Long Term Care Planning: Qualifying for Medicaid / MassHealth Assistance

Frank Grimaldi Law Can Help Protect the Assets of Your Spouse or Dependents When Qualifying for Medicaid / MassHealth Assistance

Whether age or illness related, an individual’s need for nursing home care is sometimes inevitable. In the Boston-Cambridge area this level of care is often cost prohibitive resulting in the need to apply for Medicaid/MassHealth to help carry the financial burden. Navigating the Medicaid/MassHealth Application can be a daunting prospect for the uninitiated. Since this program, unlike Medicare, is need or impoverishment based there are strict income and asset limitations as well as a need to copiously document past financial transactions. Not understanding these limitations and documentation requirements can result in an unnecessary denial of the Medicaid/MassHealth Application. Such a denial will result in the need to “private pay” for nursing home care, sometimes to the financial detriment of a spouse, child or adult special needs child. This is why it is so important to consult with an expert prior to applying for Medicaid/MassHealth.

nursing home resident and familyGenerally speaking in order to qualify for Medicaid/MassHealth an individual must be a Massachusetts resident, have only $2,000 in countable assets and the individual cannot have made any disqualifying transfers in the five years preceding the Application date. Typically, non-countable assets are Life Insurance Policies if the combined value is less than $1,500, a Pre-Paid Funeral plan, a $1,500 Burial Account held in the name of the nursing home resident with a transfer in death beneficiary, and finally, a car of any value.

Over the past year, Medicaid/MassHealth has become increasingly discerning when looking at any possible disqualifying transfers of money during the five year look back. Should the transfer be considered “disqualifying” a penalty period will be instated rendering the individual unable to benefit from Medicaid/MassHeath.

Theoretically, in order to prevent spousal impoverishment, there are some spousal protection rules in place. For example, the nursing home resident may keep the marital house so long as the spouse resides in the home and its equity is no more than $814,000. The spouse may also retain a “minimum monthly maintenance needs allowance” (MMMNA) of between $1,967 and $2,931. Finally, the spouse may also retain a “community spouse resource allowance” (CSRA) of $117,240.

Navigating these rules and requirements to ensure Medicaid/MassHealth eligibility and the preservation of assets requires expert legal advice. Our clients come to us in usually one of two stages of planning: Either emergency planning when an individual is about to be admitted to a nursing home or preventative planning when an individual believes that he or she will likely need nursing home care five or more years in the future. In either situation we have helped our clients qualify for Medicaid/Masshealth while still protecting their assets as well as that of any spouse or children.

See the Frank Grimaldi Law page on Medicaid Planning & Asset Protection, or call 617.876.1111.