When one spouse needs nursing home care, MassHealth planning can help the other spouse preserve income and assets while meeting eligibility requirements. Massachusetts provides important protections for married couples, but how those rules apply depends on your finances, prior transfers, and the timing of the application. At Surprenant, Beneski & Nunes, P.C., we help married couples throughout Southeastern Massachusetts and Cape Cod plan for MassHealth eligibility while protecting the spouse who remains at home.
MassHealth Planning Focused on Both Spouses
MassHealth rules for married couples create planning opportunities that are not available to single applicants. We look at both spouses’ needs and coordinate long-term care planning with the rest of your estate plan.
Clients choose our firm because we offer:
- Certified Elder Law Attorneys. Managing partners Daniel Surprenant and Michelle Beneski are Certified Elder Law Attorneys through the National Elder Law Foundation.
- 60 years serving Massachusetts families. Our firm has decades of experience helping families plan for aging, incapacity, and long-term care.
- Comprehensive MassHealth assistance. We can develop the planning strategy, assist with the MassHealth application, and address application problems or appeals.
- Coordinated estate planning. We consider how MassHealth planning may affect your wills, trusts, powers of attorney, and other documents.
- Convenient access. We serve clients from offices in New Bedford, Easton, Hyannis, and Plymouth, along with virtual consultations.
What Can the Healthy Spouse Keep When the Other Spouse Needs Nursing Home Care?
MassHealth does not generally require a married couple to spend everything they own before one spouse can qualify for long-term care benefits. Spousal impoverishment rules are designed to protect the spouse who continues living in the community.
The Community Spouse Resource Allowance (CSRA) allows the community spouse to retain a portion of the couple’s countable assets. The amount is subject to limits that change periodically.
Certain property may also be noncountable for eligibility purposes. Depending on the circumstances, this can include the marital home, one vehicle, household goods, and personal belongings.
The timing of nursing home admission can also matter because MassHealth may use a financial snapshot from the beginning of the institutionalized spouse’s period of care when determining spousal resource protections. We can review your assets and explain what the applicable rules allow you to retain.
Can the Community Spouse Keep Their Income?
Massachusetts generally follows the “name-on-the-check” rule, meaning income is attributed to the spouse who receives it. The community spouse does not simply have to contribute all of their income toward the other spouse’s nursing home care.
The Minimum Monthly Maintenance Needs Allowance (MMMNA) provides additional protection when the community spouse’s income is below the applicable amount. In qualifying cases, some income belonging to the spouse receiving care may be allocated to the community spouse.
Housing expenses and other circumstances can also affect the calculation. In some cases, a community spouse may seek a higher income allowance through a fair hearing.
What If Your Assets Exceed the MassHealth Limit?
Having too many countable assets does not necessarily mean those assets must be spent entirely on nursing home bills. A lawful spend-down strategy may allow you to reduce countable resources while benefiting one or both spouses.
Depending on your situation, planning may include paying debts, making appropriate home repairs, replacing a vehicle, or prepaying funeral and burial expenses through an appropriate arrangement. Transfers between spouses can also be useful because they generally receive different treatment from gifts to other people.
A MassHealth-compliant annuity may allow certain assets to be converted into an income stream for the community spouse. Other planning tools may be available depending on how early you begin.
Keep clear records of transactions made as part of a spend down. MassHealth may request documentation when reviewing the application.
How Does the Five-Year Look-Back Affect Married Couples?
MassHealth reviews certain asset transfers made during the five years before an applicant seeks long-term nursing home benefits. Gifts or transfers for less than fair market value can result in a period of ineligibility.
Transfers between spouses are treated differently from many transfers to other people. Gifts to children or other family members, however, can create eligibility problems when made during the look-back period.
This is why you should speak with an elder law attorney before giving away assets, changing ownership, or making other significant transfers when long-term care may be needed.
What If Your Spouse Already Needs Nursing Home Care?
You may still have planning options if your spouse has already entered a nursing home or needs care soon. You do not necessarily have to plan five years in advance to benefit from MassHealth planning.
We can review your assets, income, prior transfers, and existing estate planning documents to determine what options remain. At this stage, the goal is to establish eligibility as efficiently as possible while preserving resources available to support the community spouse.
Plan for MassHealth Before Long-Term Care Costs Deplete Your Savings
MassHealth rules provide meaningful protections for married couples, but those protections do not automatically determine the best way to structure your finances. The decisions you make before applying can affect both eligibility and what the community spouse retains.
Surprenant, Beneski & Nunes helps couples throughout Southeastern Massachusetts and Cape Cod plan for long-term care and MassHealth eligibility. Contact us to schedule a consultation and discuss the options available to you and your spouse.
Frequently Asked Questions
What happens if the community spouse later needs long-term care?
MassHealth eligibility is evaluated for each spouse based on the circumstances when benefits are needed. If the community spouse later requires nursing home care, the couple’s planning may need to be reviewed and adjusted.
Should the community spouse update their estate plan?
Often, yes. If the community spouse dies first and leaves assets directly to a spouse receiving MassHealth benefits, the inheritance could affect eligibility. Reviewing wills, trusts, and beneficiary arrangements can help coordinate the estate plan with long-term care planning.
How long does a MassHealth long-term care application take?
Processing times vary, particularly if MassHealth requests additional financial records or other documentation. Preparing complete records before filing can reduce avoidable delays in the application process.