Disclaimer: This page is for general educational purposes only and is not legal advice. Medicaid estate recovery rules are state-specific and change. Always verify current rules with your state Medicaid agency and a qualified elder-law / estate-planning attorney before making decisions.
Estate Planning Data & Research → Medicaid estate recovery scorecard
A 50-state + D.C. policy scorecard comparing how aggressively state Medicaid programs pursue estate recovery after long-term care — with downloadable data, transparent scoring, and source vintages.
When a parent needs long-term care, Medicaid often becomes the payer of last resort. After death, federal law generally requires states to try to recover certain Medicaid costs from the enrollee’s estate—commonly including the family home if it is still in the probate estate and no protected survivor lives there. States differ sharply in how far they go beyond the federal minimum, whether they use TEFRA liens, how many hardship pathways they offer, and whether they skip small estates.
This scorecard turns those policy differences into a transparent 0–100 Aggressiveness Score (higher = more aggressive recovery posture in the published sources). It is a research synthesis—not a prediction of what will happen in any one family.
Related planning context: nursing home costs & quality by state, protecting a parent’s legacy beyond a revocable trust, and the Family Estate Guide home page for wills, trusts, and probate basics.
Downloads
- State scorecard CSV (50 states + D.C., scored dimensions, confidence flags)
- Score component CSV
- Methodology (text)
Cite this page URL when reusing findings. Not a substitute for state Medicaid manuals or legal advice.
Key findings
- Federal law requires recovery of nursing-facility, HCBS, and related hospital/Rx costs for many enrollees age 55+. Many states go further and recover all Medicaid benefits for that age group (KFF 2024 survey).
- Hardship protections vary widely. Justice in Aging (March 2025) documents eight common waiver categories; some states offer many pathways, while Missouri and North Dakota are flagged as offering none of those tabulated pathways.
- Cost-effectiveness floors range from roughly $100 claim waivers to estate exclusions around $25,000–$50,000 where documented—higher floors generally mean fewer small estates are pursued.
- MACPAC’s Appendix 3C (2020 state-plan vintage, published March 2021) remains the best public TEFRA-lien census in this package, but it may be stale and should be re-checked against current state plans.
Highest aggressiveness scores (this model)
- Missouri — 94.0/100
- Delaware — 90.5/100
- Alabama — 90.2/100
- Wisconsin — 88.7/100
- Idaho — 88.5/100
Lowest aggressiveness scores (this model)
- Arkansas — 29.0/100
- Vermont — 36.0/100
- California — 36.8/100
- Texas — 37.2/100
- Maine — 42.8/100
Scorecard table
Sortable-friendly markup (state, score, confidence, recovery scope, TEFRA liens, hardship pathway count, modest-home hardship, cost-effectiveness signal). Download the full CSV from the project data/ folder when published.
| State | Aggressiveness (0–100) | Confidence | Recovery scope (55+) | TEFRA liens | Hardship pathways (JIA) | Modest-home hardship | Cost-effectiveness signal |
|---|---|---|---|---|---|---|---|
| Missouri | 94.0 | medium | all_medicaid_benefits | yes | 0.0 | no | must_exceed_admin_costs |
| Delaware | 90.5 | high | all_medicaid_benefits | yes | 2.0 | no | 5000 |
| Alabama | 90.2 | medium | all_medicaid_benefits | yes | 1.0 | no | must_exceed_admin_costs |
| Wisconsin | 88.7 | high | all_medicaid_benefits | yes | 3.0 | no | 100 |
| Idaho | 88.5 | high | all_medicaid_benefits | yes | 3.0 | no | 500 |
| Arizona | 85.9 | high | all_medicaid_benefits | yes | 3.0 | no | unknown |
| Washington | 85.0 | high | some_optional_benefits | yes | 1.0 | no | 100 |
| Ohio | 84.0 | high | all_medicaid_benefits | yes | 4.0 | no | no_threshold |
| Utah | 83.5 | medium | all_medicaid_benefits | yes | 2.0 | no | exclude_estates_below_value |
| Indiana | 82.8 | medium | all_medicaid_benefits | yes | 3.0 | no | must_exceed_admin_costs |
| Illinois | 82.5 | high | all_medicaid_benefits | yes | 2.0 | no | 25000 |
| New Hampshire | 81.2 | high | all_medicaid_benefits | yes | 5.0 | no | 200 |
| Oklahoma | 81.2 | high | some_optional_benefits | yes | 1.0 | no | unknown |
| Iowa | 80.2 | high | all_medicaid_benefits | no | 1.0 | no | no_threshold |
| New Jersey | 80.0 | high | all_medicaid_benefits | no | 1.0 | no | 3000 |
| Massachusetts | 78.8 | high | all_medicaid_benefits | yes | 3.0 | no | 25000 |
| Hawaii | 76.5 | medium | all_medicaid_benefits | yes | 2.0 | yes | must_exceed_admin_costs |
| Oregon | 76.5 | high | all_medicaid_benefits | no | 2.0 | no | no_threshold |
| Rhode Island | 76.3 | high | all_medicaid_benefits | no | 2.0 | no | 3000 |
| Kansas | 76.0 | medium | all_medicaid_benefits | yes | 4.0 | no | exclude_estates_below_value;must_exceed_admin_costs |
| West Virginia | 75.5 | high | some_optional_benefits | yes | 3.0 | no | 5000 |
| Wyoming | 75.2 | medium | all_medicaid_benefits | no | 1.0 | no | must_exceed_admin_costs |
| North Dakota | 75.0 | medium | all_medicaid_benefits | no | 0.0 | no | other_criteria |
| Michigan | 74.8 | high | all_medicaid_benefits | no | 1.0 | deferral_only | 1000 |
| Pennsylvania | 72.8 | high | all_medicaid_benefits | no | 3.0 | no | 2400 |
| New York | 72.5 | medium | all_medicaid_benefits | yes | 2.0 | yes | other_criteria |
| Kentucky | 71.9 | high | all_medicaid_benefits | no | 2.0 | no | unknown |
| District of Columbia | 70.0 | high | all_medicaid_benefits | no | 4.0 | no | 100 |
| Florida | 70.0 | high | beyond_minimum_macpac2021 | no | 4.0 | no | 100 |
| Georgia | 67.5 | high | all_medicaid_benefits | no | 2.0 | no | 25000 |
| Tennessee | 67.5 | medium | all_medicaid_benefits | no | 2.0 | no | waive_claims_up_to_amount |
| Colorado | 67.3 | high | ltss_minimum_only | yes | 2.0 | no | 500 |
| Maryland | 64.1 | high | ltss_minimum_only | yes | 1.0 | no | unknown |
| Minnesota | 61.5 | medium | ltss_minimum_only | yes | 2.0 | no | must_exceed_admin_costs |
| North Carolina | 61.2 | high | all_medicaid_benefits | no | 1.0 | no | 50000 |
| Nevada | 60.2 | medium | all_medicaid_benefits | no | 5.0 | no | must_exceed_admin_costs |
| Alaska | 59.8 | high | some_optional_benefits | yes | 4.0 | yes | 10000 |
| Connecticut | 55.8 | medium | ltss_minimum_only | yes | 3.0 | no | minimum_recovery_value |
| Nebraska | 54.5 | medium | some_optional_benefits | no | 3.0 | no | minimum_recovery_value |
| Virginia | 54.0 | medium | all_medicaid_benefits | no | 4.0 | yes | must_exceed_admin_costs |
| Mississippi | 50.5 | high | ltss_minimum_only | no | 2.0 | no | 5000 |
| Montana | 50.0 | medium | ltss_minimum_only | yes | 4.0 | no | other_criteria |
| South Carolina | 50.0 | high | all_medicaid_benefits | no | 4.0 | yes | 25000 |
| New Mexico | 48.2 | medium | all_medicaid_benefits | no | 5.0 | yes | minimum_recovery_value |
| South Dakota | 44.8 | medium | ltss_minimum_only | yes | 3.0 | yes | exclude_estates_below_value;minimum_recovery_value |
| Louisiana | 44.6 | high | ltss_minimum_only | no | 4.0 | no | 1000 |
| Maine | 42.8 | medium | ltss_minimum_only | no | 3.0 | no | must_exceed_admin_costs |
| Texas | 37.2 | high | ltss_minimum_only | no | 5.0 | no | 10000 |
| California | 36.8 | high | ltss_minimum_only | yes | 7.0 | yes | 5000 |
| Vermont | 36.0 | medium | ltss_minimum_only | no | 4.0 | no | exclude_estates_below_value |
| Arkansas | 29.0 | medium | ltss_minimum_only | no | 4.0 | yes | must_exceed_admin_costs |
How the score works (summary)
Composite score = weighted average of available dimensions (missing cells are excluded and remaining weights renormalized):
- Recovers beyond minimum (25%) — KFF 2024: all Medicaid benefits for 55+ scores higher than some optional benefits; LTSS-minimum-only scores lowest.
- TEFRA liens (15%) — MACPAC 2021 Appendix 3C: yes raises aggressiveness.
- Hardship pathways inverse (30%) — Justice in Aging 2025 Table 2: more documented waiver pathways lower aggressiveness. Deferral-only (
Yes*) counts as half a pathway. - Cost-effectiveness (20%) — Higher documented dollar floors lower aggressiveness; “no threshold” raises it. Numeric floors drawn from MACPAC 3C-3 / JIA Table 3 when clear.
- Modest-home hardship (10%) — Presence of a modest-home pathway lowers aggressiveness (JIA Table 2).
Estate definition (probate-only vs expanded non-probate) is tracked as a column but is not in the composite: primary sources do not provide a complete 50-state census without invention.
Full weights, limitations, and vintage notes: see methodology.md and data-dictionary.md.
What families usually ask next
- Will Medicaid take the house? Often only after death, and usually not while a spouse, minor child, or blind/disabled child survives—but state liens and expanded-estate rules can change the practical answer.
- Does a revocable living trust stop estate recovery? Usually no for Medicaid eligibility/recovery purposes if the grantor retained benefits. See Protecting Your Parents’ Legacy.
- How do nursing-home prices affect spend-down? Compare state nursing home costs.
Sources
- MACPAC, Chapter 3: Medicaid Estate Recovery—Improving Policy and Promoting Equity (March 2021), including Appendix 3C. PDF archived in project
sources/. Accessed 2026-09-17. - KFF, What is Medicaid Estate Recovery? (published Sep 13, 2024; survey March 2024) and appendix table. Accessed 2026-09-17.
- Justice in Aging, Mitigating the Harmful Effects of Medicaid Estate Recovery (March 2025), Tables 2–3. Accessed 2026-09-17.
- Medicaid.gov estate recovery overview (federal baseline). Accessed 2026-09-17.
Downloads (when published): data/state-medicaid-estate-recovery.csv, data/score-components.csv, data/sources.csv, plus this methodology package. Do not treat CSV cells marked unknown as “no.”
Last research package build: 2026-09-17 (ET). Owner draft for Family Estate Guide; not yet published to WordPress.
Scorecard published September 17, 2026. Sources: KFF (2024 survey), Justice in Aging (March 2025), MACPAC (March 2021). TEFRA lien flags may be stale — verify with current state plans. Editorial standards.