MassHealth News Update: No More Caretaker Exemption Law

There are times when an adult child will undergo care of an elderly parent at home. When the needs of the parent surpass the capability of the child or if the care simply becomes too overwhelming, the parent may have to go into a nursing home or assisted living care facility. Under MassHealth law, nursing home benefits are provided to low and medium income patients if they require assistance with daily living activities such as feeding, bathing, dressing, hygiene and continence.

To qualify, the parent has to demonstrate a certain level of income or assets. On many occasions, the parent will transfer assets to the caretaker child, such as the home where the care was being rendered, and then apply for MassHealth coverage for nursing home care. When this occurs, MassHealth imposes a 5-year waiting, or penalty, period before the parent becomes eligible. Since 1993, however, an exception was provided by Congress if the caretaker child lived in the caretaker home for at least 2 years before the benefits are requested or applied for. By caring for the parent for this period of time, the law assumed that the care provided delayed the parent’s move to the nursing home facility for that length of time.

Following a 2012 decision handed down by the Massachusetts Court of Appeals, though, the so-called “Caretaker Exemption” may no longer be applicable to situations where the care could have been provided at home or in an assisted living facility. In Maguire v. Director of the Office of Medicaid, the appellate court signified that the parent and child must demonstrate that the care provided by the child met the law’s criteria for daily assisted living activities. In this case, the parent and child did submit the necessary supporting letter from a health care provider, though from a nurse practitioner, stating that the parent would have needed nursing home care but for the care provided by the child, but it was found too vague regarding the tasks provided. At a hearing, the hearing officer concluded that the Maguires failed to qualify for the exemption in that the evidence presented showed that the parent was apparently still able to care for herself regarding daily living activities and was even left alone while the child was at work.

Consult Patricia Bloom-McDonald, a MassHealth Care Attorney

The MassHealth law is complex and determining if you are eligible for certain benefits may not be so easy. Also, court cases like the Maguire decision can certainly complicate things. For these reason, consulting with an experienced elder law attorney is highly recommended.

Patricia Bloom-MacDonald is a MassHealth Elder Care lawyer who has been representing the rights of the elderly in Massachusetts for over 20 years. Contact her today if you have any questions regarding MassHealth law or for any of your elder law or elder law planning issues.

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