MassHealth Community Based Services Frail Elder Waiver

Finding out that a loved one may need to move into an assisted living facility can be emotionally challenging. Perhaps your loved one isn’t ready to leave their home and move into a nursing home care facility. There is another option available for elderly individuals who need assistance with day-to-day activities but want to keep living in their own homes and remain part of the community through the MassHealth Community-Based Services Frail Elder Waiver.

Those who qualify for community-based services can stay in their home or move to a community living residence while receiving MassHealth’s health care support services. If you or your loved one are interested in the community-based services waiver, Surprenant & Beneski, PC is here to help. We will review your case carefully and walk you through your options. If you are eligible for MassHealth community-based services, we can help you apply for benefits. 

Understanding the Frail Elder Waiver (FEW)

The cost of long-term care continues to increase in Massachusetts and throughout the United States. Even those who carefully save for retirement may not have enough resources to pay for a nursing home stay. When an individual has limited financial resources, they may qualify for MassHealth community-based services through a Medicaid waiver. The Home- and Community-Based Services Waiver (HCBS) is a program designed for low-income Massachusetts residents eligible for nursing home care but who want to stay in their homes.

The Frail Elder Waiver (FEW) is one type of community-based service waiver designed for frail elders age 60 or older who prefer to remain living in the community. Individuals can’t participate in more than one waiver at a time. Applicants to the program must meet the following eligibility requirements: 

  • An elder must be between 60 – 64 and have a disability, or be 65 or older
  • Meet clinical requirements
  • Need frail elder waiver services
  • Be able to remain in the community safely with assistance from FEW 
  • Qualify for MassHealth Standard in the community 
  • Meet additional special financial rules for waiver applicants 

The Benefits of Using a Frail Elder Waiver

When we think about the aging process, many of us want to age in our own homes, not in a nursing home facility. We want to be able to care for ourselves and retain our independence until the end. When our medical needs become more significant, we may need assistance. The FEW program seeks to help elders stay in their homes while providing necessary support. When you apply for a frail elder waiver, a case manager will develop a Comprehensive Service Plan on your behalf. The plan will state the applicant’s goals and the services and supports the participant will receive to stay in the community. There are many services available for FEW recipients, including assistance with the following:

  • Chores
  • Companionship
  • Dementia/Alzheimer’s coaching
  • Skilled nursing
  • Evidence-based accessibility adaptation
  • Education programs
  • Grocery shopping and delivery
  • Home health aide
  • Delivery of pre-packaged prescription medication
  • Home-based wandering response systems
  • Homemaking
  • Laundry
  • Home delivered meals
  • Orientation and mobility services
  • Transitional assistance
  • Transportation
  • Personal care assistance
  • Respite
  • Peer support
  • Orientation and mobility services
  • Medication dispensing system 

The Process of Enrolling in a FEW

Your loved one will need to meet several financial and clinical eligibility requirements to receive FEW benefits. You can request to enroll in FEW at any time by requesting a clinical eligibility assessment. Massachusetts’ Medicaid program, MassHealth, determines financial eligibility for the FEW program. An applicant must have less than $2,000 in assets and have an income of under $2,199 per month. Additionally, the applicant must show that he or she needs the level of care provided by a nursing home. 

Obtaining FEW Benefits For Your Spouse

Does your spouse need home health assistance? If so, you will need to meet MassHealth eligibility requirements. MassHealth now requires the same asset restrictions on the spouse of the individual who requires home care. If you have countable assets valued more than the community spouse resource allowance, your spouse will not qualify for the frail elder waiver. However, your income will not be counted against your spouse when applying for FEW benefits. 

When the applicant is married, his or her spouse’s income isn’t considered. However, the applicant can’t have over $121,200 in savings. The applicant and spouse can own a home and still qualify. How you and your spouse hold ownership of your real estate property and other assets will affect the success of your MassHealth application for home and community-based services. Sometimes our clients assume that they can transfer ownership of their home to qualify for FEW benefits. 

MassHealth has a five-year look-back period. Any asset transfers and gifts you make now must be reported to MassHealth must be reported on your FEW application, even though they won’t disqualify you for FEW. If you need to move into a nursing home, these transfers could make you ineligible for nursing home coverage. There are exemptions to these rules, however. The estate planning lawyers at Surprenant & Beneski, PC are familiar with all of the exemptions for Medicaid transfer rules. We have experience working within the regulations to help our clients become eligible for FEW benefits.

Contact a MassHealth Lawyer Today

The frail elder waiver program is an excellent way to seek government funding for home-based care to avoid moving into a nursing home care facility. As with other government programs, it can be challenging to understand the eligibility process. If you or your family member would like to receive home-based health care assistance, the estate planning lawyers at Surprenant & Beneski, PC, are here to help. 

We will learn about your financial situation and answer all of your questions. We’ll help you understand your options and apply for benefits. We can also help you create a comprehensive estate plan to protect yourself and your loved ones. Contact us today to schedule your initial consultation.