Medicaid Applications and Appeals

Medicaid (called MassHealth in Massachusetts) is the primary source of funding for long-term care in Massachusetts. However, MassHealth has strict medical and financial eligibility rules. While Medicare is an entitlement program, MassHealth is an eligibility-based public benefits program funded by tax dollars.

There are two types of MassHealth. Community-based and so-called Long-Term Care. Community care provides or pays for care in a private home or assisted living residence or the like. Long-Term care pays for care in a skilled nursing facility (nursing home).

A person applying for MassHealth in most cases can only have $2000 in what are called “countable” assets to be eligible. Income is not subject to guidelines, although too much income may require a separate process to obtain and maintain eligibility. MassHealth regulations determine which assets are countable and which are not. In some cases otherwise countable assets can be turned into non-countable assets using specialized annuities and other tools. There are very different rules that apply to a single person applying for MassHealth than for a married couple.

In the Long-Term Care context, while MassHealth penalizes most transfers or gifts of any countable assets made within the Five (5) year period before someone goes into a Skilled Nursing Facility, it is possible to make transfers to certain protected persons, like permanently and totally disabled persons. If someone is institutionalized, or will be soon, it is possible to “spend-down” assets on things the person needs that will not be penalized. It is also possible to utilize tools like “pooled trusts” that allow assets to be transferred out of the name of a MassHealth applicant and put aside to supplement the care and services MassHealth provides.

We can assist in advising you on all of these difficult issues and help in making decisions that will save resources and be sure that MassHealth eligibility is not prevented.

Applying for MassHealth can be a lengthy and complicated process. It may require tracing financial records for up to five (5) years prior to the date of institutionalization. It may require transferring assets between spouses. It may require detailed explanations for transfers made or being contemplated. We work with our clients to simplify that process. We explain the documentation that will be needed and how we will use it. It is important to remember that significant financial loss can result from an application being filed incorrectly or not timely.

If you have been denied MassHealth benefits, we can help you appeal and attempt to obtain eligibility. Note however that there are strict rules on appealing in a timely manner once a denial of benefits has been received.

If you are on MassHealth and receive an Eligibility Review Notice we can assist you in completing the form accurately to insure you maintain your eligibility.

If you would like more information on MassHealth Eligibility, the application process, or the appeal process please contact us.