We get frequent questions about the difference between the various MassHealth programs to provide care to elderly and disabled persons. The following is a brief summary:
MassHealth (what “Medicaid” is called in Massachusetts), pays for health care for certain low- and medium-income people living in Massachusetts. There are two general types of MassHealth that provide persons and services to care for disabled individuals: Community-based Care and Long-Term Care. Like it sounds Community-based MassHealth provides or pays for care in a community setting, such as a private home, apartment, or assisted living residence. Long-Term Care pays for care in a skilled nursing facility (nursing home). What follows is some general information about these programs. Note however that everyone’s situation is different and you should seek out competent counsel before proceeding to apply for any MassHealth program.
Long-Term Care
• Must be considered medically eligible as determined by the local Aging Services Access Point, to include dementia or the inability to do three (3) or more activities of daily living;
• Must be financially eligible: Can have no more than $2,000 in countable assets;
• In 2014 if married, a spouse living in the community can keep the primary residence, a car, and in $117,240 in other assets, plus miscellaneous other lesser assets;
• No income limits, but income less certain deductions goes to pay for care;
• Assets can be transferred between spouses without penalty;
• Any transfers of any more than a nominal amount in the five years (the “five-year look-back period) before eligibility is sought will result in disqualification for a time;
• Eligibility can be retroactive to three months before the application is filed;
• The application process can be long and cumbersome, for example requiring up to five (5) years of bank and financial statements, copies of title documents, and liquidation of assets;
• Denials of eligibility can be appealed, but must be appealed within thirty (30) days of a denial.
Community-Based Care: several sub-programs, most common is the “Frail Elder Waiver”
• Can get up to 24/7 care at home paid for by the state if qualify;
• Must be considered medically eligible as determined by the local Aging Service Access Point: would otherwise be eligible for Long Term Care in a nursing facility;
• Must be financially eligible: Can have no more than $2,000 in countable assets and income of no more than $2,163 (2014);
• Assets can be transferred to a spouse or another person to lower assets, but transfers need to be disclosed and the assets held, in case Long Term Care is needed.
