MassHealth and Estate Recovery Claims

Many people planning for end-of-life healthcare rely on MassHealth to cover some or all of the costs, depending on their ability to pay. MassHealth will often make claims for reimbursement against the applicant or their estate as allowed by law. A MassHealth estate recovery claim can dramatically reduce the value of the estate to be passed to the heirs or beneficiaries.

A recent legal decision has held that MassHealth cannot seek certain benefits against an applicant or their estate under certain circumstances. Some MassHealth programs do not actually pay for medical services for the applicant. Instead, MassHealth pays monthly premiums on behalf of the applicant to another health plan. These are known as capitated premiums. Historically, these capitated premiums were included in MassHealth’s estate recovery claims–whether or not the applicant received medical services under the program. Under the new legal change, MassHealth is not permitted to make estate recovery claims for capitated premiums unless the applicant received a specific notice in advance that MassHealth would be doing so.

If you are looking for assistance with an estate plan or with any MassHealth claims in Western Massachusetts, our probate attorneys may be able to help you. Please give us a call.

Author: Diana Day, Esq.