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Who Qualifies For Medicaid?


There is much confusion about what services are provided or covered under Medicare versus  Medicaid and how to qualify for Medicaid, which is called MassHealth in Massachusetts. While Medicare is an entitlement program, Medicaid is a welfare program that people can apply for with the help of a skilled attorney. Do you have questions or concerns about qualifying for Medicaid in Massachusetts? If so, the  Medicaid planning attorneys at Fisher Law are here to help. Call the office or contact us today to schedule an initial consultation.

What is MassHealth? 

Medicaid is a program that is jointly run by federal and state agencies that goes by different names in some states. In Massachusetts, the program is known as MassHealth. This program pays for the healthcare of people who qualify with low income. Depending on the type of medical treatment, MassHealth may cover some or all of a qualified person’s healthcare needs. MassHealth is only available to people who are residents of Massachusetts, a U.S. citizen or green card holder, in need of healthcare insurance, and whose income would be classified as low or very low compared to federal poverty level standards.

Qualifying for MassHealth 

The MassHealth program qualifies applicants primarily based on a means test, or purely based on their income level. Tables provide the maximum income that an applicant can earn based on the size of their family. For example, a household of one must earn no more than $17,131 per year before taxes, and a household of four can earn no more than $35,245 per year. However, there is an exception to the rule for applicants with disabilities. There is no income limit in this situation, but people with disabilities who wish to participate in the program may have to pay a one time premium and deductible to qualify.

There is a separate application for seniors who are 65 years old or older and for people of any age that need assistance with long-term care. MassHealth provides separate eligibility income tables to determine whether an elderly person living in the community qualifies for Medicaid.  There is no income limit for an institutionalized person applying for or receiving MassHealth benefits.  Instead, the nursing home resident is required to pay the majority of his or her income to the facility each month as the Patient Paid Amount or “PPA”.  The PPA is applied to the cost of care, with MassHealth paying the balance of care costs.  The PPA is made up of all of the nursing home resident’s gross income(such as Social Security and/or pension(s)) less certain deductions.  These deductions include Part B of the Social Security payment, medical insurance premiums, and $72.80 which is a personal needs allowance or PNA.

For seniors looking for MassHealth assistance in a skilled care facility, there is no income eligibility test.  Eligibility is based on assets.  For a single applicant, in order to qualify for MassHealth, they cannot have any more than $2,000 in countable assets.  Countable assts are all assets that are not exempt or inaccessible.  Noncountable assets include the primary residence with equity below $955,000 (2022 figure), a separate bank account of up to $1,500 for each member of the filing unit expressly reserve for funeral and burial expenses, a prepaid irrevocable funeral contract, a car of any value if the applicant or family member can establish a need to own the vehicle, and a life insurance policy if the face value is $1,500 or less.  Every other asset is countable.

If the applicant is married, the community spouse can have countable assets of $137,400.  This is in addition to the $2,000 that the applicant can have to qualify.    That is, when the combined assets for both husband and wife equal the community spouse resource allowance of $137,400 or below, plus the $2,000 that the institutionalized spouse or applicant is allowed to keep, the applicant become eligible for Medicaid.

For purposes of qualification, assets owned jointly by the applicant and his or her spouse or assets owned individually by the applicant or individually by the spouse are considered to be the asset of the applicant.   There is no ability to reduce the amount of countable assets based upon percentage of legal ownership in an asset held jointly with a spouse.  Thus, if a married couple owned a joint bank account with a balance of $100,000, the entire $100,000 would be attributed to the applicant.   Also, a community spouse with a large IRA, for example, $400,000 would be attributed to the applicant, despite ownership of such an asset in the name of the community spouse only.

In addition to the basic rules about eligibility, there are also rules relating to penalties for any transfer of a countable assets for less than fair market value during the 60-month period prior to application.  There are, however, exceptions to the transfer rules.      An experienced elder law attorney can help review the various requirements for Medicaid qualification and help with every step of the application process. To learn more, call or contact our office today.

Call or Contact Us Now 

Medicare and Medicaid are notoriously complex programs that have frustrated and confused many people who try and qualify for benefits. If you wish to learn more about your potential eligibility for MassHealth or need assistance with the application process, the dedicated and knowledgeable lawyers at Fisher Law in Norwood are here to help. Call the office or contact us today to schedule a consultation of your legal needs now.



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