Massachusetts Medicaid (MassHealth) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Massachusetts, Medicaid is called MassHealth. This article focuses on Massachusetts Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

 

Massachusetts Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Massachusetts Medicaid, which is called MassHealth, will cover the cost of long-term care in a nursing home for financially limited Massachusetts seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Massachusetts Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $72.80/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Massachusetts Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Massachusetts Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Massachusetts’s Money Follows the Person program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. Money Follows the Person beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.

 

Home and Community Based Services (HCBS) Waivers

Massachusetts Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Massachusetts seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will cover long-term care benefits for Massachusetts seniors who live in their own home, the home of a loved one, an adult care home (adult foster care) or an assisted living residence. While Massachusetts HCBS Waivers may cover some long-term care services and supports in those settings, they will not cover room and board costs.

The HCBS Waivers that are relevant to Massachusetts seniors are the Frail Elder Home & Community Based Services Waiver and the Moving Forward Plan Waiver.

1. Frail Elder Home & Community Based Services Waiver
Massachusetts’ Frail Elder Home & Community Based Services Waiver (FEW) provides long-term care benefits to Massachusetts seniors who require a Nursing Facility Level of Care but instead live in their own home, the home of a loved one, an adult care home (adult foster care) or an assisted living residence. While FEW will cover long-term care services and supports in those settings, it will not cover room and board costs.

FEW benefits include supervision, meal delivery, home modifications, housekeeping, Personal Emergency Response Services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits will be provided depending on the needs and circumstances of each individual.

FEW program participants also have the option of enrolling in MassHealth’s Senior Care Options (SCO), which uses one managed care plan to deliver all benefits – medical care, FEW benefits, behavioral healthcare, prescription medication, lab work, dental, vision, etc. FEW program participants who are also eligible for Medicare (dual eligible) can receive both their Medicaid and Medicare benefits through the SCO plan, although SCO applicants are not required to be Medicare eligible.

Unlike Nursing Home Medicaid, FEW is not an entitlement. Instead, it has a limited number of enrollment spots (roughly 19,000 spots per year as of 2023). Once those spots are full additional applicants will be placed on a waitlist.

2. Moving Forward Plan Waiver
Massachusetts’ Moving Forward Plan (MFP) Waiver is for MassHealth (Massachusetts Medicaid) beneficiaries who live in a nursing home (or a chronic disease, rehabilitation, or psychiatric hospital) and want to transition back to the community. Moving Forward Plan Waiver participants must require a Nursing Facility Level of Care, and they must have been at the nursing home (or chronic disease, rehabilitation, or psychiatric hospital) for at least 90 days before applying.

This program operates in two parts – Moving Forward Plan Residential Supports (MFP-RS) and Moving Forward Plan Community Living (MFP-CL). The MFP-RS Waiver is for people who are leaving a nursing home (or hospital) but still need full-time supervision and staffing in a provider-operated residence. The MFP-CL Waiver is for people who are leaving the nursing home (or hospital) and will move into their own home or the home of someone else in the community.

Both parts of the Moving Forward Plan Waiver offer help with the transition from the nursing home to another location as one of the benefits, which might include covering moving expenses, utility set-up fees, and basic furnishings, depending on the needs and circumstances of the MassHealth beneficiary and their new living situation. Other benefits the two MFP Waiver parts share are skilled nursing visits, home accessibility adaptations, specialized medical equipment and transportation assistance. Benefits unique to the MFP-CL Waiver include a home care aide, respite care for unpaid caregivers and homemaker services.

The MFP Waiver is not an entitlement. Instead, there are a limited number of enrollment spots, and once those spots are full additional applicants are placed on a waitlist. MFP-RS had 574 enrollment spots per year as of 2023, and MFP-CL had 993.

 

Aged, Blind, and Disabled Medicaid

Massachusetts Aged, Blind, and Disabled (ABD) Medicaid (which is also known as MassHealth Standard in Massachusetts) provides healthcare coverage and long-term care services and supports to financially limited Massachusetts residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

Massachusetts ABD Medicaid beneficiaries who show a functional need for long-term care benefits can receive them through a variety of programs:

  1. Adult Day Health (ADH) Program – provides nursing-home level care at adult day care centers across the state
  2. Personal Care Attendant (PCA) Program – pays for a part-time, in-home caregiver of the beneficiary’s choosing
  3. Adult Foster Care (AFC) Program – pays for a live-in caregiver in a private home
  4. Group Adult Foster Care (GAFC) Program – covers long-term care in congregate living settings
  5. Senior Care Options (SCO) Program – coordinates care into a single Medicaid plan
  6. Program of All-Inclusive Care for the Elderly (PACE) – coordinates care, including Medicare benefits for dual-eligible seniors, into a single plan

1. Adult Day Health (ADH) Program
Massachusetts’ Adult Day Health (ADH) Program provides daytime care and supervision in adult day care centers to MassHealth Standard beneficiaries with long term care needs. ADH applicants must need help with at least one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and/or require a skilled nursing service. Skilled nursing services can include intravenous feeding, jejunostomy feeding and regular oxygen administration. Behaviors that can be typical in people with Alzheimer’s disease and other related dementias (wandering, inappropriate language, physical abuse) may also meet the criteria of requiring a skilled nursing service, and some of the ADH day care centers have staff trained in Alzheimer’s / dementia care.

Adult Day Health (ADH) Program beneficiaries can live at home, the home of a relative, an adult foster care home or an assisted living residence.

In addition to daytime supervision and required skilled nursing services, ADH benefits can also include case management, medication administration, therapies (physical, occupation, speech), transportation to and from the center and personal care assistance with the Activities of Daily Living. ADH Program benefits will be made available depending on the needs and circumstances of the individual and the capabilities of the adult day care facility.

The ADH Program, like Massachusetts ABD Medicaid (MassHealth Standard) itself, is an entitlement. This means that all eligible ADH applicants are guaranteed by law to receive benefits without wait.

2. Personal Care Attendant (PCA) Program
Massachusetts’ Personal Care Attendant (PCA) Program will pay for up to 50 hours / week of in-home care and supervision for MassHealth Standard (Massachusetts ABD Medicaid) beneficiaries who live in their own home or the home of a loved one and require hands-on assistance with two of the seven following activities: mobility, bathing, dressing, eating, toileting, taking medication and passive range of motion exercises. To determine if that level of assistance is required in Massachusetts, a functional assessment is done by an occupational therapist or skilled nurse and signed by the applicant’s physician.

MassHealth Standard beneficiaries interested in the PCA program can contact a local personal care management agency to schedule an assessment. This assessment will also determine the number of hours of care the PCA Program will cover and which benefits will be offered. Available benefits include transportation, help with paperwork relevant to PCA services, and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) as well as essential household tasks (cooking, cleaning, laundry, shopping), medication administration and transportation to medical appointments.

Personal Care Attendant (PCA) Program participants can self-direct their care by choosing their own caregiver. This can include friends and certain relatives, like adult children and grandchildren, but not the beneficiary’s spouse. Program participants who are not capable of self-directing their own care can choose a surrogate to help manage their care. The surrogate can be anyone the PCA Program participant wants, including their spouse, but just not the person they hire as a caregiver. The state will provide a financial services company to manage some of financial aspects of being an employer, such as withholding taxes and issuing paychecks.

The PCA Program, like MassHealth Standard itself, is an entitlement. This means that all eligible PCA applicants are guaranteed by law to receive benefits.

3. Adult Foster Care (AFC) Program
Massachusetts’ Adult Foster Care (AFC) Program, which is also called Enhanced Adult Foster Care and the Adult Family Care Program, pays for a live-in caregiver who provides around-the-clock supervision, personal care and homemaker services for MassHealth Standard (Massachusetts ABD Medicaid) beneficiaries. AFC Program participants must live in a private home and need help with at least one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Behaviors that are common with Alzheimer’s disease and other related dementias (wandering, resisting care, being disruptive or abusive) are also taken into consideration when it comes to functional criteria for AFC Program eligibility.

The live-in caregiver for the Adult Foster Care (AFC) Program participant can be a friend or family member, such as an adult child, grandchild, niece, nephew or sibling, but the caregiver can not be program participant’s spouse. The caregiver can live in the home of the program participant, or the program participant can move into the home of the caregiver, and up to three AFC Program participants can reside in one home.

AFC Program benefits include nursing oversight provided by a registered nurse, maintenance of wheelchairs and other adaptive equipment, and paying the live-in caregiver to provide 24-hour supervision, housekeeping, transportation, medication management and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). While the AFC Program will pay for these benefits in a private home, it will not pay for the costs of living in the home (mortgage, rent, etc.) or food expenses.

The Adult Foster Care (AFC) Program, like MassHealth Standard itself, is an entitlement. This means that all eligible AFC Program applicants are guaranteed by law to receive benefits.

MassHealth Standard beneficiaries interested in the AFC Program should contact an adult foster care provider agency to complete and submit the MassHealth Adult Foster Care Primary Care Provider Order Form.

4. Group Adult Foster Care (GAFC) Program
Massachusetts’ Group Adult Foster Care (GAFC) Program provides long-term care services and supports in group living settings for MassHealth Standard (Massachusetts ABD Medicaid) beneficiaries who are at risk of nursing home placement and need help with at least one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). The group living setting may be an assisted living residence or subsidized group housing that is approved by MassHealth to provide GAFC Program benefits. Massachusetts uses the Minimum Data Set Version 2.0 form to conduct an assessment of the GAFC Program applicant and determine if the level of care requirement is met. This assessment also takes conditions commonly associated with Alzheimer’s disease and related dementias into consideration. To initiate this assessment, MassHealth Standard beneficiaries can contact Coastline Elderly Services at 508-999-6400 or 866-274-1643.

GAFC Program benefits include nursing oversight from skilled nurses, care management, 24/7 on-call access, transportation, medication management, meal prep, shopping, housekeeping and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). As mentioned above, the GAFC Program will pay for these services in an assisted living residence or subsidized group housing, but it will not cover the cost of room and board in those settings. However, there is a program called SSI-G (Supplemental Security Income – Category G) that provides funds to help cover the cost of GAFC room and board for financially limited individuals.

The GAFC Program is an entitlement, which means that all eligible AFC Program applicants are guaranteed by law to receive benefits. However, there must be an available space (bed) in an assisted living residence or subsidized group housing that is approved by MassHealth to provide GAFC Program benefits for the applicant to enter the program.

5. Senior Care Options (SCO) Program
Through the Senior Care Options (SCO) Program, MassHealth Standard (Massachusetts ABD Medicaid) beneficiaries can receive all of their long-term care services and supports, medical care, lab work, prescription drug coverage and behavioral health services through a single Medicaid plan provided by a managed care organization. These organizations, which are referred to as senior care organizations, are specifically designed for the SCO Program and have a network of care providers (including primary care providers) that will deliver all necessary services. SCO Program participants can choose from a variety of senior care organizations, although the SCO Program is not currently available in Dukes and Nantucket Counties. Program participants who are also eligible for Medicare can receive those benefits through the senior care organization, although SCO Program participants are not required to be enrolled in Medicare.

SCO Program participants can live at home, the home of a loved one, an assisted living residence or an adult foster care home. While the SCO Program will pay for benefits in those settings, it will not pay for room and board. In addition to care coordination and management, SCO Program benefits include 24/7 nurse phone line, adult day care, acupuncture, dental/hearing/vision and podiatry services, medical equipment, Personal Emergency Response Systems, hospice care, housekeeping assistance, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

The Senior Care Options (SCO) Program is available to MassHealth Standard beneficiaries of all functional abilities, but they must need some functional help to receive long-term care services and supports.

6. Program of All-Inclusive Care for the Elderly (PACE)
Massachusetts residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Massachusetts’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Massachusetts’ PACE programs are located in  Cambridge (CHA PACE), Dorchester (Upham’s PACE), Lynn (Element Care), Mattapan (Harbor Health Elder Service Plan), Revere (Neighborhood PACE), Springfield (Serenity Care PACE), West Springfield (Mercy LIFE MA) and Worcester (Summit ElderCare). To learn more about PACE, click here.

 

Eligibility Criteria For Massachusetts Medicaid Long Term Care Programs

To be eligible for Massachusetts Medicaid, which is called MassHealth, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid, which is also called MassHealth Standard in Massachusetts.

  Just For You: The easiest way to find the most current MassHealth (Massachusetts Medicaid) eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Massachusetts Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Massachusetts residents have to meet an asset limit in order to be financially eligible for nursing home coverage through MassHealth (Massachusetts Medicaid). The 2024 asset limit for a single applicant is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

There is no set income limit for Massachusetts Nursing Home Medicaid. However, Massachusetts Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $72.80/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying from March 2023 to Feb. 2024, the asset limit for nursing home coverage through MassHealth (Massachusetts Medicaid) is a combined $4,000, and the income limit is a combined $1,643/month. For a married applicant with just one spouse applying, the asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

 Plan Ahead: There are alternative pathways to eligibility for Massachusetts Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Massachusetts has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through MassHealth (Massachusetts Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if this level of care is needed for Medicaid purposes, Massachusetts uses the Comprehensive Data Set, which takes into consideration the applicant’s cognitive functioning as well as their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

 

Massachusetts Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Massachusetts residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for the HCBS Waiver in Massachusetts is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Massachusetts for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Massachusetts is a combined $4,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

 Plan Ahead: There are alternative pathways to eligibility for Massachusetts HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Massachusetts has a Look-Back Period of five years. This means the state will look back into the previous five years of the HCBS Waiver applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through MassHealth (Massachusetts Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if this level of care is needed, Massachusetts uses the Comprehensive Data Set, which takes into consideration the applicant’s cognitive functioning as well as their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

 

Massachusetts Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Massachusetts residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid, which is also called MassHealth Standard in Massachusetts. The asset limit for a single applicant from March 2024 to Feb. 2025 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for a single applicant from March 2024 to Feb. 2025 is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants from March 2024 to Feb. 2025, the asset limit for MassHealth Standard is a combined $3,000, and the income limit is a combined $1,704/month. These limits are used for both married couples with both spouses applying for MassHealth Standard and married couples with only one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for Massachusetts ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Massachusetts has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for MassHealth Standard (ABD Medicaid) applicants. However, MassHealth Standard applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through MassHealth Standard (ABD Medicaid) is being aged (65 and over), blind or disabled. For MassHealth Standard applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

 

How Massachusetts Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $1,071,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $1,071,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Massachusetts Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Massachusetts and how you can protect your home from it, click here.

 

Applying For Massachusetts Medicaid Long Term Care Programs

The first step in applying for MassHealth (Massachusetts Medicaid) Long Term Care coverage is deciding which of the three coverages discussed above you or your loved one wants to apply for – nursing home, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid, which is also called MassHealth Standard.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for MassHealth when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the MassHealth applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Massachusetts residents can apply for Medicaid by downloading this “Application for Health Coverage for Seniors and People Needing Long-Term Care Services” and mailing it to the MassHealth Enrollment Center, Central Processing Unit, P.O. Box 290794, Charlestown, MA, 02129, or by faxing it to the MassHealth Enrollment Center at 617-887-8799. Individuals can also drop off their completed applications at the MassHealth Enrollment Center at The Schrafft Center, 529 Main Street, Suite 1M, in Charlestown. Massachusetts residents can also apply in person at any of these six enrollment centers.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

  Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney. 

 

Choosing a Massachusetts Medicaid Nursing Home

After being approved for nursing home coverage through MassHealth (Massachusetts Medicaid), seniors have to choose a Medicaid-accepting nursing home that best fits their circumstances. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have available spaces. Finding the right nursing home can be time-consuming, especially if you’re looking in a specific location.

There are roughly 360 total nursing homes in Massachusetts, and most of them accept Medicaid. There are about 60 facilities that accept Medicaid within 10 miles of Boston, an area that extends north to Stoneham, west to Waltham and south to Quincy. There are approximately 20 nursing homes that accept Medicaid on the North Shore within 10 miles of Beverly, and there are about 20 more in the Lawrence area. Moving west, there are nearly 25 facilities around Worcester, and almost 30 around Springfield.

Residents in some Massachusetts communities may regularly cross the state border for personal or business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So, someone with MassHealth would not be covered in a nursing home in Salem, New Hampshire, or Albany, New York, even if the options in those places are convenient or well-suited for the Massachusetts resident.

 TOOLS: To find and compare nursing homes, Massachusetts residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this Massachusetts Health and Human Services search tool.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data shows that Massachusetts’ nursing homes averaged 31.6 health deficiencies per facility during a three-year stretch from 2019-2022, which is more than the national average during that time period of 25.7. On the other hand, nursing homes in Massachusetts were better than average when it came to fire safety deficiencies: the national average was 13.5 from 2019-22 but in Massachusetts it was just 6.7. And the CMS data also showed just 2.2% of residents in Massachusetts’ nursing homes had depressive symptoms, which is considerably better than the national average of 8.1%.