What Is Estate Recovery?
MaineCare estate recovery is a federally mandated process which requires MaineCare to seek reimbursement from a deceased recipient’s estate for long-term care and related medical expenses that were paid by MaineCare.
MaineCare may seek repayment from a member's estate if the member:
- Was age 55 or older when they received certain services
- Received qualifying long-term care services
- Did not have a surviving spouse
- Did not have a surviving child under age 21
- Did not have a surviving child of any age who was blind or permanently disabled
Most MaineCare members will never be affected by estate recovery.
What Services Can MaineCare Recover Costs For?
MaineCare only seeks recovery for certain long-term care services, including:
- Nursing facility services
- Home and community-based services (HCBS)
- Related hospital services
- Related prescription drug services
Examples include:
- Consumer Directed Attendant Services (Section 12)
- Home and Community-Based Services (Sections 18, 19, and 20)
- Home Health Services (Section 40)
- Nursing Facility Services (Section 67)
- Private Duty Nursing and Personal Care Services (Section 96)
What Property Can Be Part of Estate Recovery?
Examples may include:
- A home
- Land
- Vehicles with significant value
- Boats, campers, motorhomes, and ATVs
- Bank accounts
- Stocks and bonds
- Certain annuities
MaineCare can only recover up to the amount it paid for covered services.
Example:
If:
- The estate is worth $150,000, and
- MaineCare paid $20,000 for covered services
MaineCare may seek repayment of $20,000 – not the full value of the estate.
What May Reduce the Amount MaineCare Can Recover?
Certain expenses and exemptions may reduce the amount available for estate recovery. Examples include:
- Burial expenses
- Probate court costs
- Attorney fees
- Costs to maintain or preserve estate property
- Certain personal representative fees
- Other exemptions allowed under MaineCare rules
When Does MaineCare Not Seek Recovery?
MaineCare does not seek recovery from an estate while any of the following individuals are living:
- A surviving spouse
- A child under age 21
- A child of any age who is blind or permanently disabled
Note: Recovery may be delayed until these protections no longer apply.
Waivers
In some situations, MaineCare may reduce or waive an estate recovery claim. The two types of waivers are:
- Care Given Waiver
You may qualify if:
- You lived with the MaineCare member for two or more years.
- You provided care for two or more years that helped them remain at home.
- You meet income requirements.
Possible waiver amounts may range from:
- Up to $6,000 per year for basic assistance
- Up to $12,000 per year for higher levels of care
- Up to $32,000 per year for care comparable to institutional care
- Hardship Waiver
You may qualify if:
- Recovery would create serious financial hardship
- You have a beneficial interest in the estate
- You meet income and asset requirements
- You meet residency requirements
Long-Term Care Insurance Partnership Protection
If the member had a qualified Long-Term Care Insurance Partnership Policy, some assets may be protected from estate recovery. This is usually equal to the benefits paid under the qualifying policy.
Frequently Asked Questions
- Does MaineCare take the entire estate?
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No. MaineCare can only seek repayment up to the amount paid for covered services.
- Will my family lose recoverable assets immediately?
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Not necessarily. Recovery cannot occur while certain protected family members are alive.
- Can I appeal a decision?
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Yes. Estate recovery decisions may be appealed to the Department’s Administrative Hearings Unit.
Need Help?
For questions about estate recovery, email MaineCare’s Estate Recovery Unit at EstateRecoveryUnitQuestion.OMS@maine.gov.
Call MaineCare Member Services at 1-800-977-6740 for questions about all other covered services and benefits (TTY users, dial 711 for Maine Relay).