of Ronald H. Surabian
MassHealth has two types of coverage depending on whether or not you are in a nursing home.
If you are in a nursing home you file the same application but are subject to the five year lookback period on any transfers of assets. This means that any gifts within the last 5 years would result in a disqualification period determined by adding up the gifts and dividing by $354. This is the average nursing home cost as determined by MassHealth. The result will give you the number of days you are disqualified from benefits.
Example: You are single and have less than $2,000 (the asset limit for single individuals). 4 years ago you gave your children $20,000, you now need nursing home care. The gift would cause 56 days ($20,000/$354=56) of ineligibility. That means you are not eligible for nursing home coverage. You either have to get the money back and pay it to the nursing home, or file an appeal under undue hardship, or argue the "Intent" argument that at the time of the gift, it was made for reasons exclusively other than qualifying for MassHealth. Key component of winning this type of case is the physical condition of the person at the time of the gift. The intent argument has been fairly succesful, however the undue hardship argument has not, in my knowledge, won any cases. It is for all practical purposes nonexistent.
DISABLED CHILDREN - Families with disabled children have more options of passing assets down to their disabled children than to their non-disabled children. There was a recent law change that now allows disabled individuals under the age of 65 to establish their own Special Needs Trust. Prior to that a parent, grandparent or court had to establish the trust. If the child were to receive an inheritance, the child could establish and fund their own trust to be able to stay on the public benefits they are receiving.
Many times when there is a disabled child and other non-disabled siblings conflicts of interest occur. The main problem is the 5 year lookback period. Nothing can go to the non-disabled children without an associated disqualification period. Whereas, if the property was transferred to the disabled child (real estate only) or money and real estate to a special needs trust for the disabled child, there would not be a disqualification period. So, if dad needs to go to the nursing home and has not planned ahead the home will have to be transferred to the disabled child or his trust or you enter into an agreement to sell and then spend the proceeds on nursing home care. Depending on who is living in the house they may not require the sale but will place a lien on it.
MASSHEALTH WHEN NOT IN A NURSING HOME -
FRAIL ELDER WAIVER - This is a really cool program and not that many people know about it. If you live alone and need help, even alot of help, MassHealth will pay for care at your home, even up to 24 hour care. The recent passage of the Affordable Care Act (ACA) put a crimp in this program for married individuals who applied after January 1, 2014 and some of those folks will be receiving letters that their eligibility will be cancelled. Prior to this, it didn't really matter how much money the married couple had, as long as the put all of the money into the healthy spouse's name and left the frail spouse with less than $2,000. Now the healthy spouse will have to financially qualify by having less than $120,000. It has come to my attention that MassHealth intends to allow families with more than $120,000 to demonstrate that they have reduced their assets by the end of calendar year 2017 or be cancelled. For many single seniors this program allows their parents to stay at home and not be placed in a nursing home.