Massachusetts
What Is Long-Term Care Medicaid in Massachusetts?
Massachusetts Medicaid, known as MassHealth, provides health coverage for low-income residents, including seniors aged 65 and older. This includes support not only in nursing homes but also through services designed to help older adults remain in their homes, assisted living, or adult foster care settings.
What Types of Long-Term Care Medicaid Programs Are Available in Massachusetts?
What Is Institutional or Nursing Home Medicaid?
This is a guaranteed benefit for those who meet eligibility criteria. It only covers care received in a licensed nursing home facility.
What Are Home and Community Based Services (HCBS) Waivers?
These waiver programs are limited in participant numbers and often have waitlists. They aim to delay nursing home placements by offering care in home-based or community settings like adult day care or assisted living.
What Is Regular Medicaid for the Aged, Blind, and Disabled?
This entitlement program offers some long-term services, such as help with daily activities or adult day care, to those who meet income and health requirements.
What Are the Income and Asset Limits for Long-Term Care Medicaid in Massachusetts (2025)?
Eligibility varies by program and marital status. Below is a simplified table summarizing income and asset limits:
| Type of Medicaid | Single | Married (both applying) | Married (one applying) |
|---|---|---|---|
| Institutional / Nursing Home Medicaid | No income limit* / $2,000 assets | No income limit* / $2,000 per spouse | No income limit* / $2,000 applicant & $157,920 non-applicant |
| HCBS Waivers | $2,901/month† / $2,000 assets | $2,901/month per spouse / $2,000 per spouse | $2,901/month applicant† / $2,000 applicant & $157,920 non-applicant |
| Regular Medicaid / ABD | $1,305/month‡ / $2,000 assets | $1,763/month‡ / $3,000 assets | $1,763/month‡ / $3,000 assets |
*Most income must go toward care costs, minus specific allowances. †Income limits depend on care setting. ‡SSI eligibility may also qualify a person.
What Counts as Income for Medicaid Eligibility?
How Is Income Categorized?
Most sources, including Social Security, pensions, and wages, count. Some, like Holocaust reparations or certain VA benefits, do not count.
How Is Income Handled for Married Couples?
If only one spouse is applying, the other spouse’s income is usually excluded. The non-applicant spouse may qualify for a Spousal Income Allowance.
What Counts as an Asset for Medicaid?
What Are Countable vs. Non-Countable Assets?
Cash, stocks, and property not lived in are countable. Personal belongings, a primary home, and one car are generally not.
How Are Assets Treated for Couples?
All assets are counted jointly. However, the non-applicant spouse may keep up to $157,920 (or all assets up to $31,584 if their share is under that amount).
What Is the Medicaid Look-Back Rule in Massachusetts?
There is a 5-year period during which financial transactions are reviewed to ensure no improper asset transfers occurred. Violations may cause a penalty period.
Is a Home Always Protected Under MassHealth?
The home is typically excluded if a spouse lives there or if the applicant intends to return. However, Medicaid may seek repayment from the estate after death.
What Medical or Functional Needs Must Be Met?
Applicants must demonstrate a level of care need—either assistance with daily living or nursing home-level care, depending on the program.
How Can Someone Qualify If They’re Over the Income or Asset Limits?
What Is the Medically Needy Pathway?
Applicants with high medical expenses can “spend down” their income to qualify. For 2025, the income thresholds are $522/month (single) and $650/month (couple).
What Is an Asset Spend Down?
Assets can be spent on allowable expenses like home improvements or debt repayment to reach eligibility limits—gifting is not allowed.
What Is Medicaid Planning?
Professional Medicaid planning can help individuals become eligible while protecting assets like the family home from estate recovery.
What Specific Long-Term Care Programs Does Massachusetts Offer?
- Frail Elder Waiver (FEW): In-home and foster care support for seniors with high needs.
- Adult Day Health (ADH): Daytime supervision and skilled care in a community setting.
- Personal Care Attendant (PCA): Pay for in-home assistance, including care from adult children.
- Enhanced Adult Foster Care (AFC): Helps adults live in family homes with paid caregivers.
- Group Adult Foster Care (GAFC) & SSI-G: Covers assisted living services.
- Senior Care Options (SCO): For dual-eligible individuals, but open to all seniors.
- PACE: Integrates Medicaid and Medicare into a comprehensive care program.
- Moving Forward Plan – Community Living (MFP-CL): Aims to help people transition from nursing homes back to the community.
- Moving Forward Plan – Residential Supports (MFP-RS): Supports transitions to memory care or assisted living.
- Money Follows the Person: A federal initiative to help people leave institutional care.
How Do You Apply for MassHealth Long-Term Care?
Applications can be completed online, printed and mailed, faxed, or submitted in person at one of the state’s enrollment centers. For assistance, applicants can call 1-800-841-2900 or work with a local agency or Medicaid planner.
What Should Be Considered Before Applying?
It’s essential to verify all financial and medical eligibility before applying. Incomplete or inaccurate applications can lead to delays or denials. Medicaid planning support may be helpful.
