MassHealth operates the Frail Elder Waiver Program specifically to help residents who require nursing home level care to receive health care and ongoing support services at home instead of in a nursing home. The services provided under the Waiver program are often critical to an elder’s ability to safely remain in the home. Sometimes the services are used to pay family members for care they provide under the Personal Care Attendant program. At other times, the benefit provides payment to home care agencies who then provide the care that is needed. Additionally, the Waiver program can pay for an Adult Day Health program, which can provide a much needed break for tired caregivers while allowing the elder the opportunity to socialize in a safe and healthy environment. Whichever benefit you take advantage of, it can make a world of difference for families who are struggling to keep a loved one at home, rather than a nursing home. Recently, MassHealth revised its eligibility regulations for the Waiver program to comply with certain requirements under the Affordable Care Act (ACA). In the past, if the applicant qualified for the Waiver program then his or her spouse’s income and assets were not considered as part of the eligibility process. Only the income and assets of the applicant were considered. However, a new financial eligibility requirement for married Waiver applicants limits the assets of the applicant’s spouse to $119,220. This is the same asset limit that is imposed upon the spouse of a nursing home MassHealth applicant. How will the change affect married waiver applicants and participants?
- MassHealth will begin considering the assets of the Waiver applicant’s spouse as part of financial eligibility determinations beginning in August 2016.
- In addition, MassHealth will review the financial eligibility of current married Waiver participants whose eligibility was determined on or after January 1, 2014. For those participants whose eligibility was determined on or after January 1, 2014, their first redetermination review to take place after the change has gone into effect will be treated as an initial financial eligibility determination for purposes of this rule change. This means that an approved applicant whose spouse has more than $119,560 in countable assets will no longer qualify for the program. Surprenant & Beneski, P.C. can guide families in this situation to ensure the applicant remains qualified for the Frail Elder Waiver.
- MassHealth estimates that the new spousal asset limit will affect the eligibility of approximately 170 existing Waiver participants, or about 7% of Waiver participants.
What isn’t changing?
- Financial eligibility rules for single Waiver applicants/participants are not changing.
- The $2,000 countable asset limit is not changing. The $2,000 limit applies to countable assets that are in the applicant’s name alone or held jointly with a spouse or other individuals.
- MassHealth does not consider the income of an applicant’s spouse to determine financial eligibility for the Waiver program. This will not change.
- MassHealth does not consider the assets of the Waiver participant’s spouse as part of the annual redetermination process. This will not change. Except for those participants whose eligibility was determined on or after January 1, 2014, their first redetermination to take place after the revision has gone into effect will be treated as an initial financial eligibility determination for purposes of this rule change.
This new financial eligibility rule for spouse of a Frail Elder Program applicant will make applying for and qualifying for the program more difficult. If you believe that you will be affected by this new regulation and are concerned about ongoing eligibility, we invite you to contact our office to schedule a meeting with one of our attorneys to learn what options may be available to you. If interested, please contact our office at 508-994-5200. ©Surprenant & Beneski, P.C. 35 Arnold Street, New Bedford, MA 02740, 336 South Street, Hyannis MA 02601 and 45 Bristol Drive, Easton MA 02375. This article is for illustration purposes only. This handout does not constitute legal advice. There is no attorney/client relationship created with Surprenant & Beneski, P.C. by this article. DO NOT make decisions based upon information in this handout. Every family is unique and legal advice can only be given after an individual consultation with an elder law attorney. Any decisions made without proper legal advice may cause significant legal and financial problems.