MassHealth (Medicaid in Massachusetts) is a joint federal/state program that assists individuals with payment of long-term care and other medical costs. MassHealth is designed to pay for long-term care once a person’s funds and assets are extremely limited. Understanding MassHealth is important for potential applicants. To be considered eligible for MassHealth, applicants must meet very strict guidelines in regard to their countable assets and income.
Here are some common myths about MassHealth that we’d like to dispel so you can have a better understanding of MassHealth.
Who Qualifies for MassHealth and What Does It Cover?
Myth: Gifting money is a way to spend down assets so you’re eligible for MassHealth.
Fact: When you apply for MassHealth, MassHealth has the right to examine your bank and financial records for up to five years immediately prior to the date of application. If they discover a transfer of assets to a trust or a person during this period (like a gift to a person), they will impose a disqualification period on the your eligibility (a length of time you won’t be eligible for MassHealth). This doesn’t apply to a transfer of assets to your spouse.
Myth: MassHealth Pays for Assisted Living
Fact: MassHealth does not pay for traditional assisted living facilities. However, Massachusetts does offer alternative programs that can help seniors receive care in a home or community setting rather than a nursing home. The Frail Elder Waiver program, for example, provides home and community-based services to eligible seniors who would otherwise require nursing home care including personal care, homemaking, and adult day health services. Income and asset limits apply.
As for cost, MassHealth itself has no monthly premium for most qualifying seniors, though the program requires recipients to contribute income toward their care costs. If you’re exploring alternatives to nursing home placement, The Heritage Law Center can help you understand which MassHealth programs may be available to you.
Fact: MassHealth doesn’t pay for assisted living. Some programs do pay for a kind of group living, but there are strict income restrictions to qualify.
Can MassHealth Take Your House?
MassHealth spend-down rules also require that you reduce countable assets below $2,000 before qualifying, which can feel overwhelming without legal guidance. Matthew Karr, Esq., at the Heritage Law Center helps Massachusetts families navigate these rules and protect their homes before a crisis occurs. Learn about protecting assets from nursing homes.
Fact: A good understanding of MassHealth is imperative when it comes to you home. MassHealth doesn’t make you sell your primary residence in order to get MassHealth benefits. As a MassHealth applicant, you’re only allowed to have $2,000 in countable assets. However, if your house is valued up to $955,000 after mortgages (2022 figure), it doesn’t count toward your countable assets. If the house is valued at over $955,000 after mortgages, it’s a countable asset when applying for MassHealth. To become eligible for MassHealth, you must reduce the equity in the home so it’s below $955,000. You can do that by taking out a loan or reverse mortgage and spending that money on your care. However, once you pass away, MassHealth will likely put a lien on your home to recover the money they paid for your care.
Also, MassHealth won’t let recipients use any of their income to pay for maintaining that home. Exception: If the home is rented and the rental income pays for nursing home care as part of a recipient’s income. Other house expenses like taxes and insurance must be paid by other family members.
Myth: MassHealth doesn’t pay for home care.
Fact: MassHealth does offer assistance for home care for qualifying seniors. Programs available include the Personal Care Attendant Program, Massachusetts Community Choices, the Program for All-Inclusive Care for the Elderly, Senior Care Options, and the Frail Elder Waiver Program. More information about some of these programs is here.
Myth: MassHealth is only concerned with my countable assets for eligibility, not my spouse’s assets.
Fact: As a MassHealth applicant, you can have $2,000 in countable assets in your name. If you’re married, your spouse, who plans to continue living in the community, is only allowed to keep approximately $137,400 (2022 figure) in their name.
As an experienced MassHealth attorney, I can help you understand MassHealth and discuss how we can assist you in maximizing your legal strategies to protect your assets. We can also help you through the burdensome and often confusing application process for MassHealth benefits and certain MassHealth programs that help with home care. Contact us today to schedule a confidential, no-cost consultation.