Overview of the MassHealth MFP Community Living Waiver
The Moving Forward Plan – Community Living (MFP-CL) Waiver, or MFP Community Living Waiver, is intended for seniors and adults with disabilities or mental illnesses who are transitioning home from a nursing home facility or a psychiatric, chronic, or rehabilitation hospital. Services and supports are provided to assist these persons in “transitioning” home and to help them live independently after doing so. Benefits may include paying a security deposit and fees associated with setting up utilities, in-home personal care assistance, homemaker services, home modifications for safety and accessibility, home health aides, and many others.
MFP-CL Waiver services may be provided by licensed care workers, or alternatively, program participants have the option to self-direct some of their services. This participant-directed option allows the hiring of a relative or friend to provide personal care and homemaker services. While one’s adult child can be hired, a spouse or other legally responsible person cannot be hired. A financial management services agency handles the financial aspects of employment responsibilities, such as background checks, tax withholding, and caregiver payments.
Program participants can receive services in their own home or that of someone else. They cannot live in an adult foster care home or assisted living residence. Massachusetts, however, has another Medicaid program, the Moving Forward Plan – Residential Supports Waiver (MFP-RS), that provides assisted living services and shared living.
The Moving Forward Plan – Community Living Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid (MassHealth) Waiver. It is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. There are a limited number of participant enrollment slots, and when these are full, a waiting list for program participation forms.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of the MFP Community Living Waiver
Follows is a list of the benefits available via MFP-CLW. An individualized service plan determines the exact services and supports a program participant receives.
– Adult Companion – i.e., supervision, assistance with daily activities, socialization
– Case Management
– Chore Services – i.e., snow shoveling, window washing, moving heavy furniture
– Community Based Day Supports (in small groups) – i.e., learning independent living skills, participating in hobbies, socialization
– Community Family Training – for participants and their unpaid family caregivers
– Community Support and Navigation – for persons who need support to access other medical services / behavioral health
– Day Services – individualized day activities intended to improve and maintain one’s skills and ability to live independently
– Home Health Aides
– Homemaker Services – grocery shopping, meal preparation, laundry, light housecleaning
– Home Modifications – may include wheelchair ramps, grab bars, widening of doorways, etc.
– Independent Living Supports – companionship, personal care assistance, and homemaker services provided in buildings with multiple tenants
– Individual Support and Community Habilitation – skills training to help persons live independently
– Non-Medical Transportation
– Orientation and Mobility Services – for persons who are visually impaired or blind
– Peer Support – matches a participant with someone with first-hand experience with adapting to community living
– Personal Care Services – assistance with personal hygiene, bathing, dressing, toileting, preparing meals, light housecleaning
– Prevocational Services
– Respite Care – short-term care to alleviate a primary caregiver. Out-of-home respite care may be provided in several settings, such as an adult foster care home or assisted living residence.
– Shared Home Supports – a program participant lives with a caregiver in either the caregiver or participant’s home
– Skilled Nursing Services – medication monitoring or education
– Specialized Medical Equipment – i.e., special wheelchair cushion, voice-activated computer
– Supported Employment
– Supportive Home Care Aide – for persons with Alzheimer’s disease and related dementias or needs associated with behavioral health. Homemaker services, personal care assistance, socialization, and emotional support is provided.
– Transitional Assistance – assistance with security deposit, utility set-up fees, moving expenses, etc. for program participants transitioning from a nursing home or hospital to a private home
– Therapies – occupational, physical, and speech
– Vehicle Modifications
Eligibility Requirements for MFP Community Living Waiver
MFP-CL is for Massachusetts residents who are elderly (aged 65+), or 18+ years old and disabled. The program is intended to help nursing home residents move out of their nursing homes; therefore one must reside in a nursing home or be at an immediate risk for nursing home placement. Additional eligibility criteria are below.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases each January. In 2023, an applicant, regardless of marital status, can have a monthly income up to $2,742. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,742 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. While the non-applicant spouse of a Waiver applicant generally is entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse, MA is unique and does not extend this Spousal Income Allowance to non-applicant spouses. This is because an applicant spouse is able to retain all of their monthly income instead of contributing their income towards their care costs.
In 2023, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, each spouse can have up to $2,000 in assets. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because all assets of a married couple are considered jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.
The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $148,620. If 50% of the couple’s assets falls under $29,724, the non-applicant spouse can keep all of the couple’s assets, up to $29,724.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Massachusetts Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return home, and in 2023, their home equity interest is no greater than $1,033,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– A spouse lives in the home.
– The applicant has a child under 21 years old living in the home.
– The applicant has a blind or disabled child living in the home.
More about the potential of Medicaid taking the home here.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC) or a Hospital Level of Care (rehabilitation, chronic disease, or psychiatric) and have resided in one of these settings a minimum of 90 days. Living in one of these settings is generally indicative that this level of care need is met, but often one’s ability to independently complete Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is considered. Examples of ADLs and IADLs include personal hygiene, mobility, dressing, meal preparation, and housework. Additionally, relevant to persons with Alzheimer’s disease or a related dementia, cognitive deficits, such as memory, decision making, and judgment, are usually considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC or a Hospital Level of Care.
Qualifying When Over the Limits
Having income and / or assets over MassHealth’s / Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of Medicaid planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Massachusetts has a Medically Needy Medicaid Program for Medicaid applicants who have high medical expenses relative to their income. Also known as a spend-down program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit. The amount that must be “spent down” can be thought of as a deductible. Once one’s “deductible” has been met, the MFP – Community Living Waiver will pay for care services and supports.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid-Compliant Annuities, which turn countable assets into a stream of income. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Massachusetts to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial criteria, but can also protect assets from Medicaid’s Estate Recovery Program. These strategies often violate Medicaid’s 60-month Look-Back Rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for the MassHealth MFP Community Living Waiver
Before You Apply
Prior to submitting an application for the MFP – Community Living Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Since the Moving Forward Plan – Community Living Waiver is not an entitlement program, there may be a waitlist for program participation. MFP-CL is approved for a maximum of approximately 993 beneficiaries per year. In the case of a waitlist, an applicant’s access to a participant slot is based on the date they are determined eligible.
Applicants should be enrolled in MA Medicaid / MassHealth or have an application pending prior to applying for MFP – Community Living. Persons can apply for MassHealth by calling the MassHealth Customer Service Center at 1-800-841-2900 or by submitting a completed Application for Health Coverage for Seniors and Persons Needing Long-Term Care Services to the MassHealth Enrollment Center (address / fax number on application).
Once persons have applied for MassHealth, they can apply for the MFP – Community Living Waiver by completing and submitting a Community Living Waiver application to the address indicated on the application. Once received, an applicant will be contacted by someone from the MFP Waiver Unit to continue the application process.
Persons can learn more about the Moving Forward Plan – Community Living Waiver here. Persons can also contact the MFP Waiver Unit at 1-855-499-5109.
The Massachusetts Rehabilitation Commission (MRC) administers the MFP Community Living Waiver.
Approval Process & Timing
The MassHealth / Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, if a waiting list exists, approved applicants may spend many months waiting to receive benefits.