How to Apply to MassHealth When You Need Long-Term Care

How do you apply for Medicaid? Are you eligible? How much money can you have and still qualify, and what can you do if you find out you’re above that limit?  

Those are just a few of the questions people have when they start applying for Medicaid. As vice president of patient access at Hebrew Rehabilitation Center, I’ve answered many of these questions and more in my nearly 20 years at Hebrew SeniorLife and before that in my roles at nursing homes.

Here, I’ll discuss the basics of applying for MassHealth — the Medicaid program in Massachusetts — and some common application hurdles I’ve seen patients experience. While Medicaid is a resource for people living at home and those needing long-term care services, I will mainly talk about those who need to apply to Medicaid because they’re in or waiting to enter long-term care facilities.    

Medicare versus Medicaid 

The difference between Medicaid and Medicare can be confusing if you’re new to the process. Medicaid is a joint federal and state program that helps cover medical costs for those with limited income and resources. The federal government has rules that all Medicaid programs must follow, including that income-qualified children, their parents, people who are pregnant, older adults, and people with disabilities must be covered.

Each state runs its own Medicaid program. In Massachusetts, that program is called MassHealth. If you are on MassHealth, you are on Medicaid! That’s why you’ll sometimes hear the terms Medicaid and MassHealth used interchangeably. Later in the blog post, I’ll talk about applying to MassHealth. Living in another state means you’ll have different state-specific rules for applying to Medicaid.

In comparison, Medicare is federal health insurance for those 65 and older and some people under 65 with specific disabilities and conditions. If you were actually hoping to read about Medicare, you’re in luck — we have a Medicare basics blog post that can help you understand your options, and when and how to enroll.  

Eligibility for MassHealth to enter long-term care 

If you live in Massachusetts, MassHealth’s senior guide to health care coverage is a comprehensive resource designed for people of any age who need long-term care services. It offers detailed eligibility information and explains how to apply. While I’ll talk a bit about eligibility here, verifying information with MassHealth is always a smart idea.

For MassHealth eligibility, special rules apply to people who want to enter a long-term care facility. Basic requirements to be eligible for long-term care facility payments include:  

• Being eligible for MassHealth Standard as a person who is:
  • 65 or older
  • 21 to 54 and disabled according to the Social Security Administration’s disability rules, or pregnant
  • Under 21
• Determined by MassHealth as medically needing long-term care services
• You and your spouse meet certain income and asset rules 

Residency and asset limits 

To qualify for MassHealth, you must be a resident of Massachusetts and verify your citizenship or immigration status. You can learn more about what that means in the senior guide to health care coverage linked above or on MassHealth’s website.

MassHealth also examines your income and assets to determine whether you are eligible for long-term care payments. The asset limit is $2,000 per individual, including money in the bank, retirement accounts, and stocks.

There are exceptions to this! For example, if you are married and your spouse does not need long-term care, or vice versa, the person living in the community may keep up to a certain amount. That amount changes every year. You can find the eligibility figures for residents of long-term facilities online, including personal needs allowances, assets allowed for a spouse living in the community, and maximum home equity limits. 

What happens if you own a home? 

If you own a home, MassHealth may place a real estate lien on it if you’re unlikely to return home. MassHealth places liens on homes to get repaid for long-term care benefits paid on your behalf if your home is sold. There are exceptions to this — MassHealth will not place a lien on your home if certain relatives, such as a spouse, sibling, or child under 21 years old, still live there. If you do return home, MassHealth will remove the lien. 

The five-year gifting look-back rule 

When you apply for Medicaid for long-term care benefits, they will review your financial transactions. Gifting or transferring certain assets within five years of applying for MassHealth can lead to penalties and affect your eligibility for Medicaid. The rule is meant to discourage people from gifting assets to loved ones to meet Medicaid’s asset limit. 

“Spending down” your assets

While gifting is not allowed, you can help cover long-term care costs by “spending down” your assets to help meet eligibility requirements.

Oftentimes, people have more assets than allowable to qualify. Certain assets are “countable” by MassHealth — they count toward that $2,000 limit — while other assets are “non-countable.” By doing things such as purchasing assets that don’t count toward that amount and paying off large medical bills, it is possible to reduce your assets and qualify.  

However, you need to be careful when spending money — it’s easy to accidentally affect your MassHealth eligibility by moving your money around. I always advise people to talk to a lawyer with expertise in handling these delicate situations.  

The importance of legal experts for financial planning 

Navigating this process on your own might feel like a lot to manage. I frequently recommend that people, especially those with complex financial situations, consult with an attorney. A MassHealth attorney is usually the best bet to help you understand your assets and how to qualify for Medicaid, without accidentally risking your eligibility by transferring money the wrong way. 

How to apply for MassHealth 

If you feel overwhelmed, preparing ahead can simplify the process. Before completing your long-term care Medicaid application, consider gathering the information and documents you’ll need:

• Social Security Numbers for your household
• Proof of income and assets
• Proof of health insurance
• Information about or proof of citizenship, national status, or immigration status

To apply for MassHealth, you’ll need to submit the following:

1. The Application for Health Coverage for Seniors and People Needing Long-Term Care Services. You can fill out and apply online in English or Spanish. See below for options for applying in person.  
2. The Long-Term Care Supplement, which is on page 25 of the application above
3. Proof of the following:
   1. Your monthly income before taxes and deductions (e.g., a copy of your pension stub or award letter; two pay stubs or a tax return if you’re employed). Proof of SSI or Social Security income is not required.
   2. The current value of your assets.
   3. Your U.S. citizenship/national status and identity.

You can submit your application via mail or fax:

MassHealth Enrollment Center
PO Box 290794
Charlestown, MA 02129-0214
Fax: 617-887-8799

You can also make an appointment with a MassHealth representative to receive help with your application. If you prefer to make a phone call, call MassHealth at 800-841-2900 for application assistance or interpreter services. 

Overlooking follow-up requests could set your application back! 

One of the biggest pitfalls I’ve seen regarding applications is when patients don’t respond to MassHealth's request letters for additional information. If MassHealth sends you a letter asking for more details, it’s crucial to answer promptly.

If you don’t respond to a letter, your application will likely be rejected, and you’ll have to restart the process. That can be tough to navigate if MassHealth sends a letter to your house and you already live in a long-term care community. Having someone check your mailbox at your home address could be a good idea if you’re applying for MassHealth and know they may be in contact. 

Explore long-term chronic care at Hebrew Rehabilitation Center

We provide person-centered care in a home-like setting at Hebrew Rehabilitation Center, Hebrew SeniorLife’s long-term chronic care hospital. Our patients receive around-the-clock geriatric medical care, comprehensive therapy services, palliative care, life enhancement programming, and spiritual care. Hebrew Rehabilitation Center has two bilingual floors for Russian speakers and three floors offering intensive memory support.

If you’re exploring long-term care options, our admissions team is here to help. We’re happy to answer questions about Medicaid eligibility and the application process and to provide insights into what life is like at Hebrew Rehabilitation Center. Call the admissions team at 617-363-8372 or contact us online today.

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