PA Medicaid Estate Recovery Program

Even after your loved one qualifies for and receives Medicaid benefits, the story does not end at death. Pennsylvania operates a Medicaid Estate Recovery Program under which the state seeks reimbursement from the decedent 's estate for benefits paid.

Legal Framework

Pennsylvania's estate recovery program was enacted in 1994 (Act 49, codified at 62 P.S. § 1412) to comply with federal requirements under 42 U.S.C. § 1396p(b)(1). The regulations are published at 55 Pa. Code § 258.1 et seq. Federal law generally bars a lien against the property of a living Medicaid recipient, with two exceptions written into the statute itself. The first is a lien under a court judgment for benefits incorrectly paid. The second is a lien on the real property of a recipient who is institutionalized and whom the state determines, after notice and an opportunity for a hearing, cannot reasonably be expected to be discharged and return home (42 U.S.C. § 1396p(a)(1)(A), (B)). That second exception is itself limited. No lien may be imposed on the home while a spouse, a child under 21, a blind or disabled child, or a sibling with an equity interest who lived there for the year before the admission is lawfully residing in it, and any such lien dissolves if the recipient is discharged and returns home (42 U.S.C. § 1396p(a)(2), (a)(3)). Pennsylvania's recovery statute, 62 P.S. § 1412, is captioned "Repayment from Probate Estates" and directs the Department to recover from the decedent's probate estate. In Pennsylvania the recovery is a preferential claim against the decedent's estate , not a lien on the home during life.

What Benefits Are Subject to Recovery?

• Benefits paid on behalf of a beneficiary age 55 or older
• Nursing facility services
• Home and community-based services
• Related hospital and prescription drug services, meaning those received while the decedent was a resident in a nursing facility or was receiving home and community-based services, while the decedent was on temporary leave from a nursing facility, or after a transfer from a nursing facility to a hospital (55 Pa. Code § 258.2)
• All benefits paid after August 15, 1994 (the effective date of the estate recovery Act)

What Property Is Subject to Recovery?

Under 55 Pa. Code § 258.3:

• All real and personal property in the decedent's probate estate , whether or not actually administered
• Certain life insurance policies payable to the decedent's estate (even with facility of payment clauses)
• Deposit accounts payable to family under 20 Pa.C.S. § 3101(b) (accounts up to $20,000 per institution) and patient care accounts under § 3101(c) (up to $10,000) where funeral expenses have been paid

Priority of the DHS Claim

Under 20 Pa.C.S. § 3392, estate claims are paid in order of priority. Under the DHS priority rule (55 Pa. Code § 258.6(a)), the Medical Assistance Estate Recovery claim is split. To the extent it covers services rendered within 6 months of death, it is paid under paragraph (3) , the class that includes the funeral, last-6-months medical, nursing, and hospital costs, and medical-assistance-program services. That portion ranks below administration costs and the family exemption . Both 62 P.S. § 1412(b) and the regulation direct that the remainder of the claim is paid under paragraph (6), "all other claims," the same class as general creditors. There is one wrinkle worth knowing. A 2006 amendment to § 3392 added paragraph (5.1), a class for claims by the Commonwealth and its political subdivisions that ranks ahead of paragraph (6), and § 1412(a) gives the Department's claim "the priority of a debt due the Commonwealth." Neither § 1412 nor the regulation, which took effect in 2002, was rewritten after that amendment. The express reference to paragraph (6) in § 1412(b) is the more specific direction and remains the working rule, but confirm the Department's position before you distribute a thin estate.

The Notice Requirement: Do Not Skip This

Personal representatives of estates where the decedent was 55 or older at death must notify the Department of Human Services (formerly DPW) of the death, the grant of letters, and request a statement of claim. This notice must be sent by certified mail (return receipt requested), fax (717-772-6553), or email .

DHS has 45 days from receipt of proper notice to submit its claim, or the claim is forfeited. But the 45-day clock does not start until DHS receives a fully compliant notice. There is no limit on the number of years for which DHS can seek recovery, except that it cannot reach back before August 15, 1994.

Legal and factual content on this page was last verified: Aug. 2026. If you are reading this significantly after that date, confirm key provisions with current statute text or contact our office.