Overview of the MassHealth Residential Supports Waiver
The Moving Forward Plan – Residential Supports (MFP-RS) Waiver, or MFP Residential Supports, is for seniors and adults with disabilities or mental illnesses who are currently residing in a nursing home facility or psychiatric, chronic disease, or rehabilitation hospital. Via MFP-RS, persons who require supervision and around the clock staffing, but wish to transition back into the community, are assisted in transitioning to a residential setting, such as assisted living, and provided with services and supports to successfully live there. This may include assistance in finding housing in which to transition, arranging the move, covering moving costs, personal care assistance, homemaker services, home modifications, transportation, and peer support.
Program participants can live in assisted living facilities, group homes, or shared living homes. Assisted living facilities may house less than 10 residents and have more of a home-like environment or they may house more than 100 residents and have apartment-style housing. Group homes, which generally house up to 4 residents, have a shared kitchen and living area, but each resident has their own bedroom. In a shared living home, a program participant either lives with a caregiver in the caregiver’s home or in their own home. A residential support agency oversees this arrangement, which can be thought of as an adult foster care home.
MFP-RS Waiver services may be provided by licensed care workers, or alternatively, program participants have the option to self-direct two services: Individual Support and Community Habilitation and Peer Support. This participant-directed option allows one to hire, manage, and even fire, their own “direct care worker”. 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.
The Moving Forward Plan – Residential Supports 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) Home and Community Based Services (HCBS) Medicaid Waivers allow states to offer benefits outside of these institutions. The goal 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, such as persons who are elderly, disabled, or have Alzheimer’s, who require the level of care provided in a nursing home and are at risk of institutionalization. Waivers are not entitlements; meeting eligibility criteria does not guarantee receipt of benefits, as there are limited program participant slots.
Benefits of the MassHealth Residential Supports Waiver
Follows is a list of benefits available via MFP-RS. An individual service plan (ISP) determines the exact services and supports a program participant receives.
– Assisted Living Services – personal care assistance, homemaker services, and meals in an assisted living residence
– Case Management
– Community Based Day Supports (in small groups) – i.e., learning independent living skills, participating in hobbies, socialization
– 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 more independently
– Home Modifications –wheelchair ramps, grab bars, widening of doorways, etc.
– 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 – in groups or one-on-one
– Prevocational Services
– Residential Family Training
– Residential Habilitation – personal care assistance, supervision, assistance with meal preparation, and skills training in a group home
– Shared Living – a participant lives with a caregiver and receives supervision and personal care assistance. The caregiver can be a family member, but cannot be a spouse or someone else who is legally responsible for the participant. One to two participants are permitted in a home.
– Skilled Nursing Services – medication monitoring and / or education
– Specialized Medical Equipment – includes assistive technology and durable medical equipment
– Supported Employment
– Transitional Assistance – assistance with moving expenses, essential household items for program participants transitioning from a nursing home or hospital to a residential home
– Therapies – occupational, physical, and speech
The cost of room and board in residential settings is not paid for by Medicaid.
Eligibility Requirements for the Residential Supports Waiver
MFP-RS is for Massachusetts residents who are elderly (aged 65+), or 18+ years old and disabled or mentally ill. As the Waiver is intended to reduce nursing home institutionalization, persons must reside in a nursing home to be eligible. Additional criteria 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 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 Hospital Level of Care (rehabilitation, chronic disease, or psychiatric) and have resided (or is expected to reside) 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, MFP – Residential Supports 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, although not utilized very frequently, and limited to couples with a significant amount of “excess” assets, is a Medicaid Divorce. 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 MassHealth’s Residential Supports Waiver
Before You Apply
Prior to submitting an application for the MFP-RS 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 – Residential Supports Waiver is not an entitlement program, there may be a waitlist for program participation. MFP-RS is approved for a maximum of approximately 574 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 – Residential Supports. 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 MFP Residential Supports by completing and submitting a Residential Supports 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 – Residential Supports Waiver here. Persons can also contact the MFP Waiver Unit at 1-855-499-5109.
The Department of Developmental Services (DDS) within the Executive Office of Health and Human Services (EOHHS) administers the MFP Residential Supports 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.