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Maryland Medicaid Estate Recovery — What the State Can Take, Who Is Exempt, and the Hardship Waiver (2026)

By Oleg Kachko · Updated September 6, 2026

✓ Verified September 2026

Maryland Medicaid Estate Recovery is the letter that arrives after a parent on Medicaid dies: the state asking to be repaid, from the estate, for the nursing home and medical care it covered. Federal law requires every state to seek that repayment for long-term care costs after age 55, but each state decides how far it reaches, which heirs are protected, and when it must let the claim go.

This guide gives the Maryland answer in plain English: what the state can take, when it must wait, who is exempt, how the hardship waiver works, and what happens to the house. All facts are from Maryland law, verified as of September 2026.

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Maryland Medicaid Estate Recovery: At a Glance

Here are the Maryland facts that decide most Maryland medicaid estate recovery claims:

Governing statute or rule Md. Code, Health-General § 15-121 (“Claims against estates”), which authorizes the Department to make claim against the estate of a deceased Program recipient for the amount of any medical assistance payments, in accordance with applicable federal law and Title XIX of the Social Security Act. The implementing regulation is COMAR 10.09.24.15, “Liens, Adjustments, and Recoveries.” Claim timing is governed by Md. Code, Estates & Trusts § 8-103(b), and the personal representative’s notice duty by Estates & Trusts §§ 7-103 and 7-103.1.
Agency that files the claim Maryland Department of Health (MDH), Division of Recoveries and Financial Services (DRAFS), Estates, Liens, and Trust Section. Claims and correspondence go to P.O. Box 13045, Baltimore, MD 21203; phone 410-767-6613 (410-767-6614 also published for the estates unit). DRAFS files the claim in the estate and administers hardship waiver requests. Confirm the current mailing address with DRAFS before sending an estate notice, since unit addresses change.
What the state can reach PROBATE ONLY. COMAR 10.09.24.15 defines “estate” as all real and personal property and other assets included within an individual’s estate as defined for purposes of State probate law. Maryland has not adopted the optional federal expanded-estate definition, so assets passing outside probate — joint tenancy or tenancy-by-the-entireties property, life estates, revocable living trusts, and transfer-on-death or payable-on-death accounts and beneficiary designations — generally fall outside the recoverable estate. Whether a particular asset is probate property is a fact question; check with a licensed Maryland attorney.
What is recovered Under COMAR 10.09.24.15, MDH seeks recovery of Medical Assistance benefits correctly paid on behalf of an individual who was 55 years old or older when the benefits were received. Consistent with the federal floor at 42 U.S.C. § 1396p(b)(1)(B), this covers nursing facility services, home and community-based services, and related hospital and prescription drug costs. Health-General § 15-121 states the claim in terms of “any medical assistance payments.” No statutory minimum recovery amount is set in the regulation.
Claim deadline Under Estates & Trusts § 8-103(b), a claim by the Maryland Department of Health against the estate of a deceased Medical Assistance recipient is forever barred against the estate, the personal representative, and the heirs and legatees unless presented within the earlier of 6 months after publication of notice of the first appointment of a personal representative, or 2 months after the personal representative mails or delivers a copy of the § 7-103 notice to the Department’s estate recovery unit. The personal representative may disallow the claim in whole or part under Estates & Trusts § 8-107.
Estates not pursued / limits NONE verified. Maryland’s regulations and Health-General § 15-121 publish no dollar floor below which estates are not pursued, no codified cost-effectiveness threshold, and no statutory interest rate on the estate recovery claim. In practice MDH may decline to pursue an estate too small to satisfy the debt after higher-priority costs, but that is discretionary rather than a published limit. Confirm any current administrative threshold directly with DRAFS.

What Maryland Medicaid Estate Recovery Can Actually Take

The claim is against the estate, not against the children. No heir in Maryland is personally liable for a parent’s Medicaid bill; the state is a creditor of whatever the parent left, and if the estate is empty the claim goes unpaid. What counts as the estate is the question that matters.

Every state can reach the probate estate — assets in the parent’s name alone that pass through the court. Some states stop there. Others have adopted an expanded definition that reaches joint accounts, life estates, assets in a living trust, and property passed by a transfer-on-death deed, and in those states the planning that avoided probate does not avoid the state.

The amount is the total Medicaid actually paid for the covered services, and it is usually far larger than families expect — nursing home care at the Medicaid rate runs into six figures within a few years. The state cannot recover more than it paid, and it cannot recover from an estate while a surviving spouse or a dependent child is alive; the Maryland rules on both are below.

When Maryland Must Wait or Cannot Recover

COMAR 10.09.24.15 bars recovery while there is a surviving spouse — recovery may be sought only after the surviving spouse’s death — and while there is a surviving child under 21 or a surviving son or daughter who is blind or permanently and totally disabled, of any age. These mirror the federal deferrals in 42 U.S.C. § 1396p(b)(2).

The claim is not forgiven by deferral alone; it may be pursued once the protective condition ends.

The caregiver-child and sibling exemptions: Yes. Under COMAR 10.09.24.15, the home is protected for a son or daughter who lawfully resided in the home for at least 2 years immediately before the recipient’s admission to a long-term care facility, has resided there continuously since, and provided care that permitted the recipient to remain at home rather than enter a facility.

A sibling with an equity interest in the home who resided there for at least 1 year immediately before the admission is likewise protected. These track 42 U.S.C. § 1396p(b)(2)(B).

The Maryland Hardship Waiver

Health-General § 15-121 provides the claim shall be waived by the Department if, in its judgment, enforcement will cause substantial hardship to the surviving dependents of the deceased.

COMAR 10.09.24.15 treats substantial hardship as present where the claim would force sale or transfer of real property occupied by a dependent relative who lived there on the date of death and continuously for at least 2 years before death and has no alternative housing. There is no statewide numbered form; a written request with financial documentation goes to DRAFS.

The filing deadline after notice is UNVERIFIED — confirm it with DRAFS.

The Family Home and Maryland Medicaid Estate Recovery

Under COMAR 10.09.24.15 Maryland may impose a lien during life on the home of a permanently institutionalized recipient not reasonably expected to return home; the recipient keeps ownership and control to the extent of their interest, and the lien is satisfied on later sale.

No lien may be imposed while a spouse, a child under 21, a blind or disabled child, or a qualifying sibling or caregiver child lawfully resides in the home. Maryland publishes no low-value home exemption; a home passing outside probate is outside the recoverable estate.

How the Claim Arrives and How to Respond

Recovery runs through the ordinary probate claims process rather than a standalone MERP letter. Under Estates & Trusts § 7-103.1 the personal representative may mail or deliver to MDH’s estate recovery unit a copy of the § 7-103 notice of appointment, which starts a shortened claim period. DRAFS then presents a written claim to the personal representative or files it with the Register of Wills.

Separately, under COMAR 10.09.24.15 MDH may record a TEFRA lien against the home during the recipient’s lifetime.

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Disputing the claim: Two paths. A denial of a hardship waiver may be appealed to a Medicaid fair hearing before the Maryland Office of Administrative Hearings, requested through MDH’s Request for Fair Hearing process within 90 days of the date on the notice.

Separately, the personal representative may disallow the claim under Estates & Trusts § 8-107, after which MDH is barred to the extent of the disallowance unless it files a petition for allowance or an action within 60 days after the notice of disallowance is mailed.

Other Maryland rules: Maryland’s defining feature is that it has kept recovery limited to the probate estate and has not enacted expanded-estate recovery, so ordinary non-probate transfers remain outside the claim. It also uses an unusually short claim window: 2 months from the personal representative’s notice to the Department, versus the general 6-month creditor period under Estates & Trusts § 8-103.

The hardship waiver is written into the statute itself at Health-General § 15-121 as a mandatory waiver, not merely an agency policy.

Mistakes That Make Maryland Medicaid Estate Recovery Cost More

The first mistake is ignoring the letter. A Maryland medicaid estate recovery notice carries a deadline to object or request a waiver, and silence is treated as consent; the estate’s personal representative then has no defense when the claim is paid ahead of the heirs. The second is distributing the estate before the claim is resolved.

A personal representative who hands the house to the children and then receives the state’s claim can be personally liable for what should have been paid.

The third mistake is assuming the house is safe because it avoided probate. In an expanded-recovery state it may not be, and in every state a lien placed during the parent’s life survives death. The last mistake is not asking for the waiver because the family assumes it will be denied.

The exemptions for caregiver children, disabled children, and low-value estates exist because the law expects them to be used, and the agency cannot apply one nobody claimed.

What to Expect from Maryland Medicaid Estate Recovery

A Maryland medicaid estate recovery claim arrives as a letter to the personal representative or a claim filed in the probate case, stating the amount Medicaid paid and the deadline to respond.

It is handled like any other creditor claim: the estate can pay it, object to the amount, assert an exemption, or request a hardship waiver, and the probate court or the agency’s hearing office decides what it cannot settle.

Two things surprise families. The first is the size of the number — years of nursing home care at the Medicaid rate. The second is that the exemptions are real and routinely granted when someone asks for them.

A surviving spouse, a disabled child, a caregiver child who kept the parent home, or an heir who would be left destitute can each stop or reduce a Maryland medicaid estate recovery claim, but only by saying so in writing before the deadline.

You don’t have to do this alone

If you are settling a loved one’s estate in Maryland, your state’s probate court self-help center and free legal-aid offices can walk you through the process at no cost. For an active probate or a deadline, talk to a licensed probate attorney in your state.

Key Takeaways: Maryland Medicaid Estate Recovery

  • The estate pays, not the children: Maryland medicaid estate recovery is a claim against what the parent left, never a personal debt of the heirs.
  • Scope is everything: whether Maryland medicaid estate recovery reaches only probate assets or also joint accounts and trusts is the fact that decides the house.
  • Deferral is mandatory: Maryland medicaid estate recovery must wait while a surviving spouse, a child under 21, or a disabled child of any age is alive.
  • The caregiver child is protected: a child who lived in the home and provided care for two years can usually stop Maryland medicaid estate recovery on the house.

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Official Maryland Sources & Resources

This Maryland guide was last verified against official sources in September 2026. Laws change — verify with the state Medicaid agency or a licensed attorney.

More Maryland Estate Guides

Disclaimer: This guide is informational only and is not legal or tax advice. Estate, probate, and tax laws change and vary by state and county. Verify current rules and dollar figures with your state’s court, statute, or a licensed attorney or tax professional before acting. For urgent matters like an active probate or a tax deadline, consult a licensed professional in your state right away.

Estate planning? Make sure your life insurance is in order — see Life Insure Guide. Worried about Medicaid estate recovery? See Medicare Cover Guide. Divorced recently? Update your will and beneficiaries — see Divorce Help Guide.