When health issues arise that require a high level of care, some folks are finding success with receiving Medicaid  (known as MassHealth in Massachusetts) home care instead of moving to a nursing home. There are different qualifications to be eligible for home care versus nursing home care – we broke down the differences.

Home Care

When a loved one needs nursing home-level care but would like to remain living at home, the MassHealth Frail Elder Waiver (FEW) program is a great option. Although infrequent, there are instances where elders are receiving free 24-hour care at home. When not eligible to receive full 24-hours of care, the individual may need to supplement with private care for the remaining hours of the day.

Asset and Income Limits

In 2021, the monthly asset limit for an individual receiving FEW services is $2,000 for an individual, and $3,000 for a married couple, when both are receiving FEW services. (Note: This does NOT mean you have to spend down to nothing before applying for MassHealth. See Medicaid Applications in Massachusetts: When DIY is a Don’t for more.)

Additionally, there is an income limit. For 2021, the income limit is $2,382.00. This is your GROSS income limit, meaning the income you get each month prior to any tax or health insurance deductions.

If an individual’s income is over the monthly limit, it is still possible to receive FEW services. MassHealth will determine a deductible amount which will be due every six months.  The deductibles can be very high at times, and quite burdensome, however if you are organized and prepared, they can be managed.

Nursing Home Care

Sometimes staying at home is not appropriate or safe, and in these circumstances, a nursing home may be the next logical step. Having MassHealth pay for nursing home care is a great benefit, as private payment to a nursing home can cost around $450 per day.

Asset and Income Limits

To receive nursing home benefits, there is still a monthly $2,000 asset limit per individual.

The income limit differs from the FEW services mentioned above. The individual in the nursing home is required to pay a co-pay to the nursing home. This co-pay is called the Patient Paid Amount (PPA). The PPA is calculated by taking the individual’s monthly income, deducting any health insurance premiums, and deducting a $72.80 personal needs allowance. In situations where a married couple has one spouse in the nursing home (referred to as the “institutional spouse”) and the other healthy and at home (the “community spouse”), the community spouse may be able to keep some of the institutional spouse’s income to help pay for the community spouse’s expenses at home.

The rules to qualify for MassHealth and other government programs available to seniors in need of care can be quite confusing and complicated. Working with an elder law attorney can help you decide if this option is right for you. To find out what other benefits may be available to seniors, download our eBook “Understanding Benefits for Seniors”.

Contact Us