04/07/2026
📋 Every state is required by federal law to run a Medicaid Estate Recovery Program to recoup long-term care costs after a recipient age 55 or older dies.
23 states and D.C. limit recovery to the probate estate, meaning only assets titled solely in the deceased's name.
In those probate-only states, tools like a TOD deed, POD designation, joint tenancy, or revocable living trust can often keep the home and other assets outside post-death Medicaid estate recovery.
The other 27 states use expanded recovery, which allows Medicaid to pursue any asset the recipient had a legal interest in at death, including joint accounts, living trusts, and life estates.
In expanded states, an irrevocable trust funded outside the 5-year lookback period is often the primary planning tool, because TOD deeds and living trusts alone usually will not block recovery.
The home is the most commonly targeted asset because it is frequently the only property of significant value a Medicaid recipient still owns at death.
Even in probate-only states, federal law allows Medicaid to place a lien on the home while the recipient is alive if they are permanently institutionalized and not expected to return.
California narrowed from expanded to probate-only recovery in 2017, and Massachusetts did the same in 2024. These classifications shift, which is why the rules in effect at the time of death are the ones that apply.
