Most Americans would agree that our health care system is a mess. This particularly applies to our system of long-term care. While enormous progress has been made in providing community-based health care, some individuals will still need nursing home care. Given that Medicare does not cover most nursing home costs, many individuals will need to apply for MassHealth. And in most cases, eligibility for MassHealth long-term care requires a significant expenditure of assets.
The primary asset owned by many seniors is a home. When an individual enters a nursing home and applies for MassHealth, a number of eligibility calculations take place involving the home. Nursing home care costs are significant, around $354 a day on average, and for many this cost is unaffordable. Those individuals may need to apply to MassHealth for coverage when community-based care options are insufficient.
One of the commonest questions an elder law attorney hears from his or her clients applying for MassHealth is, “Can they (MassHealth) take my home?” This is a concern particularly for individuals who need long-term nursing home care. And as with many aspects of MassHealth the answer is, “It depends.” Following is a broad description of some of these aspects, which may not cover all situations.
- Eligibility for MassHealth nursing home care is based on an allowable level of income and assets.
- For a single individual, the cap on assets is $2,000. A number of assets are not counted in determining eligibility.
- If the individual has a spouse at home, the MassHealth formula entitles the spouse to a greater share of marital income and assets.
- If equity in the home exceeds $840,000, the home will be considered a countable asset.
- If the individual intends to return home, MassHealth will deem the home a noncountable asset.
- If a spouse or certain other relatives live in the home, the home is not counted for purposes of MassHealth eligibility.
- If an individual is deemed unlikely to return home, a lien will be placed against the home unless a different category of relatives applies (such as a sibling with an ownership interest in the home who has been living in the home for at least one year). The lien will be discharged if the individual returns home.
- If an individual does not intend to return and has a certain level of long-term care insurance, MassHealth will not seek recovery of its costs.
The criteria listed above are those that deal with the home and MassHealth eligibility for long-term nursing home care. There are many other rules related to such things as income, trusts, estate recovery, and asset transfers. Because of the complexity, it is nearly impossible to make appropriate decisions concerning the home without an expert to provide guidance. For example, MassHealth rules can result in periods of ineligibility due to asset transfers in the five years prior to application. It is important to act before options are limited to make the best possible planning decisions for you and your home.
Deb Thomson is a member of the Council on Aging board of directors, a former elder care attorney, and the recipient of numerous elder advocacy awards.
