$160,000 was the median annual cost for nursing home care in Massachusetts in 2020.
That’s a daily rate of about $440!
Source: Genworth 2020 Cost of Care Survey Massachusetts
IS THERE A DIFFERENCE BETWEEN MEDICAID VS MASSHEALTH?
Medicaid provides health insurance to millions of Americans nationwide including adults who are low-income, children, pregnant woman, elderly adults, and people with disabilities. Medicaid is administered by the states, according to specific federal regulations. In Massachusetts, the Medicaid program is called MassHealth. MassHealth is a combined program, including both Medicaid and the Children’s Health Insurance Program. With respect to seniors, MassHealth has programs to provide health-related coverage in the community as well as long-term care settings, such as nursing homes.
Medicaid is administered by the states and funded with state and federal money. It provides coverage to low-income adults, children, pregnant woman, elderly adults and people with disabilities. Medicare is a federal program that provides health coverage to adults 65 years and older and to those under 65 who have a qualifying disability, regardless of their income.
Who is eligible for MassHealth?
The eligibility rules for MassHealth can be complicated. As a senior who may be looking for services, MassHealth may look at both your asset holdings as well as your income levels. Additionally, if you are married, the asset holdings of your spouse may also be considered for certain programs. Usually, an applicant for MassHealth may not have more than $2,000 in his or her name*. In 2021, the applicant’s spouse may have no more than $130,380.00 in assets.
In some circumstances, such as becoming eligible for long-term care benefits or Frail Elder Waiver benefits, you must also meet medical-need requirements.
*Please note that these figures do not mean that one must spend down all of their money before qualifying for MassHealth. There are several asset protection measures that can be taken in advance with the assistance of an elder law attorney.
How to apply for Medicaid?
Applicants to the Medicaid (MassHealth) program often find the process overwhelming. An application for benefits, identifying the appropriate program that you would like to obtain (such as community-based care, waiver programs or long-term care benefits) must be completed and submitted. A complete list of your asset holdings must be included and will be reviewed to determine the extent of your asset holdings (and income, if applicable). Giving away assets during the 60-month period prior to your application may disqualify you or your spouse, under specific circumstances. Additionally, you need to ensure that you meet certain time requirements for responding to inquiries that the MassHealth eligibility review may make about your financial situation and health needs.
How Generations Law Group can help
At Generations Law Group, our staff are very experienced in dealing with and interpreting MassHealth eligibility regulations. We can provide you with an assessment of your circumstances and help you identify which MassHealth program may best meet your needs. Additionally, we help our clients properly plan for MassHealth eligibility, including protecting assets whenever possible.
DOES MEDICAID PAY FOR A LONG-TIME CARE FACILITY?
Yes, if the applicant meets certain medical needs and asset limitation requirements.
WHEN DO I NEED TO APPLY FOR MEDICAID?
As soon as the need for services is identified, it is best to get the process started. When dealing with payment of long-term care costs (nursing home), the application must be submitted within 90 dates of the eligibility date you are seeking.
WHEN DOES MEDICAID PAY FOR ASSISTED LIVING OR HOME CARE?
Typically, Medicaid does not cover services provided in an Assisted Living. One exception is the Group Adult Foster Care Program (GAFC). Under this specific MassHealth program, elderly low-income residents may be able to receive assistance with the cost of care provided in an assisted living or group home setting. The GAFC program pays for personal care services and medication management and administration. It does not, however, cover the living costs such as room and board. Financial assistance to cover the room and board costs are through the Supplemental Security Income (SSI-G) Assisted Living Benefit.
In Massachusetts, we have multiple programs that help to pay for services on behalf of individuals who may meet the medical requirements for nursing home level care, but want to continue to live in the community. They are called the Home and Community Based Services Waiver. An example of program found under this waiver include the Moving Forward Plan Community Living Waiver and the Frail Elder Waiver.
CAN I HAVE LONG-TERM CARE AND MEDICAID?
Yes. If you have a long-term care insurance policy, you may still be eligible for Medicaid (MassHealth) benefits if you meet the asset, and in some instances income, requirements.