By Attorney Erin. L Nunes, Esq., Partner
As elder law attorneys, we see firsthand the desire of many seniors to remain independent in their own homes for as long as possible. Fortunately, Massachusetts offers a valuable program called Community
MassHealth that can make this dream a reality for those needing long-term care services that would like to remain in their homes. Let’s explore how it works and the advantages and disadvantages of staying home with Community MassHealth.
COMMUNITY MASSHEALTH: CARE AT HOME
Community MassHealth, often achieved by qualifying for the Home and Community-Based Services (HCBS) Waiver also known as the Frail Elder Waiver (FEW) which provides for a higher income threshold,
provides free in-home care services that can help seniors with daily activities like bathing, dressing, medication management, and meal preparation. This allows them to live safely and comfortably in their familiar surroundings and remain in the community.
ELIGIBILITY:
To qualify, individuals must meet certain income and asset limitations. A functional needs assessment with your local Elder Services Agency will also be conducted to determine the level of care and amount of
time required. Let’s break down the financial criteria to become eligible for this program:
- Income limit of $2,829.00 per month under the HCBS/FEW Waiver (this includes all income, Social Security, Pensions, VA, Annuity, etc.).
- Countable Asset limit of $2,000.00.
- Non-Countable Assets include:
- Your primary residence.
- One vehicle.
- Term life insurance.
- Irrevocable, pre-need funeral contract.
- $1,500 Burial Account.
- Whole life insurance if the face value of the policy is equal to or less than $1,500.
- Tangible, personal property.
- Countable assets include (but are not limited to the following):
- Checking, savings, CDs, and money market accounts.
- Additional vehicles, motorcycles, and campers.
- 401Ks, IRAs, and 403b accounts.
- Whole life insurance with a face value greater than $1,500.
- Second properties.
- Non-Countable Assets include:
Even if the applicant’s income is under the limit, some may wonder how they can possibly get their assets down to $2,000. The question then becomes, how do I spend it down and what can it be spent on? One
of the great advantages to this program is that MassHealth does not currently impose transfer penalties in the spend down process. This opens the door to many different options to preserve assets and still become eligible for the Community MassHealth program. Keep in mind, if the elder does need long-term care in a nursing facility in the near future, MassHealth does have a look back period of 5 years. It’s imperative to preserve those funds in such a way that will not jeopardize long-term eligibility down the line, if needed.
BENEFITS OF STAYING HOME
- Familiarity and Comfort: There’s no place like home! Staying in a familiar environment reduces stress and anxiety, promoting overall well-being.
- Independence: Maintaining a sense of control over daily routines fosters dignity and self-esteem.
- Quality of Life: Seniors can continue hobbies, maintain social connections, and feel more connected to their communities.
CHALLENGES TO CONSIDER:
- Cost Sharing: While Community MassHealth helps significantly, it typically does not provide 24/7 in-home care. There may still be some out-ofpocket costs for services or additional needs.
- Finding Qualified Caregivers: The availability and quality of home care providers can vary. Careful vetting is crucial. Working with a Social Worker at your local Elder Services Agency can aid you with this challenge.
- Safety Concerns: For those with advanced needs, 24/7 supervision may be necessary. Family support or additional services may be needed to supplement those needs.
THE HIGH COST OF SKILLED NURSING FACILITIES
While some seniors may ultimately require the more intensive care offered by skilled nursing facilities (SNFs), it’s important to understand the significant financial
implications. Here’s a sobering reality:
- Long-Term Stay: The average length of stay in a skilled nursing facility is 3.2 years. This can translate to a significant financial burden for individuals and families.
- National Average Cost: According to Genworth’s 2024 Cost of Care Survey, the national median cost for a private room in a nursing home is a staggering $330 per day, translating to $10,025 per month. Semi-private rooms are slightly less expensive at $294 per day or $8,929 per month. However, in our office we are seeing local monthly rates between $15,000 – $18,000.
MAKING THE RIGHT CHOICE
Community MassHealth is a fantastic program for many seniors, but it’s not a one-size-fits-all solution. Here’s what to consider:
- Level of care needed: Can your needs be met safely at home with the available support system?
- Family involvement: Will family members be able to help supplement some of the care and needs of the elder outside of the Community MassHealth program?
- Financial situation: Can you afford any potential out-of-pocket costs associated with home care or the high cost of a skilled nursing facility?
NEXT STEPS
If you are considering Community MassHealth, consulting with an elder law attorney can be invaluable. We can help navigate the application process, answer your questions, and ensure you understand all the financial implications and risks. We can also help you explore other options like assisted living facilities if staying at home is not the best fit. Remember, the goal is to find the care solution that best promotes your health, safety, and well-being while honoring your desire for continued independence.
Message from our Medicaid Team
“I wish more elders were aware of the Community MassHealth program. A common myth I hear all too often is that people believe they will never qualify for government assistance because they have too much money. Even if that is the case, there is almost always a strategy or solution to become eligible. I envision my own grandfather, who struggled to do many things independently and living alone after losing my
grandmother. I know there are many, many elders out there just like my grandfather, that could benefit from some simple daily assistance. Even if it isn’t much, anything helps. If it’s free and out there, why not benefit from it?”
Taylor A. Dubois
MassHealth Assistant Case Manager
