts for both.

Hardship Waivers When Nothing Else Fits

When no exemption applies, heirs can ask for an undue hardship waiver to reduce or eliminate the claim. Massachusetts offers three. Each caps at $50,000 per qualifying heir, with no more than $100,000 waived across all heirs in a single estate.⁸

The residence and financial hardship waiver applies when paying the claim would require selling real property. The heir must have lived in the property for at least two years before the member’s admission or death, must have inherited an interest in it, must not be forced to sell by other heirs, and must have had household income at or below 133% of the federal poverty level when MassHealth presented its claim.⁸

The care provided waiver tracks the caregiver child exemption but applies at the estate recovery stage. The heir must have lived in the home for two years before the member’s admission, provided care that delayed institutionalization, still be living in the home when the claim is filed, and have inherited an interest.⁸

The income-based waiver is the broadest and easiest to qualify for. If the heir’s household income was below 400% of the federal poverty level for two years before MassHealth filed its claim, a partial waiver may be available, subject to the same $50,000 cap, which often won’t cover the full claim on a valuable property.⁸

The 60-Day Deadline After a Claim Is Filed

Once MassHealth files its claim in probate court, the estate has 60 days to respond. If no one responds, the claim is allowed as a matter of law and MassHealth’s full amount is approved without any further review. Within those 60 days, the personal representative can request a hardship waiver, a deferral, or assert any of the statutory exemptions.⁴ Letting that window close is where families most often give up leverage they otherwise had.

Even if a surviving spouse or a minor or disabled child means recovery is deferred rather than active, the family should still notify MassHealth and assert the deferral rather than assuming the state will sort it out.¹

One Note on Home Equity and Getting Approved

Home equity can also keep you from qualifying for nursing facility coverage in the first place, which is a different problem from losing the home later. Federal law lets states deny coverage when home equity exceeds an annually adjusted ceiling, and Massachusetts uses the higher of the two federal options; for 2026 that is projected at roughly $1,130,000. The limit does not apply if your spouse or a child who is under 21, blind, or permanently disabled lives in the home.⁹ Below the ceiling, the home is generally exempt as an asset while you’re alive, which is exactly how it ends up exposed to estate recovery after you die.

1
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
2
U.S. Department of Health and Human Services. Medicaid Liens and Estate Recovery in Massachusetts
3
Mass.gov. 130 CMR 515.012 Real Estate Liens
4
Mass.gov. Overview of the Office of Medicaid (MassHealth) – Review of Estate Recovery
5
Mass.gov. Eligibility Operations Memo 25-09 – Updates to the MassHealth Estate Recovery Policy Under the LTC Act
6
Mass.gov. Massachusetts Medicaid Estate Recovery
7
Mass.gov. Eligibility Letter 174 – Revisions to Look-Back Periods for Transfers Into or From Trusts
8
Mass.gov. MassHealth Estate Recovery Hardship Waiver Request Form
9
Mass.gov. MassHealth Eligibility Letter 147 – Changes to the Regulations about Assets and the Determination of Eligibility for Long-Term-Care Services