MassHealth plays a vital role in providing health coverage to many Massachusetts residents, especially older adults and those with disabilities. But qualifying once doesn’t mean you’re set for life. MassHealth has strict rules, and if those rules are broken—even unintentionally—your benefits could be revoked. We sometimes hear from people who were caught off guard by a termination notice. Here’s what you should know to protect your coverage and avoid unnecessary stress.
Common Reasons for MassHealth Disqualification
MassHealth eligibility is based on both financial and personal factors. Changes in your income, assets, or household status can cause the state to reassess your case. If something shifts and you don’t report it, or if it pushes you outside the eligibility range, you could lose coverage.
Here are some of the most common disqualifiers:
- Increased income: If your income rises above the allowable limit, whether from a new job, pension, or rental income, MassHealth may determine that you no longer qualify.
- Exceeding the asset limit: Owning too much in countable assets, such as bank accounts, investment funds, or certain real estate, can lead to disqualification. Receiving an inheritance or cash gift may also affect your eligibility.
- Marital status changes: Getting married, divorced, or losing a spouse can impact household composition and income levels. Failing to report these changes could cause problems.
- Not reporting life changes: Address changes, changes in the number of people in your household, or significant financial shifts must be reported to MassHealth in a timely manner.
- Paperwork issues: Missed deadlines or incomplete renewal applications often result in automatic termination, even if you still qualify.
Many of these situations are preventable with careful planning and attention to the rules.
The Role of Periodic Eligibility Reviews
MassHealth conducts regular reviews to make sure recipients still qualify. These reviews typically happen once a year, but can also be triggered if you report a major change mid-year.
When a review is due, you’ll receive a notice asking for updated financial and household information. If you don’t respond—or if the information you send is incomplete—your benefits may be suspended or revoked.
We sometimes see people lose coverage because they missed a letter or forgot to sign a form. It’s easy to do, especially if you’re overwhelmed or dealing with a health issue. That’s why it helps to stay organized and ask questions if anything is unclear.
Strategies for Maintaining Eligibility
Maintaining MassHealth eligibility isn’t always simple, but there are steps you can take to reduce the risk of disqualification. In many cases, small proactive decisions can make a big difference.
Some helpful strategies include:
- Tracking income and assets carefully. If your income fluctuates, keep a monthly record so you’re aware of where you stand.
- Spending down assets wisely. If your assets exceed the limit, certain purchases—like home improvements, medical supplies, or prepaid funeral expenses—can legally bring you back into range.
- Using trusts when appropriate. Some families choose to place assets in irrevocable trusts as part of long-term planning, though this must be done thoughtfully and well in advance of needing care.
- Reporting changes right away. Letting MassHealth know as soon as your financial or living situation changes helps avoid unpleasant surprises.
We’ve helped many clients work through these options and remain eligible for benefits that make a real difference in their lives.
What to Do If Your Benefits Are Cut Off
If you receive a notice that your MassHealth coverage has ended, don’t panic—but don’t ignore it either. Time is limited, and the sooner you act, the better your chances of resolving the issue.
Start by reviewing the notice carefully. It will include the reason for the termination and instructions for filing an appeal or submitting additional information. In many cases, people can fix the problem by supplying missing documents or clarifying an error.
If you request a fair hearing within the deadline, you may be able to keep your benefits while the case is under review. Acting quickly is key.
How We Can Help You Stay Covered
At Surprenant, Beneski & Nunes, we’ve worked with individuals and families across Southeastern Massachusetts to help them qualify for MassHealth and maintain their benefits over time. Whether you’re applying for the first time, concerned about asset limits, or facing a potential disqualification, we’re here to support you.
We can help you develop a long-term plan, avoid common missteps, and respond to changes in your situation. Our goal is to keep your care consistent.
Don’t Let a Technicality Cost You Coverage
MassHealth benefits are too important to risk. A missed deadline or small financial change can put your healthcare in jeopardy, but it doesn’t have to. With some planning and support, you can hold onto the coverage you need.
If you’re unsure whether your current income or assets could affect your benefits or if you’ve received a notice you don’t understand, we encourage you to contact Surprenant, Beneski & Nunes, P.C. We’re ready to help.