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7.0(A): Notice to Administrator of Medicaid Estate Recovery

Ohio · Supreme Court of Ohio

This form is a notice that must be filed with the Medicaid Estate Recovery Program Administrator if the deceased person's estate is covered by that program. It asks the person in charge of the estate to provide details about the deceased person and their assets.

Open the official PDFfrom Supreme Court of Ohio

Where this fits in a case

General & info

Information / general use — not tied to one step of a case

This form is used when the estate of a deceased person is subject to the Medicaid Estate Recovery Program. The notice must be filed with the Program Administrator, not in the Probate Court.

Either party may file.

Common questions

Who fills out this form?
The person responsible for the estate fills out this form.
Where is this form filed?
This notice must be filed with the Administrator of the Program at a specific address, and it should not be filed in the Probate Court.
What information does it ask for?
It asks for the name, address, date of birth, date of death, and Social Security Number of the deceased person, as well as details about the estate's assets.

Revision history

No changes recorded since we started tracking this form on October 10, 2026.

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