MassHealth Frail Elder Waiver (FEW)
The Frail Elder Waiver (FEW) is MassHealth’s home and community-based waiver for people 60 and older who need a nursing facility level of care and want to stay at home. This page is part of our Massachusetts Long-Term Care Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
At a glance
| Item | Details |
|---|---|
| Type of program | Medicaid home and community-based services (HCBS) waiver |
| Who runs it | MassHealth and the Executive Office of Elder Affairs, through Aging Services Access Points (ASAPs) |
| Age | 60 and older |
| Care need | Needs a nursing facility level of care |
| Massachusetts 2026 income rule (long-term care) | Home care waivers: under $2,982 a month (300% of the SSI rate) |
| Massachusetts 2026 asset limit (single applicant) | $2,000 |
| Waiting list | No waiting list reported in 2026 |
The Frail Elder Waiver in brief
In short, the Frail Elder Waiver is run by MassHealth and the Executive Office of Elder Affairs, through Aging Services Access Points (ASAPs). Who it is for: 60 and older. Care need required: Needs a nursing facility level of care. As for waiting: No waiting list reported in 2026. More detail on each point follows, and the Massachusetts state guide covers the shared financial rules. Families weighing the Frail Elder Waiver against other Massachusetts options can use the related pages at the end to compare programs side by side.
What the program is
The FEW is arranged through local Aging Services Access Points (ASAPs). An ASAP care manager and nurse assess the person, confirm the level of care and write a service plan. The FEW lets MassHealth use special income rules for people at home (under 300% of the SSI rate) so that people who would not otherwise qualify for community MassHealth can get coverage. The FEW cannot be used in assisted living, rest homes or group homes.
The Frail Elder Waiver is a “waiver” because federal Medicaid lets Massachusetts waive certain rules in order to pay for care at home and in the community. Expect a cap on enrollment, a written plan of care, and a coordinator who lines up providers. They do not replace regular Medicaid: a person on a waiver still has ordinary Medicaid coverage for doctor visits, hospital care and prescriptions, with Medicare paying first for people who have it. See our overview of HCBS waivers.
Who qualifies in 2026
To get the Frail Elder Waiver, a person generally has to meet each of these:
- Is 60 or older
- Needs a nursing facility level of care
- Qualifies for full Medicaid under Massachusetts’s long-term care financial rules (see the money test below)
- Lives in their own home or a family home in Massachusetts (not assisted living)
The money test. The Frail Elder Waiver requires full Medicaid eligibility under Massachusetts’s long-term care financial rules. The income and asset figures in the table above are Massachusetts’s 2026 Long-Term Care Medicaid figures from our state guide. MassHealth’s countable assets do not usually include the home (within the equity limit, if the applicant or a spouse lives there or intends to return), one car, personal belongings and a small burial fund. Married couples get extra protection in Massachusetts: the spouse at home keeps a share of assets and may get some of the applicant’s income. See Spousal impoverishment rules.
How the care assessment works. MassHealth’s assessment covers daily activities, from bathing and dressing to toileting and medications, plus memory and safety. For the Frail Elder Waiver, an assessor, usually a nurse or social worker, visits the person at home, in the hospital or in the facility. Before a the Frail Elder Waiver assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.
What services it can pay for
Services depend on the person’s assessed needs and written care plan. Depending on the plan, they can include:
- Home health aide and personal care
- Homemaker
- Adult day health
- Home-delivered meals
- Respite
- Personal emergency response
- Supportive home care aide
- Transportation
- Chore
- Home safety equipment
Not every participant gets every service; the plan reflects assessed need and the help family already gives. A change in health is a reason to request a reassessment.
How to apply
Applying usually involves two decisions: one about money (financial eligibility for Medicaid) and one about care needs. In plain terms, the steps are:
- Contact your local ASAP.
- An ASAP nurse assesses the level of care.
- Apply for MassHealth (the senior application).
- The care manager writes the service plan.
Before contacting MassHealth, see Applying for a waiver and the documents checklist for what to gather.
Waiting lists
Recent reports show no waiting list for the FEW, but ASAPs manage services within budgets.
General advice is in Waiver waiting lists.
How it relates to nursing home Medicaid
The FEW uses the nursing facility level of care and the 2026 home care income rule (under $2,982 a month) and asset limit.
What is the same as nursing home Medicaid. As in nearly every state, Massachusetts’s financial rules for home and community programs follow its nursing home rules closely. Gifts and below-value transfers in the five-year look-back can trigger a penalty period for home care as well as nursing home care. Estate recovery also applies: the state can seek repayment from the estate of a person who received long-term care services after age 55. Under the Frail Elder Waiver, income above an allowance may go toward the cost of care each month.
If a nursing home becomes necessary. A Massachusetts nursing home resident keeps a 2026 personal needs allowance of $72.80 a month, and most other income goes to the facility. Details are in our state guide.
Tips for families
- Do not wait for a crisis. Lists and assessments for the Frail Elder Waiver take time, and the start date is usually when you first request help.
- Keep a paper trail: copies of forms and notices, plus the names and dates of every call to MassHealth.
- Use your appeal rights. Notices that deny or reduce services explain how to request a fair hearing; acting quickly can protect current services.
- Report changes promptly, including income, assets, a move or a new living arrangement.
- Mark renewal dates. Eligibility and the care plan are usually reviewed annually; see Renewals.
- Protect a spouse at home. Spousal protections must be claimed; a certified Medicaid planner or legal aid office can explain them for your family.
Common questions
Can the FEW pay for assisted living? No. FEW participants cannot live in assisted living residences, rest homes or group homes, except for short respite stays. Group Adult Foster Care is MassHealth’s route for care in assisted living.
Can family be paid? Not through the FEW itself; see Adult Foster Care or PCA.
What is an ASAP? A local agency that handles elder home care.
Related pages
- Massachusetts Long-Term Care Medicaid guide
- MassHealth Group Adult Foster Care
- MassHealth PCA program
- Three kinds of Long-Term Care Medicaid
- PACE programs
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.