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Helping People Age with Dignity

State high court issues ruling in MassHealth case

Among the benefits qualifying individuals can receive from MassHealth is financial help with the costs related to nursing home care. Getting nursing home care they need can be of great importance to an elderly person’s overall health and well-being. However, such care can cost a lot. So, what effects trusts and other things can have on one’s MassHealth eligibility can be a significant issue for the state’s elderly population.

Recently, the state’s highest court made a decision in a case regarding trusts and MassHealth eligibility.

The case involved two seniors who applied for nursing home care coverage from MassHealth. Each had a home and put this home in a trust over five years prior. Despite the homes being in trusts, MassHealth decided, for both of the elderly individuals, to include their home in their countable assets.

One of the eligibility requirements for MassHealth coverage is that a person’s countable assets can’t exceed a certain amount. MassHealth denied both of the above-mentioned elderly individuals’ requests for coverage on the grounds that their assets were above this limit when their home was included.

The state’s Supreme Judicial Court, however, recently ruled that MassHealth’s decision was wrong. It ruled that the fact that the homes of the elderly individuals in this case were in trusts at least five years prior to an application for benefits being submitted means that MassHealth was in error when it decided to include the homes as countable assets and deny the elderly individuals’ requests for coverage based on this. The court sent the case back down with instructions for MassHealth to handle the case in a manner that complies with this ruling.

In recent years, concerns have been raised about inconsistent treatment of assets in trusts by MassHealth when it comes to their eligibility decisions. One wonders if the state will see increased consistency on this issue in the wake of this case.

This case and the environment in which it arose underscore how complex planning for MassHealth eligibility can be. The rules related to such eligibility are complicated and numerous, and there can still be a fair amount of uncertainty in this area. Given this complexity, there are many pitfalls an elderly individual could fall into when they try to navigate MassHealth planning without any help. Skilled attorneys can give Massachusetts seniors guidance on trust use and other methods of MassHealth planning.

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