We Wrote the Book! Nuts and Bolts Guide to MassHealth


You’ve paid taxes all these years for just this reason.

  • Stay at home with the help you need.
  • Obtain valuable Medicaid benefits to pay for medical and health costs at home, an assisted living residence or nursing home.
  • Protect your hard earned savings for your family or your spouse.
  • Prevent costly mistakes and make your money last as long as possible.

For all practical purposes, in the United States the only “insurance” plan for long-term institutional care is Medicaid, not to be confused with Medicare which pays for only approximately 7 percent of skilled nursing care in the United States.  Private insurance pays for even less.  The result is that most people pay out of their own pockets for long-term care until they become eligible for Medicaid.  While Medicare is an entitlement program, Medicaid is a form of welfare – or at least that’s how it began.  To be eligible you must be “impoverished” under the program’s guidelines.

Despite the costs, there are advantages to paying privately for nursing home care.  The foremost is that by paying privately an individual is more likely to gain entrance to a better quality facility and faster.  The obvious disadvantage is the expense; in Massachusetts, nursing home fees cost an average of $300 or more a day. Without proper planning nursing home residents can lose the bulk of their savings.

For most individuals the goal of long-term care planning is to protect savings while simultaneously qualifying for Medicaid benefits that will help pay for home care, assisted living or nursing home care.  This can be done by following the rules of Medicaid eligibility outlined in this guide.

In Massachusetts, Medicaid (also known as “MassHealth”) is administered by the Executive Office of Health and Human Services – Department of Medicaid (the “Medicaid Department”).  However, in order to qualify for federal reimbursement, the state programs must comply with applicable federal statutes and regulations.  The following explanation includes both Massachusetts and federal law.

iStock_000022980847MediumWhat are the Benefits?

There are three common benefits utilized by people needing long-term care: 1) Home– and Community-Based Services; 2) Group Adult Foster Care; and 3) Nursing Home Care. All three are available to people who need long-term care services, regardless of their type of residence, so long as they meet the various requirements for each individual program.

The Home– and Community-Based Services Waiver Program is designed to provide services for people who would be in a nursing home but for the services they can receive through this and other programs. This is for people who need nursing home care, but probably more at a custodial level than a skilled nursing level. There are asset and income limits to this program, but gifts and transfers are not penalized. Deductibles may be used for applicants with too much income.

The Group Adult Foster Care Program is used by people in assisted living communities. Not all assisted living communities participate in this program, and many will only allow participation after private funds are exhausted. However, for veterans who simultaneously qualify for the Non-Service Connected Disability Improved Pension (so-called Aid and Attendance benefits), this can make assisted living an affordable option. There are asset and income limits to this program, but no penalties for prior transfers or gifts. Deductibles may be used for applicants with too much income.

Nursing Home Medicaid is the most commonly used long-term care MassHealth program. It pays for care received in nursing homes when Medicare won’t and when other possible resources are limited or nonexistent. This is most crucial when there is a spouse who is still in the community and needs those resources for his or her future and well-being. This program has asset limits only, and strict rules and penalties for gifts and prior transfers.

In our newly published Nuts and Bolts Guide to MassHealth for Long-term Care at Home, in an Assisted Living or a Nursing Home we review each of these benefits.  We analyze the rules for qualification, the pros and cons of each and when to use which benefit.

What’s Inside the Guide???

What are the Benefits?, The Asset Rules, The Home, Transfer Penalty, Exceptions to the Transfer Penalty, Liens and Estate Recovery, Treatment of Income, Spousal Protections—Assets and Income, Planning Opportunities vs. Salvaging Techniques including Doing Nothing, Gifting Assets, Owning Assets Jointly, Life Estate Deeds, Asset Protection Trusts, Resource Allowances, Annuities, and Pooled Trusts, and Post-Medicaid Application Follow-Up.

iStock_000015146378MediumKnow Your Rights

Everyone has a right to know their legal options. The Guides are free and available through our office. And just for requesting a Guide you’ll get a free gift from us. Please contact us through this site, or by calling the office at 508-281-7900 to request your copy today.



Other items of interest:

4 Responses to We Wrote the Book! Nuts and Bolts Guide to MassHealth

  1. Barbara Gariepy June 5, 2014 at 10:08 am #

    Hi Tracey, Dick and I would like to receive a copy of your guide, Nuts and Bolts to MassHealth. Mom is still at Heritage in Framingham, but we are aware of her dwindling funds and the need to update our information as we anticipate her relocation…an event I do not look forward to doing.

    Thank you for your continued assistance (even from a distance).


    • Tracey Ingle June 5, 2014 at 1:50 pm #

      Barbara, we’ll get one right out to you! I emailed you earlier today to get your current address. Thanks for checking in!

  2. mary valliere January 9, 2015 at 4:58 pm #

    Could you send me the free Medicaid report. I know someone that is 71and is not able to receive Mass Health because she just about squeeze by above the limit. She leaves alone. Does this report help show someone how you can fill out the application to qualify for Mass Health?

    • Tracey Ingle January 11, 2015 at 4:21 pm #

      Thanks for posting Mary. Our Nuts and Bolts Guide will explain the three different Medicaid programs for seniors who need assistance: one of at home, one for assisted living and one for nursing home care. It also explains the rules of qualification for each. The application process is too long and complicated for a basic Nuts and Bolts Guide though. Our office may be able to assist, depending upon the circumstances and financial situation. If you’d like the Guide, we’ll need your address for mailing purposes. You can call our office at 508-281-7900, and Wendy will be happy to get that out to you. Or, you can email us your address through the Contact page (click here.) Let us know if there’s anything else we can do to help!

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