Rhode Island Medicaid Estate Recovery: Protect Your Home from EOHHS Claims

If a Rhode Island resident aged 55 or older receives Medicaid-funded long-term care, the state will seek to recover those costs from their estate after death. Understanding exactly how this works — and where the boundaries are — is critical for families trying to protect the family home.

How Rhode Island Medicaid Recovery Works

Under R.I. Gen. Laws § 40-8-15, the Executive Office of Health and Human Services (EOHHS) must seek recovery of long-term care benefits paid on behalf of Medicaid recipients who were 55 or older when they received care. This includes nursing facility services, home and community-based services (HCBS) waiver programs, and related hospital and prescription drug costs.

Mandatory notice to EOHHS: When filing any probate petition — whether formal, voluntary, or informal — for a decedent who was 55 or older at death, the petitioner must send a copy of the petition and death certificate to the EOHHS Legal Office in Cranston. Proof of this notice must be filed with the probate court.

Distribution freeze: If the petitioner fails to notify EOHHS and the decedent received recoverable Medicaid benefits, no distributions or payments — including administration fees — may be made from the estate. Any heir or entity that receives an unauthorized distribution becomes personally liable to EOHHS for the value received.

The Probate-Only Rule: Rhode Island's Key Protection

Rhode Island's Medicaid estate recovery is limited strictly to the probate estate — assets that pass through the municipal probate courts. This "probate-only" definition creates a clear line between what EOHHS can reach and what it cannot.

Subject to recovery (probate assets):

• Real estate titled solely in the decedent's name
• Bank accounts titled solely in the decedent's name
• Personal property that goes through probate

Protected from recovery (non-probate assets):

• Real estate held as joint tenants with rights of survivorship or tenancy by the entirety — title passes automatically to the surviving owner
• Bank accounts with Payable on Death (POD) designations — funds go directly to the named beneficiary
• Investment accounts with Transfer on Death (TOD) designations
• Life insurance policy proceeds paid to a named beneficiary
• Retirement accounts with named beneficiaries
• Assets held in a revocable or irrevocable trust — they bypass probate entirely

The distinction is mechanical, not discretionary. If the asset does not pass through probate court, EOHHS cannot attach a recovery lien to it.

Mandatory Exemptions That Block Recovery Entirely

Regardless of how assets are titled, EOHHS is permanently barred from pursuing estate recovery when the decedent is survived by:

1. A surviving spouse — recovery is barred for the duration of the spouse's lifetime
2. A child under 21 years of age
3. A child of any age who is blind or permanently and totally disabled

If any of these survivors exist, EOHHS cannot recover from the estate at all — not now, not later (except in the case of a surviving spouse, where recovery may resume after the spouse dies).

The Caregiver Child Exemption

Federal and state law provide a "caregiver child" exemption that protects the family home. Under this exemption, EOHHS must waive recovery on the home if an adult son or daughter:

• Lived in the property
• Provided full-time care that delayed the parent's institutionalization
• Resided there for at least two years immediately prior to the parent's nursing home placement

This exemption requires documentation — medical records showing the care provided, evidence of residence, and proof that the caregiving delayed facility admission. If you think this exemption applies, gather records early and consult with an elder law attorney to ensure the documentation meets EOHHS requirements.

Additional Hardship Waivers

Beyond the mandatory exemptions, EOHHS may grant "undue hardship" waivers when:

• The asset is a family business or farm that is the sole source of income for the heirs
• Recovery would make the heirs eligible for public assistance themselves
• A sibling with equity interest lived in the home for at least one year before the decedent's institutionalization

Practical Steps to Protect Assets

Given Rhode Island's probate-only recovery rule, the most effective protection strategy is keeping assets out of probate:

1. Add POD/TOD designations to bank and investment accounts so they transfer directly to named beneficiaries
2. Title real estate appropriately — joint tenancy with rights of survivorship or tenancy by the entirety for married couples means the home passes automatically outside of probate
3. Consider a revocable living trust — assets titled to the trust bypass probate entirely. This is especially effective in Rhode Island because the state's $15,000 summary probate threshold is exceptionally low, meaning most estates go through full probate anyway
4. Review beneficiary designations on retirement accounts and life insurance policies annually

These are planning steps best taken while the person is healthy and competent. Transfers made during the Medicaid look-back period (60 months in Rhode Island) can trigger a penalty period of ineligibility.

The Rhode Island Advance Directive & Living Will Kit includes estate planning integration guidance, including how Medicaid recovery interacts with your advance directive and estate plan.

See more Rhode Island guides →