Long-Term Care Medicaid in Massachusetts: 2026 Guide

In Massachusetts, Medicaid is called MassHealth. It is run by the Executive Office of Health and Human Services (EOHHS), and MassHealth itself decides eligibility. Long-Term Care Medicaid can pay for nursing home care and for care at home through the Frail Elder Waiver, Senior Care Options (SCO), PACE and other programs. Massachusetts has a higher home equity limit and its own penalty divisor. This guide explains the 2026 rules in plain language.

At a glance: Massachusetts 2026 figures

Item	2026 figure
Income limit (applicant)	Home care waivers: under $2,982 a month (300% of the SSI rate)
Asset limit (single applicant)	$2,000
Asset limit (couple, both applying)	$3,000
Home equity limit	$1,130,000
Spouse at home: resource allowance (CSRA)	Minimum $32,532 / maximum $162,660
Spouse at home: monthly income allowance (MMMNA)	Minimum $2,705 (from July 1, 2026) / maximum $4,066.50
Personal needs allowance (nursing home)	$72.80 a month
Look-back period	60 months (5 years)
Penalty divisor	$469 a day (from November 1, 2026)

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with MassHealth before relying on them.

What Long-Term Care Medicaid covers in Massachusetts

Nursing home care. MassHealth pays for care in a certified nursing facility. You pay most of your income toward the cost each month (your “patient-paid amount”), and MassHealth pays the rest.

Frail Elder Waiver (FEW). This home and community-based waiver helps people 60 and older who need a nursing facility level of care live at home. Services can include home health aide and personal care help, homemaker help, adult day health, home-delivered meals, respite and emergency response systems. The waiver is arranged through local Aging Services Access Points (ASAPs).

Senior Care Options (SCO). A health plan for MassHealth members 65 and older that combines Medicare and MassHealth benefits and coordinates long-term care at home or in a nursing home.

PACE (Program of All-Inclusive Care for the Elderly). For people 55 and older in a PACE service area who need a nursing facility level of care. A PACE team provides and coordinates all care, often at a PACE center.

Other home care. MassHealth also has programs such as Personal Care Attendant (PCA) services, Adult Foster Care and Group Adult Foster Care. Each has its own rules; ask MassHealth or your ASAP which ones fit.

Assisted living. MassHealth does not pay room and board in assisted living. Some care services there may be covered through Group Adult Foster Care, SCO or PACE.

Who qualifies

A person generally must:

be 65 or older, or disabled (60 or older for the Frail Elder Waiver);
live in Massachusetts and be a U.S. citizen or qualified non-citizen;
need a nursing facility level of care. For home care, an ASAP nurse does a clinical assessment. For nursing homes, a screening is done before or at admission;
meet the income and asset rules below, as decided by MassHealth.

Income rules

For the Frail Elder Waiver and MassHealth’s other adult home care waivers, the applicant’s income must be less than 300% of the SSI rate, which is $2,982 a month in 2026. Only the applicant’s income is counted for this test.

For nursing home care, the income rules are different. Once you qualify, most of your income goes toward your care as a patient-paid amount.

Once you are on MassHealth in a nursing home, you keep a personal needs allowance of $72.80 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable assets. For a couple who both need care, the limit is $3,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

Your home (equity up to $1,130,000) if you live there or plan to return, or a spouse or dependent relative lives there
One vehicle
Household goods and personal belongings
Burial plots and irrevocable burial contracts, within MassHealth rules

Spousal protections

Assets: The spouse at home can keep a Community Spouse Resource Allowance of at least $32,532 and up to $162,660 in 2026, plus the home, one car and belongings.
Income: The spouse at home keeps their own income. If it is below $2,705 a month (from July 1, 2026), part of the applicant’s income can go to them, plus extra for high housing costs, up to $4,066.50 a month.

Look-back and penalties

When you apply, Massachusetts looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
Selling a house or car to a relative for much less than it is worth.
Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($469 a day (from November 1, 2026)).

Example: Suppose you gave your son $50,000 three years before applying. $50,000 divided by $469 is about 107 days (about 3.5 months) without MassHealth payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Massachusetts

Massachusetts’s estate recovery program is run by MassHealth.

What is recovered: MassHealth paid for services received at age 55 or older, and for some people of any age in a nursing facility. Ask MassHealth which services and which property are included.
When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
Hardship waivers: MassHealth can waive or put off recovery in some situations. Ask MassHealth for the current rules.
Family members and personal representatives can contact MassHealth Estate Recovery directly with questions.

How to apply

For long-term care: use the MassHealth application for seniors and people needing long-term care services, available on Mass.gov. It can be mailed or taken to a MassHealth Enrollment Center.
For home care programs: contact your local Aging Services Access Point (ASAP). It does the clinical assessment for the Frail Elder Waiver and can help with the MassHealth application.
For SCO or PACE: contact a SCO plan or the PACE organization in your area.

After you apply. MassHealth will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

Photo ID, Social Security card and Medicare card
Proof of age and of U.S. citizenship or immigration status
Proof that you live in the state (for example, a utility bill or lease)
Proof of all income: Social Security award letter, pension statements, annuity statements
Bank, credit union and investment statements (often for the full 60-month look-back period)
Deeds, property tax bills and the value of any real estate
Life insurance policies (showing cash value) and prepaid funeral or burial contracts
Vehicle titles
Health insurance cards and long-term care insurance policies
Power of attorney or guardianship papers, if someone is applying for you
For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Massachusetts

MassHealth and MassHealth Enrollment Centers: applications and eligibility.
Aging Services Access Points (ASAPs) and Area Agencies on Aging: local information on home care and long-term care options.
SHINE (Serving the Health Insurance Needs of Everyone): Massachusetts’s free Medicare counseling program (SHIP), through the Executive Office of Aging and Independence.
Massachusetts Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and rest homes.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Massachusetts:

Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Massachusetts’s 2026 home equity limit is $1,130,000, which is above the new cap. Massachusetts will have to lower its limit to no more than $1,000,000 by January 1, 2028.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

Frequently asked questions

What is the Frail Elder Waiver? It is a MassHealth program for people 60 and older who need a nursing facility level of care but want to stay at home. Your local ASAP does the assessment and arranges services.

What is Senior Care Options? SCO is a health plan for MassHealth members 65 and older that combines Medicare and MassHealth and coordinates care at home or in a nursing home.

How much can my spouse keep? In 2026, at least $32,532 and up to $162,660 in assets, plus the home, a car and belongings, and income of at least $2,705 a month.

Is the Massachusetts home equity limit going to change? Yes. The 2026 limit is $1,130,000, and federal law requires it to drop to no more than $1,000,000 from January 1, 2028.

How long is the penalty for a gift? Divide the gift by $469 to get the number of days. A $20,000 gift would mean about 43 days without MassHealth payment for long-term care.

Will the state take my home after I die? MassHealth can seek repayment from the estate, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with MassHealth before relying on them.

Sources

Mass.gov, Program financial guidelines for certain MassHealth applicants and members
Mass.gov, Home and Community Based Services Waivers
Mass.gov, Frail Elder Waiver information
MassHealth
CMS, 2026 SSI and spousal impoverishment standards
Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.