Mass Health
Mass Health Facts, in the event of a nursing home admission

It is important to lay out the basic Medicaid rules in the event a family member needs care at a skilled nursing home. Health insurance does not pay for long-term custodial care. The private pay rate for such care is around $390 per day. At $12,000 PER MONTH most people sooner or later need Medicaid to pay this bill. In Massachusetts, this program is called MassHealth.

Here are the 2019 rules for MassHealth financial qualification; meaning, MassHealth pays the nursing home bill. MassHealth cannot force the sale of the primary residence until both the applicant (person in the nursing home) and the spouse have died, even if the home is vacant. After both the applicant and spouse have died, during the probate court process of transferring ownership of the home to the beneficiaries, MassHealth gets paid back unless the applicant (and spouse) signed a Life Estate Deed (see my prior article).

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The home is called a “Non-Countable” asset. One automobile, a pre-paid irrevocable funeral for both the applicant and spouse, a burial account of $1500 each, and assets needed to support the spouse are also Non-Countable. Most all other assets are “Countable.” The applicant can keep under $2,000 and the spouse can keep $126,420 plus all of the Non-Countable assets and the applicant will qualify for MassHealth benefits. There are techniques to protect assets over this amount.

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Once MassHealth starts paying the nursing home bill, the applicant’s income, minus a couple of deductions, is paid to the nursing home. MassHealth pays the rest. The spouse can keep all of his/her income and receive some or all of the applicant’s income to get the spouse’s total monthly income to between $2,000-$3,000 depending upon the spouse’s needs.

No gifts can be made by the applicant or the spouse during the five years immediately preceding the date of the application. A disabled person or caregiver child can be protected from this rule.