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For seniors or low income individuals and families, there are federal and state programs to help with medical care and long-term health care. Medicaid is designed for long-term health care, called MassHealth in Massachusetts. Medical expenses can be considerable and cost thousands of dollars per month for nursing home care or in-home personal care assistants.
To be eligible for MassHealth, applicants have to meet certain criteria that meets state and federal laws. To get more information on eligibility requirements, contact an elder law lawyer.
Assets
Generally, an applicant can have no more than $2,000.00 in “countable” assets. Also, any income the applicant has must be paid to the nursing home though there are deductions for personal needs of $72.80 per month and for uncovered medical costs. A spouse need not contribute his or her income to the nursing home and may be entitled to a monthly maintenance sum based on the spouse’s housing costs.
Consequences of Transferring Assets
To be sure, there are occasions when an applicant’s assets need to be transferred. If so, the applicant may become ineligible for MassHealth for months or years at a time, depending on the amount that is transferred. The formula for determining the ineligibility period is the dividing of the asset’s value by the monthly cost of nursing home care. The average cost in Massachusetts is $12,000.00 per month. If you transfer $100,000.00 before applying for MassHealth within the previous 60-months, the ineligibility period is significant. Transfers may cause 5 years of ineligibility.
There are exceptions to making transfers to certain individuals or trusts that will not render the applicant ineligible. If the benefitting party is a blind or disabled child, a spouse, or a special needs trust for a disabled child, or individual under 65, then there may be no transfer penalty.
Other exceptions include transfer of the applicant’s home to:
• A child under 21
• A sibling holding an equity interest in the home
• An applicant’s child who has lived there for 2 years or more immediately before the applicant’s entering the nursing home and who cared for the applicant 24/7.
Further, if the applicant needs nursing home care within 5 years of the transfer, the recipient could return the funds and the applicant can spend the funds down and then apply for MassHealth. These transfer and penalty rules can be complicated. Consult with an elder law attorney for any questions or concerns.
The Community Spouse
The community spouse is the spouse of the nursing home resident. In Massachusetts, the community spouse may retain up to $115,920.00 of the couple’s countable assets while the nursing home resident spouse can keep up to $2,000.00. These figures change yearly depending on the cost of living. There are exceptions for community spouses if their incomes are less than their minimum monthly maintenance needs allowance so that the spouse may divert income from the institutionalized spouse to meet the income requirement as set by law. This amount also increases periodically.
When the Nursing Home Resident Spouse Passes Away
When the resident passes away, MassHealth does have the right to seek recovery for whatever benefits it provided from the decedent’s estate, if any are available. It is not allowed to recover from property that is jointly owned, in a life estate, or trust, or any other property not subject to probate.
Although MassHealth can place a lien on the resident’s home, it cannot if the community spouse, caretaker, or disabled child is living there.
Consult Elder Law Attorney Patricia Bloom-McDonald
If you have any questions about MassHealth eligibility or are having problems with your application, consult Elder Law lawyer Patricia Bloom-McDonald. Attorney Bloom-McDonald has over 20 years of experience handling elder law issues and has a team approach that utilizes the experience of accountants, financial planners, bankers, and other qualified professionals to give you the service and assistance your individual case requires. Call her today for a free initial consultation.