Get A Second Opinion -- Your Loved One May Still Be Eligible for MassHealth Long-Term Care Benefits

Completing a Medicaid or MassHealth application may appear to be a rather straightforward process. However, the eligibility requirements for MassHealth change frequently, and applying the rules to each applicant’s set of particular circumstances is often anything but straightforward.  While a social worker or employee of a nursing home may be versed and an excellent resource to learn about most long-term care programs both in and out of the home, he or she may not be entirely familiar with your particular legal and financial situation, or the newest MassHealth eligibility rules.  This is largely because it is not their responsibility; it is however the responsibility of an elder law attorney.

Community MassHealth Eligibility / Frail Elder Waiver Program Eligibility Under MassHealth

It is not uncommon to learn that those in need of long-term care benefits have been told by a long-term care provider they are ineligible for benefits, either because they have too many assets or too much income.  Unfortunately, many do not look any further or explore their options to become eligible within the existing Medicaid rules and MassHealth regulations.  As a result, families unnecessarily struggle to properly care for a parent or loved one, without the assistance that would have been otherwise available to them.  Or, the elder simply goes without the care he or she needs.  Unfortunately, this occurs even though there was help available to relieve the burden, and keep the elder in his or her home longer with long ter care services.  The family simply did not know enough to qualify for the assistance.  In the end, the elder did not receive the care he or she needed and could have been eligible for all along. 

Collateral Damage

Aside from the elder needing the long-term care services, the primary caregiver often suffers from burnout when the necessary help is not accessed.  Had the elder qualified for services, the primary caregiver would have had the necessary reprieve to keep caring for the elder and not jeopardize his or her own health.


Preserving Assets and the Well-being of the Well Spouse

When applying for benefits, if there is a spouse that is NOT in need of long-term care services (often referred to as the “Community Spouse”), failure to seek the proper advice from an elder care attorney often places the Community Spouse at risk financially. The elderly are particularly fragile financially-speaking, and an experienced attorney can guide you through the eligibility process to ensure proper balance of healthcare coverage and the preservation of assets for the care of a MassHealth applicant and a Community Spouse.

Medicaid/MassHealth Eligibility Requirements

Medicaid has many requirements for income and asset allocation.  Depending on the benefits that you are seeking, the income and asset requirements are often not the same for each program.  Additionally, not all sources of income and resources are countable for MassHealth purposes and there are often legitimate ways to offset some of an applicant’s income and assets for MassHealth eligibility purposes. 

As it relates to MassHealth asset thresholds, an applicant can be faced with penalties from outright transfers of money to family members and trusts regardless of the intent at the time of transfer.  At the same time certain expenses like prepaying a funeral, final expenses, and certain home modifications are generally allowed. Avoid penalizing yourself or your family and consult an experienced Massachusetts elder law attorney that can review with you the benefits that may be available as you develop a plan to care for an elder.

Call Us Today With Your Concerns
Seniors face more choices than ever, and although on the surface Medicaid eligibility may appear straightforward, there are many rules to follow to best protect yourself, your health, your finances, beneficiaries, and family members. Call us today for a complementary review by an elder law attorney of your asset allocation, financial concerns, and Medicaid/MassHealth eligibility.

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Hingham, Massachusetts 02043

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