Program Description
Massachusetts, through its state Medicaid program, under the name MassHealth, supports aging seniors during daytime hours with its Adult Day Health (ADH) Program. Through a combination of daytime services, this program aims to provide a care environment that supports elders in their emotional, cognitive, and physical wellbeing. Trained staff assists seniors with their Activities of Daily Living (ADL), such as bathing and dressing, as well as providing skilled nursing tasks. In addition to the elderly who require adult day health services due to the process of aging, this program also serves persons with severe conditions, as well as those who have been diagnosed with Alzheimer’s Disease and other related dementias.
By providing Adult Day Health, the state health administrators hope to delay institutionalization and help facilitate a community-aging alternative to nursing home care. Not only is adult day care much less expensive than is nursing home care, many Massachusetts families and seniors prefer this type of care over being institutionalized. Family caregivers also benefit by being able to continue to work during business hours without the need to hire a private caregiver.
Massachusetts’ rules require licensed adult day care centers to operate at least 8 hours per day between Monday and Friday.
Eligibility Guidelines
Massachusetts’ residents are eligible if they are at least 18 years old and have an impairment that is physical, cognitive, or behavioral in nature. Applicants must require assistance with at least one activity of daily living or require skilled nursing services, and a doctor must deem adult day health care necessary. Applicants must also meet the financial requirements of MassHealth, which are complex. We summarize the most important aspects for prospective applicants below.
Income Rules
Single seniors, as of 2022, will need to have equal or less than $1,133 in total monthly income and couples equal or less than $1,526 / month. This figure is 100% of the Federal Poverty Level (FPL), which changes on an annual basis. Massachusetts also permits residents to reduce their income by some of the qualified unreimbursed medical expenses under their Medically Needy provisions. Participants using the Medically Needy pathway will have a monthly deductible amount that must be spent on medical or care services. Learn more about getting assistance to file an application under the medically needy rules.
Asset Rules
Seniors over 65 in Massachusetts must have savings and other cash equivalents that are less than the Medicaid asset limits. Individuals who apply must have less than $2,000 total in savings and other countable assets. If a married couple is applying together, they should have less than $3,000 in savings or other assets. One should note that higher asset limits exist for MassHealth eligibility to a ‘buy-in program’ where the member shares part of the costs for the care with the state.
Please note: It is vital that applicants do not give away cash or assets, or sell them for less than fair market value, in an attempt to meet Medicaid’s asset limit. If one does so within 5 years of applying for Medicaid benefits, it violates Medicaid’s look back period and will result in a penalty. This will take the form of a period of Medicaid ineligibility.
IIf your assets and / or income are over the published limit(s), this is not necessarily the end of the process. A MassHealth planning professional can assist you in understanding how to arrange your finances and help to prepare a successful application to MassHealth.
Benefits and Services
The Adult Day Health program helps elders to avoid the need for more intensive care in a 24-hour facility. The following is a general list of services that are available via the Adult Day Health program in Massachusetts:
- Case management
- Counseling (individual/group)
- Medication management
- Meals / Snacks
- Nutritional and dietary guidance
- Occupational, physical and linguistic therapies
- Personal care for activities of daily living
- Skilled nursing on site
- Social, therapeutic, and recreational activities
- Supervision
- Transportation assistance (to/from adult day health facility)
How to Apply / Learn More
Individuals interested in applying for the Adult Day Health program should make an application to MassHealth for senior services. If you or your family member is already enrolled in MassHealth and would like to learn more about this additional benefit, you should contact either an Area Agency on Aging or an Aging Service Point. Find the closest office to you by searching here.
Learn more about this Massachusetts Medicaid program in the Adult Day Health Manual on the state website.
