MassHealth / Massachusetts Medicaid Income & Asset Limits for Nursing Homes & Long Term Care

Massachusetts Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are many different coverage groups, the focus here is on long-term care Medicaid eligibility for elderly Massachusetts’ residents (aged 65 and over). In addition to care services in nursing homes, assisted living facilities, and adult foster care homes, MA Medicaid pays for non-medical services and supports to help frail seniors live in their homes. There are three categories of Medicaid long-term care programs for which Massachusetts seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are a limited number of participant slots and waiting lists may exist. Intended to delay nursing home admissions, services and supports are provided at home, adult day care, adult foster care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged Blind and Disabled – An entitlement; meeting the eligibility guidelines ensures one will receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.

Medicaid in Massachusetts is called MassHealth. While it is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Executive Office of Health and Human Services (EOHHS) is the administering agency.

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and functional eligibility requirements. Further complicating eligibility is that the financial criteria changes annually, varies with marital status, and that MA offers multiple pathways towards eligibility.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a MassHealth program. Alternatively, interested persons can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Massachusetts. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore in MA, VA Aid & Attendance and Housebound benefits, which are above and beyond the Basic VA Pension, do not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Institutional (nursing home) Medicaid or home and community based services via a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse.

The non-applicant spouse of a Nursing Home Medicaid applicant, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) / Spousal Income Allowance. This is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. Effective 7/1/24 – 6/30/25, the MMMNA in MA is $2,555. If a non-applicant spouse’s monthly income falls under this amount, income can be transferred to them from their applicant spouse to bring their income up to $2,555 / month. In Massachusetts, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance. More on how this allowance is calculated.

MA is unique in that it does not extend the MMMNA to a non-applicant spouse of an applicant for the state’s existing Medicaid Waivers. This is because the state does not require the applicant spouse to pay a “patient paid amount” towards care costs. Instead, they are able to retain their monthly income, which eliminates the need for a Spousal Income Allowance for the non-applicant spouse.

Income is calculated differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant and non-applicant spouse is counted towards the income eligibility of the applicant spouse. Additionally, there is no Spousal Income Allowance for a non-applicant spouse. More on how Medicaid considers income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Massachusetts, IRAs are counted. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, burial spaces for the applicant and immediate family members, and generally one’s primary home.

Treatment of Assets for a Couple
Medicaid considers all assets of a married couple to be jointly owned. This holds true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. The non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant, however, is permitted a Community Spouse Resource Allowance (CSRA). In 2024, this Spousal Impoverishment Rule allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s share of the assets falls under $30,828, 100% of the assets, up to $30,828 can be kept by the non-applicant.

Medicaid’s Look-Back Rule
Massachusetts has a 5-year Medicaid Look-Back Period that immediately precedes the date of one’s Nursing Home Medicaid or Medicaid Waiver application. During this period, the Medicaid agency checks to ensure no assets were gifted or sold under fair market value. If any such transfers were made during the “look back”, it is assumed it was done to meet Medicaid’s asset limit and a period of Medicaid ineligibility will ensue.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

There is no Medicaid Look-Back Period for Regular Medicaid applicants and their spouses.

MassHealth Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $1,071,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Massachusetts’ Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

An applicant must have a functional need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NHLOC) is required. Furthermore, for some program benefits, such as home modifications, additional eligibility criteria might need to be met. For example, an inability to safely and independently live at home without modifications might be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.

Qualifying When Over the Limits

For residents of Massachusetts, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – Seniors who have income over Medicaid’s limit can still become income-eligible for Medicaid / MassHealth services if they have high medical bills. Often called a Medically Needy Program or a “Spend Down” Program, the state sets a Medically Needy Income Limit (MNIL), and one’s income must be “spent down” on medical bills until the MNIL is met. In 2024, the MNIL is $522 / month for an individual and $650 / month for a couple. The “spend down” amount, which can be thought of as a deductible, is calculated for a six-month period. Once one has met their spend down, they will be income-eligible for the remainder of the period. The Medically Needy Asset Limit is $2,000 for an individual and $3,000 for a couple.

2) Asset Spend Down – Persons who have assets over Medicaid’s limit can still become asset-eligible by spending down extra assets on non-countable ones. Examples include making home modifications (addition of wheelchair ramps, roll-in showers, or stair lifts), prepaying funeral and burial expenses, and paying off credit card and mortgage debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s Look-Back Rule. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid-eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

Specific Massachusetts Medicaid Programs

Like all states, Massachusetts will pay for nursing home care for those residents who are financially qualified and have a medical need for nursing home care. However, the state generously (when compared to other states) offers many programs that help frail elderly individuals to live outside of nursing homes.

1) Frail Elder Home & Community-Based Services Waiver – Abbreviated as FEW, a variety of supports are provided at home, in adult foster care homes, and in congregate housing for nursing home qualified persons. This includes persons with Alzheimer’s disease and other related dementias. Benefits may include personal care assistance, homemaker services, home modifications, meal delivery, and personal emergency response systems.

2) Adult Day Health Care – The ADH Program provides day-time supervision and care, including skilled nursing, in adult day care centers across the state. This can serve as respite care for informal caregivers, allowing them to continue to work.

3) Personal Care Attendant – The PCA Program pays for an in-home personal care provider for a defined number of hours. Beneficiaries are permitted to hire an attendant of their choosing, which includes hiring select family members, such as one’s adult child.

4) Enhanced Adult Foster Care / Caregiver Homes Program – The AFC Program helps individuals who require assistance with daily living activities to reside in the home of a loved one and compensates the loved one for providing care.

5) Group Adult Foster Care (GAFC) &  SSI-G – This is a combination MassHealth and state-funded program that pays for assisted living type care.

6) Senior Care Options Program  – The SCO Program was designed for persons who are “dual eligible” (eligible for both Medicaid and Medicare). However, seniors do not have to be on Medicare to participate in this managed care program.

7) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental care and eye care, may be available.

8) Moving Forward Plan – Community Living (MFP-CL) Waiver – This program helps nursing home residents transition back to living at home.

9) Moving Forward Plan – Residential Supports (MFP-RS) Waiver – This program helps nursing home residents transition to assisted living or memory care residences.

10) Money Follows the Person – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

How to Apply for Massachusetts Medicaid

Seniors in Massachusetts can complete the Application for Health Coverage for Seniors and People Needing Long-Term Care Services online and submit it electronically, or alternatively, they can download and print the application. The completed application can be faxed to the MassHealth Enrollment Center at 617-887-8799 or mailed to the MassHealth Enrollment Center, Central Processing Unit, at P.O. Box 290794, Charlestown, MA 02129-0214. Persons can also apply in person at any of the six enrollment centers. For questions or application assistance, seniors can call the MassHealth Customer Service Center at 1-800-841-2900 or contact their local Area Agency on Aging. The application process may vary based on the program for which one is applying.

Before submitting a MassHealth application, it is vital that the elderly are confident that they meet all eligibility requirements. If one does not meet the income and / or asset criteria, or are unsure if they do, Medicaid Planning can be very instrumental. The Medicaid application process can be complicated and lengthy, and if the application is not completed correctly and all required documentation provided, Medicaid benefits may be denied or delayed.  More information on applying for long-term care Medicaid.