Massachusetts Medicaid Definition
Medicaid in Massachusetts is called MassHealth, and is a jointly funded state and federal health care program for low-income individuals of all ages. Via this program, several groups of people are able to receive coverage, including children, pregnant women, families, seniors, and disabled individuals. However, the focus here will be strictly on Medicaid eligibility for elderly Massachusetts’ residents (aged 65 and over), and specifically for long term care, whether that is in one’s home, an adult foster care home, a nursing home facility, or in assisted living.
Income & Asset Limits for Eligibility
In Massachusetts, there is a number of Medicaid programs that provide long-term care for elderly residents. Not all of these programs have the same eligibility requirements, nor do they all offer the same benefits. Eligibility can be complicated, and further complicating this fact is that the criteria vary with one’s marital status, and that Massachusetts offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Only allows a limited number of participants. Provided at home, adult day care, adult foster care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – this is an entitlement (meeting the eligibility guidelines ensures one will receive benefits) and is provided at home or adult day care.
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 the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Massachusetts. More.
|2020 Massachusetts Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$1,063 / month*||$2,000||Nursing Home||$1,437 / month*||$3,000||Nursing Home||$1,063 / month for applicant*||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||Each spouse is allowed up to $2,349 / month||Each spouse is allowed up to $2,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,063 / month||$2,000||None||$1,437 / month||$3,000||None||$1,063 / month||3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for institutional (nursing home) Medicaid or home and community based services via a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. However, when only one spouse of a married couple applies for regular Medicaid, income is calculated differently. In this case, the income of both the applicant and non-applicant spouse is considered towards the income eligibility of the applicant spouse. For additional information on how Medicaid considers income, click here.
There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse of a nursing home Medicaid applicant or HCBS waiver applicant is entitled. As of July 2020, the MMMNA is $2,155.00 / month. (This figure will increase in July 2021). If a non-applicant spouse has high living expenses (mortgage, rent, property taxes, utilities), a maximum monthly spousal allowance is in place, and as of January 2020, is $3,216.00 / month. (This figure will increase in January 2021). This spousal impoverishment rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live. This spousal income allowance is not applicable to married couples with one spouse applying for regular Medicaid (aged, blind and disabled). Put differently, in this situation, the non-applicant spouse will not be entitled to an income allowance.
*Please note that although there is a monthly income limit for nursing home Medicaid, beneficiaries are not able to keep monthly income up to this level. Rather, they must give all of their income, minus a personal needs allowance of approximately $72.80 / month, and possibly a monthly maintenance needs allowance for a non-applicant spouse, to the nursing home to help cover their care costs.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for the purposes of Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home (given specific circumstances are met). For the home to be exempt, the Medicaid applicant must either live in it or have “intent” to live in it in the future, and his / her’s equity interest in the home must be no greater than $893,000 (in 2020). (Equity interest is not the same as the home’s value. Instead, it is the value of the home in which the Medicaid applicant owns). The home is also exempt, regardless of where the applicant resides or the applicant’s equity interest in the home, if a non-applicant spouse resides there.
For married couples, as of 2020, the community spouse (the non-applicant spouse of a nursing home Medicaid applicant or a Medicaid waiver applicant) can retain up to a maximum of $128,640 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). This resource allowance, like the income allowance, does not extend to married couples with one spouse applying for regular Medicaid.
When applying for MassHealth long-term care services, it’s important to be aware that Massachusetts has a 5-year Medicaid Look-Back Period. This is a period of time in which Medicaid checks to ensure no assets were sold or given away under fair market, allowing one to meet Medicaid’s asset limit. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For residents of Massachusetts, 65 and over, who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – this pathway, often referred to as a Medically Needy Program or a “Spend Down” program, is for seniors who have considerable health issues, have income higher than the MassHealth eligibility limit, yet still cannot pay for their care due to high medical bills. The way this program works is that the state sets a medically needy income limit, and one’s income must be “spent down” on medical bills until the medically needy income limit is met. Massachusetts has a six-month “spend-down” period, so once the spend down (sometimes thought of as a deductible) has been met, the elderly individual is able to receive Medicaid services for the remainder of the six-month period. The asset limits remain consistent to those above: $2,000 for a single individual and $3,000 for a married couple. However, the income limit is much lower and is currently set at $552 / month for an unmarried elderly person and is $747 / month for a married couple.
Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in reducing their extra assets. However, one can “spend down” assets by spending excess assets on ones that are non-countable, such as 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.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or 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 several programs that help frail elderly individuals to live outside of nursing homes.
1. Frail Elder Home & Community-Based Services Waiver – provides a variety of supports at home, such as personal care assistance, home modifications, and meal delivery, for nursing home qualified persons. This includes persons with Alzheimer’s disease and other related dementias. However, enrollment is limited and wait lists may exist.
2. Adult Day Health Care – provides nursing home level care in adult day care centers across the state to help families work and care for a loved one at home during non-work hours.
3. Personal Care Attendant (PCA) – pays for a personal care provider for a defined number of hours at home. Beneficiaries are permitted to hire an attendant of their choosing which includes hiring their own family members.
4. Enhanced Adult Foster Care / Caregiver Homes Program – helps nursing home qualified individuals reside in the home of a loved one and compensates the loved one for providing care.
5. Group Adult Foster Care & SSI-G – a combination MassHealth and state-funded program that pays for assisted living type care.
How to Apply for Massachusetts Medicaid
Seniors in Massachusetts can download an “Application for Health Coverage for Seniors and People Needing Long-Term Care Services” here. 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. Alternatively, persons can drop their completed applications off at the MassHealth Enrollment Center, Central Processing Unit, at The Schrafft Center, located at 529 Main Street, Suite 1M, Charlestown, MA 02129-0214. In addition, there is the option to apply in person at any of the six enrollment centers.
Seniors can call the MassHealth Customer Service Center at 1-800-841-2900 with any questions or for assistance with filling out the application. Alternatively, persons can also contact their local Area Agency on Aging office with questions or to request application assistance. At this time, there is no option for applying online for long-term care Medicaid.
Before submitting a completed MassHealth application, it is vital that the elderly are confident that they meet all eligibility requirements, as discussed in detail above. 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.