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.

What 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.

Know 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.