What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through state-specific “Medicaid Waivers,” which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Waiver Description
This program helps the elderly remain living at home or in the homes of friends or family members.
Massachusetts Medicaid—called MassHealth—operates the Frail Elder Waiver (FEW) specifically to help residents who require nursing home level care to receive health care and ongoing support services in their homes or community living residences instead of in nursing homes.
The objective of this program is two-fold. Lawmakers’ intention was to provide residents with an option about their long-term care. Additionally, by preventing the placement of frail individuals in nursing homes, the state saves significant financial resources as the burden of caring for these individuals is shifted onto family caregivers. Despite this, many families and care recipients still prefer this model, as it allows program participants to age in their homes or the homes of family members.
The Frail Elderly Waiver is operated by the Executive Office of Elder Affairs (EOEA). There is a version of this program called the Community Choices Program, which provides more hours of services to those at immediate risk for nursing home placement.
Eligibility Guidelines
Eligibility for this waiver depends on the age, location, functional ability, and financial status of the applicants. Candidates must be a minimum of 60 years of age. However, those between the ages of 60 and 64 must be physically disabled. All applicants must require the level of care provided in nursing homes, yet they should be willing to receive the care at home. The cost to provide that care cannot exceed what it would cost in a nursing home.
To be eligible for the HCBS Waiver, persons must be financially qualified for MassHealth Medicaid. The 2022 income limit is $2,523 per month for an individual. The income of married couples with both spouses as applicants is considered separately. This means each spouse is allowed up to $2,523 / month in income. Unlike other states, when only one spouse of a married couple is an applicant, the non-applicant spouse is able to retain all of their monthly income.
Massachusetts does offer an alternative method to qualify if one is over the income limit. Individuals who have very high medical expenses can qualify through the Medically Needy pathway for MassHealth. As of 2022, individuals should not have more than approximately $552 in monthly income after medical expense deductions. And couples are limited to approximately $650 after subtracting medical expenses.
MassHealth also considers one’s countable assets, which includes cash, bank accounts, certificates of deposit, and life insurance policies with a face value over $1,500. The limits for an individual and a married couple (both spouses applying for services) respectively are $2,000 and $4,000. When only one spouse of a married couple is applying, the asset limit for the other spouse is up to $137,400 (as of 2022). Their home, if owner-occupied, is considered exempt up to a value of $955,000 in 2022. There are also other exempt assets, such as a vehicle, funeral trusts, and personal valuables.
As with other state Medicaid programs, the applicant’s five-year financial history is considered to prevent the applicant from giving away his / her money to qualify. (This is called the Medicaid Look-Back Period.) Violating the Medicaid look-back rule can be cause for a period of Medicaid ineligibility.
A professional, who is familiar with state Medicaid rules, can determine the exact limits and the best structures for resources to ensure a qualification, while also preserving some of the couple’s net worth for the healthier spouse. Read more about planning services for MassHealth eligibility.
Benefits and Services
It is the goal of this program to help seniors to age in place outside of nursing homes, and as such, the benefits are selected to aid in independent living. Beneficiaries and their caregivers can receive any of the following services:
- Alzheimer’s and Related Dementia Coaching
- Companion Services
- Education Programs
- Goal Engagement Program
- Grocery Shopping / Delivery
- Home Delivered Meals
- Homemaker & Chore Services
- Home Modifications to Improve Accessibility
- Home Health Aide
- Occupational Therapy
- Pre-packaged Medication Delivery
- Personal Care
- Respite Care for the Primary or Family Caregiver – in-home and out-of-home (can be provided in adult day care)
- Skilled Nursing
- Supportive Day Program
- System for Dispensing Medications
- Transitional Services
- Transportation Assistance for Medical and other Appointments
- Wander Response System (Reserved for Alzheimer’s and Dementia Patients)
- Cellular Personal Emergency Response Services
How to Apply / Learn More
Applicants can come from any part of the commonwealth of Massachusetts. However, while individuals may meet all the requirements to qualify, they may have to wait to receive waiver services. This is because Medicaid waivers are not entitlement programs, and there are a limited number of participant enrollment slots.
Massachusetts has both Area Agencies on Aging and Aging Services Access Points (ASAPs) that can help interested individuals to learn more and begin the application process. Find your local office here. One can also find assistance by calling the MassHealth Customer Center at 888-665-9993. It is not uncommon to experience long periods on hold.For additional information on the Frail Elder Waiver, click here.
