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5 Rules About MassHealth Nursing Home Eligibility

This article was written by Harry Margolis of Margolis & Bloom, LLP.

MassHealth (Medicaid) is the main payment source for nursing home care in Massachusetts (and nationally).  Its eligibility rules are complicated and often misunderstood.  Here are the basics:

 1.    Countable Assets Limit.  The nursing home resident is limited to $2,000 in “countable” assets.  Most assets are counted against this limit, except for the home (in most instances), one automobile, a prepaid funeral plan, and personal belongings, such as clothing and furniture.  The spouse of a nursing home resident is limited to about $110,000 in countable assets (the number is adjusted annually to reflect inflation).

    2.    Transfer Penalty.  Gifts of property to get under the above asset limits are penalized by a period of ineligibility for MassHealth if they occurred within five years of the application for benefits.  While the actual rules for calculating the period of ineligibility, the effect of most gifts is that they cause five years of ineligibility from the date of the gift.  However, penalties may be “cured” by the return of the gift, which MassHealth treats as if the original gift had never happened.

    3.    Income.  In most cases, a nursing home resident must pay all of his income to the facility less a $72.80 a month personal needs allowance and anything he is paying towards health insurance.  In some instances, he may be able to divert some of his income to a spouse who is living at home or to dependent children, if any.  The spouse of a nursing home resident does not have to contribute any of her own income to the nursing home spouse’s cost of care.

    4.    Estate Recovery.  When a nursing home resident dies, the state has the right to recover from his probate estate whatever it has paid for his care under MassHealth.  In most cases, there’s no estate since the decedent only received coverage due to his poverty.  The only significant asset that many beneficiaries have is their home.  While there are many ways with planning to protect the home from this claim, if those steps are not taken it may be subject to MassHealth reimbursement.

    5.    Exceptions.  Exceptions apply to just about every rule stated above.  For instance, where the “healthy” spouse has high care expenses herself, she may be entitled to keep more than $110,000.  There is not penalty for transfers to disabled children or into trust for the exclusive benefit of anyone under age 65 and disabled.  Estate recovery claims may be waived under stringent hardship rules.

    In short, while these are the basic rules, they are clarified by hundreds of pages of regulations and often unwritten custom governs how MassHealth will react to specific situations.  It’s these complications (in part) that keep elder law attorneys in business.  No one who doesn’t practice in the field on a daily basis can keep up with all of the permutations of MassHealth rules and their application.

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