Helping You Plan For MassHealth (Medicaid)
It is possible – and in most cases, advisable – to plan for MassHealth (Medicaid) proactively, long before care is needed or a crisis comes up. However, the process can be complicated and full of potential pitfalls.
Simple mistakes can lead to disqualification for benefits or the unnecessary loss of assets. This is where our qualified lawyers at Curley Law Firm LLP come in. With decades of combined experience, our board-Certified Elder Law Attorneys (CELAs) can guide you through the complexities of MassHealth rules and create a plan that protects you and your hard-earned assets.
Crisis Planning
When a health crisis strikes, planning for MassHealth requires immediate action. Our lawyers move quickly to help you qualify an applicant for MassHealth benefits, whether at home or in a nursing home, while protecting their home, savings and even income to the maximum extent permitted under law. If an applicant is married, we can help their spouse preserve and protect assets for their future to ensure they do not become impoverished. Many people mistakenly believe it is “too late” to plan at this stage. Unfortunately, this belief often causes families to spend down a lifetime of savings until nothing is left. We urge you to consult with us to learn about your legal options so you can make an informed decision.
Advance Planning
Proactive planning can provide you with more comprehensive and personalized options. Our attorneys work with you to create a long-term plan to preserve your hard-earned assets. This way, if you require nursing home care in the future, your home and savings are already protected. Because many of these strategies involve the MassHealth five-year look back period, careful, early planning is essential.
Medicaid Versus Medicare
Medicare is insurance issued through the federal government. It does not cover long-term care costs at home or in a nursing home. In contrast, Medicaid (also known as “MassHealth” in Massachusetts) is a combined state and federal program that covers most long-term care expenses. However, it is available only to applicants with $2,000 or less in countable assets.
Our board-certified attorneys have in-depth experience in assisting clients with Medicaid planning. They have encountered numerous scenarios, and chances are they have handled matters for another client with issues similar to yours. Our lawyers can help whether a situation calls for immediate assistance or a long-range plan.
For additional information about our qualifications and the benefits of retaining our attorneys’ services, please see our page entitled “Why Choose Us.”
Medicaid Planning
Our attorneys can help you prepare for the possibility of future nursing home care. This preparation can also help you qualify for MassHealth benefits more quickly down the road, should you ever need them.
Using certain lawful strategies can help protect the assets you have worked hard to save. While every family’s situation is unique, a few important rules apply to most planning:
- Gifts and asset transfers: Careful planning is key, as giving assets away can make a MassHealth applicant ineligible for benefits.
- Spending down: We can help you create a plan to spend down assets in a way that helps you qualify for MassHealth while legally protecting you or your spouse’s finances.
- Irrevocable trusts: Under current laws, specific types of irrevocable trusts are an effective tool for long-term asset protection.
Because each individual’s situation is unique, it is hard to provide general rules about how best to prepare for Medicaid. It’s wise to consult with qualified elder law attorneys such as Patrick Curley and Lucy Budman, who have daily experience with Medicaid planning and applications.
Addressing Your Concerns About MassHealth Eligibility
Applying for MassHealth can feel overwhelming, especially for families managing this from another state. Here are brief answers to some of the most common questions our lawyers receive:
What are the financial and clinical requirements for MassHealth long-term care?
To qualify for long-term care benefits, MassHealth requires you to meet both financial and clinical criteria. An applicant must:
- Have $2,000 or less in countable assets
- Be assessed as needing a nursing home level of care
This applies whether they are in a skilled nursing facility or seeking services at home. The application process demands detailed proof for both. Our experienced lawyers can help you gather the extensive documentation required and present your case to MassHealth in a way that avoids common delays or denials.
How do the five-year look back and transfer penalties work in Massachusetts?
When you apply, MassHealth “looks back” at your finances during the 60 months prior to the application date. This is to search for any assets you may have gifted or transferred for less than fair market value.
If they find such a transfer, MassHealth may impose a penalty period. This is a length of time when the applicant is ineligible for MassHealth benefits, even if they are otherwise qualified. The penalty is calculated by dividing the amount of the gifted assets by a state-set daily cost of care. Our attorneys can review your financial history and help you determine whether this can affect you or your loved one’s application and strategies you can take to speed eligibility.
What if an applicant has made gifts during the five-year look back?
We understand and respect that many of our clients have made gifts over the last five years. Being generous with family, loved ones and charity is a right of passage as we age. For this reason, we have developed systems and strategies to maximum the chances of avoiding disqualifying transfer penalties for past gifting. If you or your loved one has made gifts, do not assume that you cannot qualify for MassHealth benefits. Consult us to discuss how we can help you address the gifts and qualify sooner for benefits.
Will the nursing home and MassHealth take my house or investment property?
Real estate presents tremendous complexity and requires the attention of an attorney with daily experience dealing with MassHealth and real estate. MassHealth regulations are complex when it comes to real estate and there are many exceptions to the rules. Never assume that you have to sell your real estate and spend it down. Consult a Certified Elder Law Attorney to confirm your options before making any decisions about real estate.
Won’t the nursing home prepare and file the application for me for free?
A nursing home or their contractor may offer to prepare and file a MassHealth application for free or very low cost. But the true cost is that you will be forced to spend down all countable assets before the nursing home will work to qualify you for MassHealth benefits. Thus, it is definitely not “free” and could end up costing you all your savings and your home. For this reason, you should consult a Certified Elder Law Attorney like us to understand your planning options and preserve what you worked so hard to save across your lifetime.
Can a spouse remain at home without becoming impoverished under MassHealth rules?
Yes. Massachusetts law allows the spouse living at home, also known as the “community spouse,” to keep a portion of the couple’s combined assets. This is called the Community Spouse Resource Allowance (CSRA).
The community spouse can also keep a minimum amount of monthly income. If their own income is below this level, they can keep a portion of the other spouse’s income. Our lawyers help couples legally restructure their assets in advance to maximize this protection and ensure that both spouses remain financially secure.
Which assets are countable versus noncountable for MassHealth eligibility?
Countable assets are what MassHealth expects you to use for your care first. These include, but are not limited to:
- Checking and savings accounts
- Retirement accounts
- Stocks, bonds and mutual funds
- Second homes or vacation properties
- Cash value of life insurance policies
MassHealth eligibility rules require that an applicant spends down their countable assets to $2,000 to qualify for benefits.
Noncountable assets, as the name implies, are not counted when assessing your eligibility. Except in a few specific situations, this means that your noncountable assets are generally protected. If the MassHealth application is completed correctly, these may include your primary residence (up to a certain equity value), one car, personal belongings and certain prepaid burial contracts. Our attorneys can show you how to legally and ethically spend down countable assets in ways that benefit you.
To what extent can MassHealth cover my care costs at home?
MassHealth offers several programs, often called Home- and Community-Based Services (HCBS) waivers, designed to help eligible individuals receive care in their homes rather than in a nursing home. These programs can be an excellent option for preserving independence and aging with dignity. The Frail Elder Waiver is one of the most common programs, providing services such as personal care, housekeeping, meal delivery and adult day health.
Eligibility for these waivers involves strict financial and medical requirements, which are different from the requirements for nursing home care. Our attorneys can help you determine which waiver program is appropriate. Our team can also assist with the application process, which often runs parallel to asset protection planning.
Contact A Massachusetts Medicaid Planning Attorney
For information about Medicaid planning or to discuss your particular situation with an experienced lawyer, please schedule a confidential consultation by calling us at 866-406-8582. You may also elect to submit our intake form, and we will contact you. Out-of-office consultations can be arranged by appointment. We serve clients in Wakefield, and throughout Essex, Suffolk and Middlesex counties.