Long-term care (LTC) is a crucial consideration for seniors, as statistics show a high likelihood of needing some form of LTC in the future. Currently, a 65-year-old individual has a 70 percent chance of requiring LTC services at some point. While a majority of seniors can receive assistance at home, over one-third will need care from an assisted living facility or nursing home, which can come with staggering costs that could deplete your retirement nest egg. To help you prepare for that cost, the Medicaid planning attorneys at Legacy Care Law Firm discuss what every senior needs to know about Medicaid in Massachusetts.
Understanding the Need for Medicaid
Nationally, the average monthly cost for LTC in a facility stands at around $9,000; however, Massachusetts residents face even higher costs, with an average of over $13,000 per month for LTC services. These expenses can rapidly deplete a senior’s savings, making it crucial to plan for future LTC needs.
Medicare, which many seniors depend on for healthcare coverage during retirement, does not cover LTC services provided in nursing homes. As a result, unless you have a long-term care insurance policy or the financial means to pay out of pocket, Medicaid may be the only viable option for covering LTC costs. To make sure you qualify for Medicaid as a senior, you need to plan accordingly by including Medicaid planning in your estate plan.
Medicaid for Seniors in Massachusetts
The Massachusetts Medicaid program offers three different categories of Medicaid for seniors, each with its own eligibility guidelines. The available programs include:
- Institutional / Nursing Home Medicaid. This is an entitlement program; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
- Medicaid Waivers / Home and Community Based Services (HCBS). These are not entitlement programs; there are a limited number of participant slots and waiting lists may exist. Intended to delay nursing home admissions, services and support are provided at home, adult day care, adult foster care, or in assisted living.
- Regular Medicaid / Aged Blind and Disabled. This is an entitlement program; meeting the eligibility guidelines ensures one will receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.
Qualifying for Medicaid as a Senior in Massachusetts
Regardless of the program to which you are applying, there will be an income and an asset limit that applies. If your income or assets exceed the limit, your application will be denied. For a single applicant for institutional or regular Medicaid you cannot have income of more than $1,215 per month as of 2023 and your assets cannot exceed $2,000. For the Medicaid waiver program, your income cannot exceed $2,742 per month and your assets cannot exceed $2,000. While the rules are similar for married couples when both spouses are applying, the rules are more complicated if one spouse needs LTC, but the other spouse remains in the community. In that case, the spousal impoverishment rules apply.
The Medicaid Look-Back Rule
The Medicaid asset limits are important because simply transferring assets out of your estate when you need to qualify for Medicaid will not work. Medicaid uses a five-year look-back rule that allows the program to review your finances for the five-year period leading up to your application. Any asset transfers made for less than fair market value will be scrutinized and may trigger a waiting period during which time you will have to pay your own LTC costs. In effect, this puts your retirement nest egg at risk.
Understanding the Medicaid Community Spouse Rules
The community spouse of a Nursing Home Medicaid applicant, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) / Spousal Income Allowance. This is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. Effective 7/1/23 – 6/30/24, the MMMNA in MA is $2,465. If a non-applicant spouse’s monthly income falls under this amount, income can be transferred to them from their applicant spouse to bring their income up to $2,465 / month. In Massachusetts, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $739.50 / month (eff. 7/1/23 – 6/30/24). However, in 2023, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,715.50. This is the Maximum Monthly Maintenance Needs Allowance.
Medicaid considers all assets of a married couple to be jointly owned. This holds true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. The non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant, however, is permitted a Community Spouse Resource Allowance (CSRA). In 2023, this Spousal Impoverishment Rule allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $148,620. If the non-applicant’s share of the assets falls under $29,724, 100% of the assets, up to $29,724 can be kept by the non-applicant.
Do You Need Help with Medicaid in Massachusetts?
For more information, please join us for an upcoming FREE seminar. If you have additional questions about Medicaid for seniors in Massachusetts, contact our probate attorneys in our North Andover, Woburn, and Beverly offices at (978) 969-0331. Our Salem and Nashua, New Hampshire office can be reached at (603) 894-4141.
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