Massachusetts Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Massachusetts provides long-term care resources to seniors through its Executive Office of Health and Human Services (EOHHS) and the Executive Office of Elder Affairs. The state offers a Home Care program that provides manyservices to over 45,000 seniors every month and has certain criteria for eligibility. In addition to the Home Care program, the state offers long-term care services in a community based or in-home setting. Some of the programs include the Adult Foster Care Programand the Community Based Care program which offers Adult Day Care and Day Habilitation services.

The Office of Elder Affairs oversees the local Area Agencies on Aging (AAA), which support home and community based supportive and nutrition services. In Massachusetts, there are twenty-two Area Agencies on Aging representing a like number of Planning and Service Areas (PSA). Planning and Service Areas are collections of communities that any given Area Agency on Aging serves.

Finally, for seniors over the age of 65 and who need a nursing home level of care but would choose to reside in their own homes or community instead, Massachusetts offers a home-and-community based Medicaid waiver program that allows participants more choice and flexibility in their long-term care planning.

Medicaid Waiver Program for Assisted Living and In Home Care

Massachusetts MFP Community Living (MFP-CL) (HCBS MFP-CL Waiver)

Services

Services included: Adult Companion; Assisted Living Services; Chore Service; Community/Residential Family Training; Day Services; Home Health Aide; Homemaker; Independent Living Supports; Individual Support and Community Habilitation; Occupational Therapy; Peer Support; Personal Care; Physical Therapy; Prevocational Services; Respite; Skilled Nursing; Specialized Medical Equipment; Speech Therapy; Supported Employment; Supportive Home Care Aide; Transportation; Residential Habilitation (group home); Shared Living – 24-Hour Supports; Shared Home Supports; Vehicle Modification; Home Accessibility Adaptations; Transitional Assistance Services

Eligibility

  1. Health: Applicant must need a hospital or nursing home level of care.
  2. Financial: An applicant must meetcertain income and asset limitsto be eligible for the waiver program. For 2017, an individual is allowed to keep up to $2,205 in income per month and have assets totalling no more than $2,000 (or, if married and both spouses applying, $3,000). In addition, because of the strict income limit, an applicant can not use a trust to divert any income to become eligible financially. For the non-applicant spouse (or,”community spouse”), certain assets and other financial allowances are disregarded for purposes of determining financial eligibility. For 2017, the community spouse resource allowance (CSRA) is $120,900 and the monthly amount of income allowed is $3,022.50 for person and household expenses while their spouse is participating in the waiver (the maximum monthly maintenance needs allowance, or MMMNA).

Practical Considerations

As a “medically-needy” state, to meet the financial eligibility criteria the use of a Miller Trust is not allowed, so the spend down on medical and remedial care services will need to be used to meet the income limit. However, the fact that the amount of enrollees is so small means this program is not very practical, even considering the fact they don’t keep a waitlist.

Conclusion

Massachusetts offers many services for seniors, however, Medicaid related long-term care assisted living and in-home care supports are relatively meager. While the state does allow for an applicant to spend down income under the “medically-needy” provision, the small number of enrollees make this program practically infeasible. If, however, you wish to apply for eligibility it would be essential to use a Medicaid Planning specialist to help with categorizing expenses so that the strict financial limit is met using the “medically-needy” provision.