Pennsylvania Medicaid Estate Recovery: Can the State Take Your Home After a Nursing Home Stay?

Most Pennsylvania families ask the same thing the day a parent moves into a nursing home: “Are we going to lose the house?”

The honest answer has two parts. The state does not take your home when you enter a nursing home. However, after the Medicaid recipient dies, Pennsylvania can send a bill to the estate, and a house that passes through probate may have to be sold to pay it.

This guide from Hill Group Law explains how Pennsylvania Medicaid estate recovery works, which assets are exposed, who is protected, and what an executor must do. It is written for families in Johnstown, Cambria County, and across Pennsylvania.

Estate Recovery at a Glance

• Pennsylvania recovers what Medicaid (Medical Assistance) paid for long-term care received at age 55 or older, such as nursing facility care and home and community-based services.
• Recovery happens after death, from the probate estate. The state files a claim against the estate. It does not take the deed.
• A home titled in the recipient’s sole name usually passes through probate, so it is the most common asset at risk.
• A surviving spouse, a child under 21, or a child who is blind or has a permanent disability can delay collection. Delay is not the same as forgiveness.
• The Department of Human Services (DHS) must file its claim within 45 days of a complete notice from the executor, or the claim is forfeited.
• An executor who distributes estate property before dealing with the claim can be personally liable.
• Hardship waivers exist, including one for a caregiver who lived in the home. DHS decides each request.

What Is Pennsylvania Medicaid Estate Recovery?

Medicaid estate recovery is a rule that lets the state get repaid for certain long-term care costs after the person who received them has died. Federal law requires every state to run a program. Pennsylvania’s version is run by the DHS Estate Recovery Program under Section 1412 of the Human Services Code (62 P.S. § 1412) and 55 Pa. Code Chapter 258.

DHS describes the program as recovering Medical Assistance payments from the time a person turned 55 until their death. Three details matter:

• Age: The recovery covers benefits received at age 55 or older.
• Type of care: It covers nursing facility services, home and community-based services (HCBS), and related hospital and prescription drug costs.
• Date: The payments must have been made on or after August 15, 1994.

The claim is not limited to the last few years of care. It covers qualifying payments made from age 55 onward.

Regular health coverage that is not long-term care is not the target. Instead, the program focuses on the largest bills, which are nursing home stays and in-home care programs.

Is this the same as the Medicaid look-back?

No. Families often mix up the two rules, and the difference matters.

Pennsylvania has a five-year look-back for asset transfers, which is covered in more detail in our Medicaid crisis planning page. Estate recovery is a separate process, and it can apply even when every transfer rule was followed.

Can Pennsylvania Take Your Home While You Are Alive?

In general, no. Moving into a nursing home does not force a sale of the house, because the home is usually treated as an excluded resource.

For Medicaid eligibility, a primary residence is usually not counted as an available resource when the equity is below a federal limit, and certain people are living there. That limit is reported at $752,000 for 2026, according to Medicaid Planning Assistance. The limit does not apply when a spouse, a child under 21, or a child who is blind or has a permanent disability lives in the home. Your attorney should confirm the current figure at the time you apply.

One new rule is worth knowing about. A 2025 federal law (H.R. 1, summarized by Justice in Aging) sets a $1,000,000 cap on home equity for Medicaid long-term care beginning January 1, 2028, with an exception for land zoned for agricultural use. Most Johnstown-area homes are far below that number, so the change mainly affects larger properties.

What about liens?

Federal law generally bars a state from placing a lien on the property of a living Medicaid recipient. There are two narrow exceptions: a court judgment for benefits that were wrongly paid, and a lien on the home of a person who is permanently institutionalized and cannot reasonably be expected to return home, after notice and a hearing. Even then, a lien cannot be placed while a spouse, a child under 21, or a child who is blind or has a disability lives in the home.

Pennsylvania’s program, described in the state’s Medicaid State Plan, is built around the claim against the estate after death. We did not find evidence that Pennsylvania routinely records liens on living recipients. Still, because the federal exception exists, we do not tell families that a lien is impossible. If your parent has been in care for some time, an attorney can check the deed records and confirm that nothing has been recorded.

Can the State Take Your Home After You Die?

The state does not seize the home. Instead, it files a claim against the estate for what Medicaid paid. The estate then has to pay that claim before heirs receive their inheritances.

Here is the key point. Pennsylvania recovers from the estate, and the regulation defines that estate narrowly. Under 55 Pa. Code § 258.3, the claim reaches real and personal property that a personal representative administers, whether or not it is actually administered. Some other states reach assets that pass outside probate. Pennsylvania has considered expanding its program, but we found nothing showing that the expansion became law. Rules can change, so verify before you rely on this.

If a house is titled in the recipient’s name alone with no co-owner, it passes through probate. In that case, it is part of the estate the claim can reach.

Which assets count?

Two exceptions are worth knowing. Small deposit accounts that pass to family under 20 Pa.C.S. § 3101 (up to $20,000 per institution) can still be reached. Likewise, a trust that is payable to the estate is treated as part of it.

This table is a general guide, not a promise. How an asset is titled, how a trust is written, and who is named as beneficiary all change the result. Do not rearrange ownership of a home based on a chart, because a deed transferred at the wrong time can trigger a Medicaid penalty and cost your family other tax benefits.

Who Is Protected From Estate Recovery?

Pennsylvania delays collection when certain family members survive the recipient. These protections come from federal law and 55 Pa. Code § 258.7, and Philadelphia Legal Assistance offers a plain-language summary. They apply to the estate claim.

While collection is on hold, the executor must protect DHS’s claim. Typically that means recording a mortgage or other encumbrance on the real estate. No interest accrues during the delay. A surviving spouse, an adult child, or the representative of a child under 18 can also choose to waive the delay.

The most important point is that delay is not forgiveness. If a surviving spouse inherits the house, DHS may still file a claim against the estate when the spouse later dies. Families sometimes celebrate the deferral and forget that the claim is still on the books.

Can You Ask DHS to Waive the Claim?

Yes. DHS has the authority to waive, compromise, or postpone its claim, and the DHS Estate Recovery Program provides the request forms. The regulation (55 Pa. Code § 258.10) describes several undue hardship situations:

• A caregiver living in the home. DHS waives its claim on the primary residence when the person asking lived there continuously for at least two years before the recipient entered nursing facility care, has no other permanent home, and provided care or support for at least two years.
• A family business, farm, or rental property. DHS can waive its claim on an income-producing asset when a spouse, child, parent, sibling, or grandchild depends on it for the household’s main income and gross family income is under 250 percent of the federal poverty guideline. However, cash, stocks, and similar investments do not count for this waiver.
• Home upkeep costs. Necessary expenses to keep up the home, such as property taxes, utilities, and repairs, can be waived. Creditors cannot request this waiver.
• Very small estates. DHS does not seek recovery from an administered estate worth $2,400 or less if there is an heir.

Someone whose collection is already postponed can still ask for these waivers. DHS also has exclusive authority to waive its claim in other hardship cases or when collecting would not be cost-effective. Requests go to the Estate Recovery Program, P.O. Box 8486, Harrisburg, PA 17105-8486. If DHS denies a waiver, the affected person has 30 days from the date of notice to appeal. Missing that deadline can end your options, so mark it on the calendar the day the letter arrives.

A Johnstown Example

This scenario is hypothetical and uses round numbers.

Margaret, 82, lives in Johnstown and owns her house alone. It is worth $160,000. She moves into a nursing facility and her care is paid for by Medicaid over three years, totaling $150,000. She has no spouse, and her two adult children live out of state.

When Margaret dies, her house passes through probate because she owns it alone. Her executor notifies DHS. DHS files a claim for the Medicaid payments it made. The estate holds the house, a small bank account, and a car, so the claim takes most of the value.

• Without planning: Her children sell the house. Most of the sale price goes to repay DHS after estate costs.
• If a child had lived with Margaret and cared for her for two years or more: That child may qualify for the primary residence hardship waiver, but only if DHS approves it and every condition is met.
• If Margaret had a surviving spouse: DHS would delay collection until the spouse died.

The same family facts can lead to very different results. For that reason, advice in the early stages of care matters so much.

What an Executor Must Do

If you are the executor or administrator of a Pennsylvania estate, estate recovery becomes your responsibility. The statute places real duties on you.

1. Find out whether the person received Medical Assistance. The notice regulation requires you to check whether benefits were received in the five years before death. That five-year window is only for the notice step. It does not limit the claim, which can reach payments back to 1994 for care at age 55 or older. Ask the nursing facility, the county assistance office, and the family. If you are new to the role, our guide to estate administration explains the basics.
2. Notify DHS and request a statement of claim. Send the notice by certified mail, fax, or email. It must include the decedent’s name, last address, date of birth, date of death, and Social Security number, your name, address, and phone, and written documentation of the estate’s gross value. A notice that is incomplete or misaddressed does not start the clock.
3. Watch the 45-day deadline. DHS has 45 calendar days to send a statement of claim. If DHS misses it, the claim is forfeited. You may agree to extend the period. A deadline that lands on a weekend or holiday moves to the next business day.

Protecting yourself from personal liability

1. Do not distribute assets early. Under § 258.8, an executor who transfers estate property to an heir or a lower-priority creditor for less than full value, without satisfying or protecting the claim, can become personally liable.
2. Give DHS notice before the court approves a distribution. A court decree discharges the executor only if DHS received the proposed distribution at least 30 days earlier, the record shows the inquiry was made, and DHS receives the final order. Hiding property or refusing to pay keeps the executor liable.
3. Pay the claim in the proper order. The claim is paid after higher-priority creditors. Where it falls among other estate debts is a legal question worth reviewing with an attorney, especially in a thin estate.

You can reach the DHS Estate Recovery Program at 800-528-3708. Its mailing address is P.O. Box 8486, Harrisburg, PA 17105-8486.

How Families Reduce the Risk Before It Becomes a Problem

Planning does not mean hiding assets. Rather, it means understanding the rules early enough to make lawful choices. These are the options elder law attorneys typically review (see also our ideas for asset protection):

• Spousal planning. Transfers between spouses are generally permitted for Medicaid purposes, and the community spouse has protections of their own.
• Caregiver child planning. Federal law lets a parent transfer the home to a child who lived there for at least two years and provided care that delayed the move to a nursing facility, without triggering a transfer penalty.
• Titling and beneficiary review. Because the regulation reaches the estate rather than everything you own, how assets are titled and who is named as beneficiary can change what is exposed.
• Medicaid asset protection trusts. An irrevocable trust can be part of a plan, but gifts to it are subject to the five-year look-back.
• Timing. Most strategies work only if they are in place well before care begins.

Each option has trade-offs. Giving a house to your children, for example, can create a Medicaid penalty period. It can also cost them the stepped-up tax basis they would get if they inherited the home. Still, never sign a deed because a neighbor or a website said it would “protect” the house.

Common Mistakes Families Make

• Waiting until a crisis. Planning is far less flexible after a parent is already in care. If you are already in that situation, crisis Medicaid planning can still help.
• Assuming a will avoids the claim. A will does not avoid probate. Assets passing under a will are in the probate estate.
• Assuming a deferral cancels the debt. A surviving spouse or child may delay collection, but the claim can return later.
• Ignoring the 30-day appeal window after a waiver denial.
• Skipping the notice to DHS. Without a proper notice, the 45-day clock never starts and the executor stays exposed.
• Distributing the estate first and asking questions later.

How Hill Group Law Can Help

Hill Group Law is an elder law and estate planning firm in Johnstown, Pennsylvania. We help families plan for long-term care, protect assets within the rules, and handle probate and estate administration when a loved one passes away.

We offer free initial consultations and hold free workshops, so families can understand their options before a crisis. Whether you are planning ahead, already facing a nursing home decision, or administering an estate that may owe a Medicaid claim, we can review the facts, explain the rules, and recommend a plan.

Call Hill Group Law at (814) 245-3832 or schedule a free consultation to talk about your family’s situation.

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