What If a Medicaid Recipient Dies Before an Immediate Annuity's Term Is Up?

That depends on how the state is applying federal law. Under the federal Medicaid law, the state is supposed to be reimbursed out of the future annuity payments for whatever it had paid out for the now-deceased nursing home resident's care. Only after such repayment has been made may future annuity payments, if any, go back to the family. However, not all states are applying this provision, so you will need to consult with a local elder law attorney to be certain.