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Legal Notes

MassHealth rules and proposed legislation – income, assets, and care

Members of the Massachusetts State House and Congress have introduced legislation that will impact elders in our community.

The three bills below under consideration by Massachusetts legislators provide protections for the uninformed individual who engages in financial transactions unaware that they have created a serious problem for themselves when they need long-term care MassHealth benefits. Please contact your state legislator if you want them to support these bills.

Current MassHealth regulations penalize applicants who transferred assets within 60 months of the application for benefits, regardless of the reason. HD2927/SD1387 (An Act Relative to Transfer of Assets by MassHealth Members) establishes criteria to be used by MassHealth to determine whether a transfer should result in a period of disqualification for eligibility and clarifies that a period of ineligibility will not apply if the transfer was for an intent other than to qualify for MassHealth. For example, many applicants may be able to show that the transferred assets were part of a regular pattern of small gifts, or that they were for a child’s unexpected illness or financial crisis.

HD3066/SD981 (An Act to Protect MassHealth Applicants Facing Undue Hardship) protects individuals who made innocent transfers, waiving the ineligibility period if certain criteria are met. MassHealth could not impose a penalty where 1) it would create a risk of serious harm to the individual, 2) the transferred assets are irretrievable from the recipient, and 3) there is no affordable alternate care available to the individual.

HD1478/SD419 (An Act to Support Equal Access to Community Care for Elders and the Disabled) helps seniors who are clinically eligible for nursing home care, but wish to remain home. Currently, if an applicant for in-home benefits has gross income less than $2,205/month, the applicant will receive MassHealth services at no cost. However, if an applicant’s income exceeds $2,205/month, even by $1, the applicant may retain only $542/month and must contribute the balance to the cost of care. No one can live on $542/month! This bill would allow applicants to keep all income up to $2,205/month, with only any excess contributed to the cost of care.

Congress has a bill pending (H.R. 180) which will eliminate retroactive coverage under the Medicaid program (called MassHealth in Massachusetts). Currently, MassHealth applicants 65 years of age and over or in a nursing home may be approved for up to four months of retroactive benefits. This bill would limit the benefit start date to the month in which the application is filed. This will particularly impact individuals who do not have family or others to quickly file an application for healthcare benefits on their behalf, leaving them financially liable for the higher private rates they currently have. Please contact your federal legislators to ask them to vote against this bill if you are concerned about this national change.

Finally, MassHealth has issued sweeping changes in regulations related to community (in-home) benefits which will severely restrict eligibility. Most significantly, spousal income and assets, which were previously ignored, will now be considered when determining whether a married applicant is financially eligible for MassHealth benefits. Many couples will be required to contribute more toward the cost of care than they can afford, forcing individuals who wish to remain home into nursing homes (with the additional expense borne by taxpayers).

Contact information for legislators may be found here.

The views expressed in this column represent general information. To address your particular and specific needs consult your own attorney. If you need help with referral to an attorney, contact the Franklin County Bar Association at (413) 773-9839 or the Worcester County Bar Association at (978) 752-1311. Elder law resources may be found through the National Academy of Elder Law Attorneys, Massachusetts Chapter, at massnaela.com or 617-566-5640.

Community Legal Aid (CLA) provides legal services free to people age 60 and older for civil legal matters with an emphasis on access to health care coverage (MassHealth and Medicare) and public benefits as well as tenants’ rights. A request for legal assistance can be made by phone at 413-774-3747 or toll-free 1-855-252-5342 during their intake hours (Monday, Tuesday, Thursday, and Friday from 9:30 a.m. to 12:15 p.m. and Wednesday from 1:30 p.m. to 4:15 p.m.) or any time online by visiting www.communitylegal.org.