Elderly man and a nurse at a nursing home

Does MassHealth Cover Nursing Homes in Massachusetts?

When it comes to planning for long-term care, understanding the differences between MassHealth (Medicaid) and Medicare, as well as knowing which services are covered by each program is essential. At Surprenant & Beneski, P.C., a well-respected estate planning law practice serving clients throughout Southeastern Massachusetts, we are committed to providing you with the information you need to navigate these complex systems. In the state of Massachusetts, Medicaid is referred to as MassHealth, and plays a vital role in covering nursing home care for those who qualify. 

The Difference Between Medicaid and Medicare

Medicaid and Medicare are both government programs designed to assist with healthcare costs, but they serve different populations and offer distinct areas of coverage. Medicare is a federal program primarily for people over the age of 65, regardless of income. It covers hospital stays, doctor visits, and short-term skilled nursing facility (rehabilitation) care following a hospital stay. However, it does not cover long-term care in a nursing home.

MassHealth, on the other hand, is a joint federal and state program that assists with medical costs for people with limited income and resources. Unlike Medicare, MassHealth does cover long-term care in nursing homes, making it a critical resource for most families in Massachusetts since nursing home care is extremely expensive and, as an out-of-pocket cost, well beyond the reach of the all but the exceptionally wealthy.

Why It Is Necessary To Preplan for MassHealth

Because no one knows what the future holds, responsible individuals of all ages must plan for the possibility they may become incapacitated due to illness or injury. If your family, like most, will have to depend on MassHealth as a resource if long-term nursing care is required, it is necessary to plan ahead for this eventuality since Medicaid is means-tested and has specific eligibility criteria. 

One of these eligibility criteria is a look-back period of 5 years, meaning that you must not only have limited income and assets at the time you apply for Medicaid, but also for the 5 preceding years. As your estate planning attorneys, Surprenant & Beneski will help to make sure that you have lowered the legal value of your estate in preparation for the look-back investigation so that you are eligible for government funds when you need them. If you don’t have a skilled elder law attorney overseeing your preparations, you may end up having to pay down a sizable portion of your estate before MassHealth will begin to cover your long-term care.

Strategies Our Savvy Attorneys Use to Maintain Your Eligibility for Medicaid

At Surprenant & Beneski, our estate planning attorneys have extensive experience in developing strategies to preserve your eligibility for Medicaid while protecting your assets. Some of these strategies include:

  • Asset protection trusts designed to keep your assets from being counted as part of your estate.
  • Caregiver agreements allow a family member to be compensated for providing care, while ensuring that money does not count as a disqualifying transfer of funds.
  • Tax-free gifting annually up to the present standards allowed by law.
  • Life estate deeds that grant you the right to live in your home for the duration of your life, while transferring ownership of the property to your beneficiary.
  • Spousal transfers between which are not subject to the look-back period.

Contact Our Astute Medicaid Planning Attorneys Today

As you can see, there are a number of ways our lawyers can work closely with you to tailor a plan that ensures you have access to MassHealth resources for nursing care if you should need them. In addition, we will assist you in the application process which can be time-consuming and taxing, as well as in the appeals process if your application is denied. Don’t worry about the future. Instead, let Surprenant & Beneski help you prepare for it. Contact our attorneys today.