Pennsylvania Medicaid estate recovery
Last checked: May 18, 2026
If your family member got Medicaid long-term care in Pennsylvania, the state may ask for repayment after death. This is called estate recovery.
The house is often the asset families worry about most. The answer depends on the deed, who is still living, what kind of Medicaid care was paid, and whether a delay or hardship waiver applies.
State warning: Rules can change. Counties, managed care plans, waiver contractors, and agencies may use different names. Confirm details with official Pennsylvania sources before you transfer property, open or close an estate, sell a home, or ignore a notice.
Quick answer
Yes, Pennsylvania may seek repayment from a person’s estate after that person dies if Medicaid, called Medical Assistance in Pennsylvania, paid for long-term care after age 55. This can include nursing facility care, Community HealthChoices, home and community-based services, and related hospital or prescription drug costs.
The state does not make you sign over the deed just because someone enters a nursing home or starts Medicaid home care. But after death, a house may be part of the estate recovery claim if it is part of the person’s estate or the person owned a recoverable share.
Some families have protections. Recovery may be delayed for a surviving spouse, a child under 21, a child who is blind or totally and permanently disabled, or a qualifying sibling. Some families may also ask for a hardship waiver.
Main programs and where to start
This table is for routing. It is not a promise that the program applies to your family.
| Program or route | Who it helps | Where to start in Pennsylvania |
|---|---|---|
| Medical Assistance Estate Recovery Program | Families, executors, heirs, and personal representatives dealing with a possible estate recovery claim after death. | Contact Pennsylvania DHS Estate Recovery Program. Ask for a statement of claim, waiver form, appeal rights, or status of a claim. |
| Medicaid long-term care and HCBS | People who need nursing facility care or home and community-based services. | Apply through COMPASS, the Consumer Service Center, or the PA Independent Enrollment Broker. Read Medicaid HCBS Waivers Explained before you apply. |
| Community HealthChoices | Adults age 21 or older who have Medicare and Medicaid, or who receive Medicaid long-term services and supports because they need help with daily tasks. | Start with DHS, the Independent Enrollment Broker, or the person’s CHC managed care plan if already enrolled. |
| Services My Way | Some people who need long-term care support and can direct their own services, with help if needed. | Ask the Independent Enrollment Broker, DHS, or the service coordinator whether Services My Way is an option. |
| OPTIONS Program, PA Link, and Area Agency on Aging | Older adults and caregivers who need help staying at home, finding services, or filling out forms. | Call the local Area Agency on Aging or PA Link. Also see Respite Care for Caregivers. |
| Legal help | Families with a home, deed, probate, hardship waiver, appeal, transfer, spouse, disabled child, sibling, or caregiver-resident issue. | Ask the Area Agency on Aging about the Older Pennsylvanians Legal Assistance Program. You can also contact PA Legal Aid, PALawHelp.org, SeniorLAW HelpLine, or a Pennsylvania elder law attorney. |
What Medicaid estate recovery means
Estate recovery means the state asks to be paid back from a person’s estate after that person dies.
In Pennsylvania, Medicaid is called Medical Assistance. The Pennsylvania Department of Human Services runs the Medical Assistance Estate Recovery Program.
The claim is not for every person who ever had Medicaid. The main risk is long-term care Medical Assistance after age 55. That can include care in a nursing facility and care at home or in the community through Medicaid long-term services.
A simple way to think about it is this:
- Medicaid may pay for care while the person is alive.
- The state keeps a record of covered long-term care costs.
- After death, the state may make a claim against estate property.
- The claim cannot be more than the covered costs that fall under estate recovery rules.
This is why a person can qualify for Medicaid long-term care even if they own a home, but the home may still matter after death.
When estate recovery may apply in Pennsylvania
Pennsylvania’s estate recovery program may apply when all of these are true:
- The person died.
- The person was age 55 or older when Medical Assistance paid for covered long-term care.
- The person received covered services on or after August 15, 1994.
- There is estate property or other property subject to the state’s claim.
Covered long-term care can include:
- nursing facility care;
- Community HealthChoices;
- home and community-based services, also called HCBS or waiver services;
- related hospital care and prescription drug services while the person was receiving covered long-term care.
Estate recovery happens after death. Pennsylvania’s DHS materials say the personal representative of the estate should give DHS notice and request a statement of claim. DHS then sends the amount of the claim if the notice is accurate and complete.
If you are still planning care, also read Medicaid Spend Down and Medicaid Look-Back Period. Those pages are about getting eligible while the person is alive. Estate recovery is about what can happen after death.
Is the house at risk?
Sometimes. Not every house is treated the same way.
The first thing to check is the deed. The deed shows legal ownership. Family stories, old wills, or who paid the taxes may not match the deed.
Pennsylvania’s rule focuses on estate property. Estate property includes real and personal property of the person who died that is subject to administration by a personal representative, whether an estate is actually opened or not.
That means a family should not assume that avoiding probate makes the issue go away. If a home or other asset may be subject to estate administration, ask DHS Estate Recovery or a Pennsylvania probate or elder law attorney before acting.
Deed words can matter
Pennsylvania’s DHS estate recovery materials say property is excluded from estate recovery if the deed states “tenancy by the entireties” or “joint tenancy with the right of survivorship.” If the deed does not say that, the property may be subject to estate recovery.
Do not change a deed just to try to avoid estate recovery. Transfers can affect Medicaid eligibility and can create tax, probate, and family problems.
Important: The home can be treated one way while the person is alive and another way after death. A home may not count for eligibility in the same way it counts for estate recovery. Ask before you sell, transfer, refinance, or record a deed.
Common protections and exemptions
These protections are not automatic in every fact pattern. Some delay recovery. Some exclude property. Some require a waiver request. Get legal help when a home is involved.
| Situation | What may happen | What to do next |
|---|---|---|
| Surviving spouse | Pennsylvania can delay collection while a surviving spouse is alive. Federal rules also protect estates from recovery while a spouse survives. | Call DHS Estate Recovery. Ask whether recovery is delayed and what must be filed to protect the spouse. |
| Child under age 21 | Recovery may be delayed until the child reaches age 21. | Tell DHS about the child. Ask what proof is needed. |
| Child who is blind or totally and permanently disabled | Recovery may be delayed until that child dies. | Ask what proof DHS needs. SSI or disability records may matter. |
| Sibling with equity interest in the home | Pennsylvania rules allow delay when a sibling has an equity interest and lived in the home for at least one year before the decedent’s death. | Gather the deed and proof of residence. Talk with a lawyer before selling or transferring the home. |
| Joint tenancy with right of survivorship or tenancy by the entireties | DHS materials say property with these deed terms is excluded from estate recovery. | Get a copy of the deed. Ask a lawyer to read the exact wording. |
| Caregiver who lived in the home | Pennsylvania official sources confirm a hardship waiver route for a person who lived in the primary home and provided care or support for the required time. The state materials do not use the phrase “caregiver child exception” for this estate recovery waiver. | Ask for the Undue Hardship Waiver Request Form. Gather proof of residence, care, and lack of another permanent home. |
| Small administered estate | DHS rules say it will waive its claim for an administered estate with a gross value of $2,400 or less, if there is an heir. | Ask DHS how to document the estate value and the heir. |
| Income-producing asset | A hardship waiver may apply to an income-producing asset, such as a family farm or family business, if state criteria are met. | Gather tax returns, 1099s, W-2s, income records, and proof that the asset is the main income source. |
| Costs to maintain a vacant home | Some necessary and reasonable costs, such as real estate taxes, utilities, repairs, and maintenance, may reduce the recovery amount. | Keep receipts and invoices. Do not pay cash without proof. |
If your family is asking, “Can I get paid for taking care of Mom or Dad?” estate recovery is only one part of the picture. Read Can I Get Paid to Be a Caregiver? or try the caregiver pay quiz to sort the payment paths.
Hardship waivers
A hardship waiver asks Pennsylvania DHS to give up all or part of its estate recovery claim because recovery would cause hardship under state rules.
For a primary residence, Pennsylvania rules say DHS will grant a waiver when the person asking for the waiver meets all of these conditions:
- The person lived continuously in the decedent’s primary residence for at least two years before the decedent received nursing facility services, or for at least two years while Medicaid-funded home and community-based services were received.
- The person has no other permanent residence.
- The person provided care or support to the decedent for at least two years during the required period, and the decedent needed care or support to remain at home.
The hardship form asks for proof. Examples include proof of residence, a physician statement, a certified appraisal, and income records if an income-producing asset is involved.
For an income-producing asset, such as a family farm, family business, or rental property, Pennsylvania rules may allow a waiver if the asset is the household’s main source of income and the family would be under the required federal poverty guideline level without it.
Do not rely on an old income figure in an old brochure. Federal poverty guidelines change. Ask DHS Estate Recovery what current proof and current standard they will use.
Hardship waiver mailing address
Department of Human Services
Division of Third Party Liability
Estate Recovery Program
P.O. Box 8486
Harrisburg, PA 17105-8486
Estate Recovery Hotline: 1-800-528-3708
Fax: 717-772-6553
Email listed by DHS: RA-PWESTATERECOVERY@pa.gov
Keep copies of everything you send. If you mail papers, use a trackable method. If you fax, keep the fax confirmation page.
What families should not do
- Do not give away the house without legal advice. Transfers can affect Medicaid eligibility and may not stop estate recovery.
- Do not assume home care is safe from recovery. HCBS and Community HealthChoices can be part of the estate recovery claim.
- Do not assume Medicare paid for everything. Medicare and Medicaid are different. Estate recovery is tied to Medicaid long-term care payments.
- Do not ignore a DHS letter. A deadline may apply. If you disagree, ask for the appeal process in writing.
- Do not distribute estate money too fast. A personal representative can have duties to handle the DHS claim.
- Do not trust deed advice from a non-lawyer. One phrase on a deed can change the answer.
- Do not assume a surviving spouse means the issue is gone forever. In Pennsylvania, recovery may be delayed. Ask what happens later.
- Do not pay a large claim without checking the numbers. Ask for the statement of claim and compare dates, services, and the person’s age at the time of care.
Who to contact
The right first call depends on the problem.
If someone has died and there may be a claim
Call the Pennsylvania DHS Estate Recovery Program.
Ask for: estate recovery, statement of claim, hardship waiver, delayed recovery, appeal rights, or claim status.
If the person needs care now
For Medicaid long-term care or HCBS, contact the PA Independent Enrollment Broker, the DHS Consumer Service Center, COMPASS, or the County Assistance Office.
Also use the care cost calculator before you choose a care plan.
If you need aging services or local help
Call PA Link or the local Area Agency on Aging. Ask for help with in-home services, the OPTIONS Program, caregiver support, forms, and local referrals.
If there is a home, deed, spouse, child, sibling, or waiver issue
Ask for legal help. Start with the Older Pennsylvanians Legal Assistance Program through the Area Agency on Aging, PA Legal Aid, PALawHelp.org, SeniorLAW HelpLine, or a private elder law attorney.
Phone script for DHS Estate Recovery
“Hello. I am calling about Pennsylvania Medical Assistance Estate Recovery. My family member died, and I need to know whether there is a claim. I also need to know whether delayed recovery or a hardship waiver may apply because there is a home and a family member living there. Can you tell me what documents to send and where to send them?”
Phone script for legal help
“Hello. I need legal help with a Pennsylvania Medicaid estate recovery claim. There is a house involved. I need someone to review the deed, DHS claim, possible hardship waiver, and deadlines before we sell or transfer anything.”
If the first answer is no, ask this:
- “Can you send that decision in writing?”
- “What rule are you using?”
- “Is there an appeal deadline?”
- “Can I request a hardship waiver?”
- “Can you tell me what proof is missing?”
Pennsylvania regulations say an affected personal representative, transferee, or family member may appeal an adverse DHS decision under this chapter within 30 days of the date they are notified. Do not wait if a notice says appeal rights or gives a deadline.
For more call wording, see Phone Scripts for Caregivers. For a paperwork list, see Caregiver Checklists.
Documents to gather
- death certificate;
- will, trust papers, or proof there is no will;
- letters testamentary or letters of administration, if an estate was opened;
- current deed and any older deeds;
- mortgage, home equity loan, tax, and insurance papers;
- bank, investment, life insurance, and beneficiary papers;
- all DHS, Medicaid, Community HealthChoices, nursing home, or waiver letters;
- Medicaid notices showing dates of eligibility and services;
- proof of who lived in the home and when;
- proof of care provided by a family member or caregiver;
- doctor statement if you are asking for a hardship waiver based on care that kept the person at home;
- certified appraisal if requested for the hardship form;
- receipts for real estate taxes, utilities, repairs, and maintenance;
- income records, W-2 forms, 1099 forms, and tax returns for an income-producing asset claim;
- copies of anything already sent to DHS.
What if your family is trying to plan before death?
Do not wait until there is a crisis if the person owns a home and may need Medicaid long-term care.
Talk with a Pennsylvania elder law attorney before making deed changes, gifts, trust transfers, or caregiver payment agreements. Ask how the Medicaid look-back period, spend-down rules, tax issues, and estate recovery may work together.
Caregiver payments can also create tax issues. Read Caregiver Tax Deductions for general tax starting points, then ask a tax professional about your facts.
If the person is a veteran or surviving spouse, check VA Aid and Attendance as a separate path. VA benefits have different rules from Medicaid.
FAQ
Can Pennsylvania take the house while my parent is alive?
DHS estate recovery happens after death. Pennsylvania’s estate recovery brochure says a person does not have to sign over the deed to receive Medicaid long-term care services. But a home can still matter for eligibility, liens, sale proceeds, and estate recovery later. Talk with a lawyer before changing a deed.
Does estate recovery apply if care was at home?
Yes, it can. Pennsylvania includes home and community-based services, Community HealthChoices, and related hospital or prescription drug services when those services meet the estate recovery rules.
What if there is a surviving spouse?
Recovery may be delayed while the surviving spouse is alive. This does not always mean the claim is gone. Ask DHS what applies to your property and what happens later.
What if an adult child lived in the home and provided care?
Pennsylvania has a hardship waiver route for a person who lived in the decedent’s primary residence for the required time, had no other permanent residence, and provided care or support for the required time. Ask DHS for the waiver form and get legal help.
What if the deed has both names on it?
Get the deed reviewed. DHS materials say property is excluded when the deed says “tenancy by the entireties” or “joint tenancy with the right of survivorship.” If the deed does not say that, the property may be subject to recovery.
What if the estate is very small?
Pennsylvania rules say DHS will waive its claim for an administered estate with a gross value of $2,400 or less if there is an heir. Ask DHS how to document that.
Can we appeal?
Yes, if you are affected by an adverse DHS decision under the estate recovery rules. Pennsylvania regulations give a 30-day appeal period from the date the affected person is notified. Use the address and instructions in the notice, and get legal help fast.
Resumen en español
En Pennsylvania, Medicaid se llama Medical Assistance. Después de la muerte de una persona, el estado puede pedir pago de la herencia si Medicaid pagó cuidado de largo plazo después de los 55 años.
La casa puede estar en riesgo, pero hay protecciones posibles para un esposo o esposa sobreviviente, un hijo menor de 21 años, un hijo con discapacidad, ciertos hermanos, y algunas personas que vivieron en la casa y dieron cuidado. Llame al programa de Estate Recovery de Pennsylvania DHS antes de vender, transferir, o cambiar la escritura de la casa.
Official sources used
- Pennsylvania Department of Human Services, Estate Recovery Program: https://www.pa.gov/agencies/dhs/resources/for-residents/estate-recovery
- Pennsylvania DHS, Medical Assistance Estate Recovery Program Questions and Answers, PUB 332: https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/for-providers/documents/ma-provider-forms/Pub%200332.pdf
- Pennsylvania DHS, Undue Hardship Waiver Request Form: https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/services/other-services/estate-recovery/Undue%20Hardship%20Waiver%20Request%20Form.pdf
- 55 Pa. Code Chapter 258, Medical Assistance Estate Recovery: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter258/chap258toc.html
- Medicaid.gov, Estate Recovery: https://www.medicaid.gov/medicaid/eligibility-policy/estate-recovery
- Pennsylvania DHS, Community HealthChoices: https://www.pa.gov/agencies/dhs/resources/medicaid/chc
- Pennsylvania DHS, Home and Community-Based Services: https://www.pa.gov/agencies/dhs/resources/home-community-based-services-hcbs
- Commonwealth of Pennsylvania, Access Long-Term Care Services: https://www.pa.gov/services/dhs/apply-for-long-term-care-services
- Pennsylvania Department of Aging, PA Link to Aging and Disability Resources: https://www.pa.gov/agencies/aging/local-resources/pa-link-to-aging-and-disability-resources
- Pennsylvania Department of Aging, Area Agencies on Aging: https://www.pa.gov/agencies/aging/local-resources/area-agencies-on-aging-
- Commonwealth of Pennsylvania, Apply for the OPTIONS Program: https://www.pa.gov/services/aging/apply-for-options-program
- Commonwealth of Pennsylvania, Older Pennsylvanians Legal Assistance Program: https://www.pa.gov/services/aging/apply-for-the-older-pennsylvanians-legal-assistance-program
About this guide
This guide was written for family caregivers who need a practical starting point. It is based on official Pennsylvania and federal sources listed above.
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state.
