Planning ahead for potential disability often centers on protecting assets in order for seniors to qualify for MassHealth coverage of nursing home care. However, for many seniors and their families, at-home care options are preferable to nursing home options. The question of how to finance these services, however, can be just as daunting. Luckily, Massachusetts provides several options to help support the care of frail elders while remaining in their own or in a loved one’s home.
MassHealth is a single Massachusetts Medicaid program that pays for care in virtually all nursing homes, provided a senior can qualify both medically and financially. However, several different programs exist in Massachusetts for community care, each with its own eligibility criteria, making it difficult for families to find the best care option for them. An elder law attorney can help guide you through the red tape and help your loved one qualify for the most appropriate care program.
MassHealth Community Programs
In order to be eligible for community benefits, seniors must still meet MassHealth’s strict asset guidelines. Typically, this means no more than $2,000 in countable assets with monthly income capped at $903. Applicants may also qualify for the MassHealth “waiver” program if they clinically require nursing home care even though they are receiving the service at home, which allows an increased income limit of $2,022.
While MassHealth regulations do allow for a penalty period for asset transfers, to date MassHealth has not applied these rules to community-based benefits.
Massachusetts Adult Foster Care
Adult Foster Care (AFC) is a program that provides a non-taxable stipend of up to $1,500 a month to a caretaker, other than a spouse, who lives with the individual in need of services.
The amount of the monthly stipend depends on the number of activities of daily living with which the senior needs assistance, such as dressing, eating or bathing. The stipend can be used either to supplement the income of a family member who is caring for a loved one or to hire some part-time assistance.
Massachusetts Personal Care Assistants
The Personal Care Assistant (PCA) program helps support individuals with disabilities pay for private aides, which can include family members. Applicants for this program must require “hands-on” assistance with at least two activities of daily living. In addition, either the beneficiary or someone else living in the household must be able to supervise the PCA.
To determine eligibility, your local Aging Services Access Point (ASAP) must perform a clinical assessment of the applicant and make a recommendation to MassHealth for the number of hours of care needed (find your local ASAP here).
Once approved, MassHealth contributes $12 per hour to the cost of PCAs. Beneficiaries or their families can pay the PCAs directly for additional hours of care not covered by MassHealth.
Massachusetts Community Choices
The Community Choices program provides seniors with a variety of at-home services, such as skilled services, home health aides, housekeeping, laundry, meal preparation and transportation to and from doctor’s appointments.
Applicants must also be eligible for the Masshealth “waiver” program, discussed above. Like the PCA program, your local ASAP will determine the level and type of services required.
One of the main differences between Choices and PCA is that Choices services must be provided through agencies that have contracted with MassHealth, meaning you do not have the flexibility to hire your own workers.
Program for All Inclusive Care for the Elderly and Senior Care Options
The Program for All Inclusive Care for the Elderly (PACE) and Senior Care Options (SCO) are programs under which Medicare and MassHealth combine to pay health care providers a fixed monthly amount to provide all the care needs of participating seniors.
These programs are designed to provide comprehensive care for frail seniors. Because the PACE and SCO programs use a team approach of staff physicians, nurses and therapists, patients must give up her own doctors. These programs may use adult day health centers rather than provide home care during the day, and will typically contract with particular assisted living and nursing home facilities when such care is needed, giving the patient and her family fewer options. PACE and SCO programs are not available in all areas of Massachusetts. Patient needs to determine whether the benefit of the comprehensive care outweighs these limitations.
The options for senior care in Massachusetts have never been greater. However, the complicated eligibility and application procedures can create confusion for seniors and their families. Contact the Heritage Law Center for a free consultation on the care options available for your loved one.