Combining the benefits from these programs will pay for personal care as well as room and board in assisted living residences.
The Group Adult Foster Care (GAFC) program helps elderly, low-income Massachusetts’s residents with the cost of group adult foster care. Group adult foster care includes assisted living care, provided the GAFC Program has approved the residence. The residences included in this program tend to be smaller group homes.
GAFC pays for personal care services and medication management and administration. But it does not cover living costs, such as room and board. Massachusetts, however, provides financial assistance for assisted living room and board costs through the Supplemental Security Income (SSI-G) Assisted Living Benefit. This can be used in combination with the GAFC Program. The GAFC Program is under the administration of MassHealth—the Massachusetts Medicaid program.
In addition to being age 22 or older and a Massachusetts resident, the eligibility requirements for the GAFC program consider both the applicant’s health and financial situation. To qualify, the applicant must need help with at least one of his or her activities of daily living, e.g. dressing, bathing, or using the bathroom. A medical doctor must document and certify the participant’s conditions and the level of care required.
Financially, the applicant must qualify for MassHealth, which as mentioned before, is the state name for their Medicaid program. Massachusetts considers both the applicant’s income and their countable assets. In 2019, the maximum monthly income for a single senior is $1,041 per month. A married couple with both spouses applying can have up to $1,409 per month in income. These income limits are set at 100% of the Federal Poverty Level (FPL), which increases every year.
The above income limits are for aged applicants only, which mean that they must be 65 or older. Applicants under 65 have a higher income limit. Massachusetts also permits people to qualify for MassHealth through demonstrating that they have very high reoccurring medical expenses. This is known as the medically needy pathway, which serves as a “spend down” program, often thought of similarly to a deductible. This program does not depend on the applicant’s age.
The maximum value of the applicant’s countable assets is set at $2,000 for an individual or $3,000 for a married couple (with both spouses applying for services). However, there are many exceptions to this rule. Countable assets do not include one’s home (given the applicant intends to return to the home or has a spouse living in the home), personal effects, household items, and a motor vehicle. If only one spouse of a married couple is an applicant, the non-applicant spouse (commonly called the community spouse) is permitted up to a maximum of $126,420 in assets. The applicant spouse is still able to retain up to $2,000 in assets.
MassHealth eligibility is complicated and there are many gray areas and different income levels depending on the applicant’s conditions. Persons who do not meet the strict financial limits are encouraged to consult with a MassHealth eligibility expert before completing an application to ensure the best possibility of acceptance into this program.
The GAFC Program pays for the cost of personal care, medication administration, housecleaning, and transportation in group adult foster care or at approved assisted living communities throughout the state of Massachusetts. This program does not pay for room and board. Personal care includes assistance with the five activities of daily living—bathing, transferring or mobility, toileting, dressing, and eating—as well as other important activities, such as personal hygiene.
SSI-G, administered by the Social Security Administration, provides funding for the room and board part of adult foster care or assisted living. The maximum monthly benefit is estimated to be up to $1,000 per month.