North Carolina's Medicaid estate-recovery policy is explicitly expanded — it was never designed to be limited to the probate estate the way some states' programs are.
Under NCDHHS Policy MA-2285, the state's recovery reach extends to life estates, living trusts, joint tenancy with right of survivorship, tenancy-in-common interests, and other assets that pass to a survivor, heir, or assignee through nonprobate mechanisms. That breadth is exactly why avoiding probate isn't a sufficient strategy on its own in North Carolina.
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