MERP: Nevada Medicaid Estate Recovery Program Explained

Medicaid paid for your parent's nursing home care, and now the state wants that money back. Nevada's Medicaid Estate Recovery Program (MERP) is not optional — it is a federally mandated program codified in NRS 422.29302 that seeks reimbursement from whatever estate the deceased beneficiary leaves behind. The reach is broader than most families expect.

What Nevada Can Recover From

Nevada uses an expanded estate definition, which goes beyond assets that pass through probate. The state can pursue recovery from:

• Real property — the primary home, land, rental properties, regardless of how title is held
• Financial accounts — checking, savings, remaining funds in a Miller Trust, and irrevocable funeral trusts
• Non-probate assets — joint tenancies, reserved life estates, revocable living trusts, transfer-on-death (TOD) accounts, payable-on-death (POD) accounts, and annuities
• Personal property — vehicles, cash, and household goods of significant value

This expanded definition is what makes Nevada's MERP particularly aggressive. In some states, assets held in joint tenancy or a living trust bypass probate and avoid estate recovery. In Nevada, those same assets are reachable.

The Family Home

The primary home is the asset families worry about most, and the rules are nuanced:

• During the parent's lifetime: The home is exempt from Medicaid asset calculations if the applicant intends to return home or if a spouse, minor child, or disabled child lives there. Home equity cannot exceed $752,000 (2026 limit).
• After death: MERP can pursue the home's value unless a delay condition applies (see below). The exemption that protected the home during life does not automatically protect it after death.

TEFRA Liens: Recovery Before Death

Under certain circumstances, Nevada Medicaid can place a lien on a beneficiary's real estate during their lifetime. This is called a TEFRA lien and is permitted only when the beneficiary is permanently institutionalized — residing in a nursing home with no reasonable expectation of returning home.

The state cannot place a TEFRA lien if any of the following people reside in the property:

• A surviving spouse
• A child under age 21
• A blind or permanently disabled child of any age
• A sibling with an ownership interest who has lived there for at least one year before the beneficiary's institutionalization

If a TEFRA lien is in place and the property is sold while the beneficiary is alive, the sale proceeds may push them over the $2,000 asset limit and jeopardize ongoing Medicaid eligibility.

Delay Conditions: When MERP Cannot Collect

Federal and state law require Nevada to delay estate recovery under specific circumstances. MERP cannot seek reimbursement if the deceased is survived by:

• A living spouse — recovery is deferred until the surviving spouse also passes
• A child under age 21
• A child of any age who is blind or permanently disabled as defined by the Social Security Act

Additional protections for the home specifically:

• A sibling with an ownership interest who lived in the home for at least one year before the beneficiary entered care
• An adult child who lived in the home for at least two years before the parent's institutionalization and who provided care that delayed the need for facility placement

These are hard legal protections, not discretionary. If any delay condition applies, MERP must wait — and in the case of a qualifying caregiver child or sibling, the home may be permanently shielded from recovery.

Hardship Waivers

Nevada offers hardship waivers that can reduce or eliminate the state's recovery claim. To qualify, the heir must demonstrate one of the following:

• The asset subject to recovery is the sole income-producing asset of the heir (a family farm, rental property, or small business)
• Recovery would cause the heir to become eligible for public assistance programs (Medicaid, SNAP, TANF)
• A physician verifies that the heir has a medical condition compromising their ability to repay
• The heir provided significant hands-on care to the deceased that delayed institutionalization and saved public funds

Hardship applications must be filed within the deadline specified on the state's notice of estate recovery — typically 30 to 45 days. Missing this deadline forfeits the right to request a waiver.

What Families Can Do Now

MERP recovery happens after death, but the planning happens now:

• Understand what is reachable — living trusts and joint accounts do not avoid MERP in Nevada
• Document caregiver contributions — if an adult child lives with and cares for the parent, keep records of the duration and nature of care for a future caregiver exemption claim
• Review sibling residency — a sibling living in the home for at least one year before institutionalization may create a permanent exemption
• Consider Medicaid-compliant planning with an elder law attorney for families with significant assets — but only within the rules of the 60-month look-back period

The Hospital-to-Home Nevada Toolkit includes a MERP risk assessment checklist and asset-protection planning worksheet.

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