Public Benefits Eligibility FAQ

What is the difference between Medicaid and Medicare?
Medicare is a federal health insurance program associated with Social Security Insurance benefits for the elderly and disabled that assists in paying for medical expenses, including inpatient hospital, up to 100 days of rehabilitation, home health visits and durable medical equipment, and prescription drugs.  Medicare does not pay for extended nursing home care.  Medicaid is a joint federal-state assistance program based on financial need that comprehensively pays for the medical and health maintenance needs of those receiving coverage.  Medicaid also pays for long term nursing home care and other medical services not covered by Medicare or other medical insurance.
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Who is eligible for Medicaid?
Medicaid (MassHealth) is available to the elderly, disabled, blind, children, and other groups in need of medical coverage who meet the financial eligibility rules and for those persons eligible for Supplemental Security Income (SSI) and other needs based public benefit programs.  There are different eligibility rules for community and nursing home coverage.  The criteria for Medicaid eligibility differs widely by age and category.  For example, for those age 65 and over, the “countable” asset limitation is $2,000 for an individual, but there is no asset limit for those under age 65 living in a community setting.  The allowable countable income limit also varies widely depending on age and category.  For example, the monthly income limit for older individuals living in the community varies from $903 to $2,022 depending on medical need.   In some programs, excess income may be “spent down” on medical care to receive benefits.  For nursing home coverage, there may be penalties for certain gifting of assets, and all monthly income over $72.80 must be paid to the nursing home, although there are exceptions if there is a spouse still living in the community.
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If I need a nursing home, but my spouse does not, will I still be able to get Medicaid?
Many assets are not countable.  For 2010, the “community spouse resource allowance”, the amount of “countable” assets that the community spouse may keep of the couple’s joint assets, is $109,560.  There are also various techniques available to save additional funds.
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When is a person considered disabled for Social Security Disability Insurance or Supplemental Security Income Disability?
Disability under Social Security for an adult is based on your inability to work because of a medical condition. To be considered disabled:

• You must be unable to do the work you did before or adjust to other work because of a medical condition and taking into account age, education, and prior work experience.
• Your disability must last or be expected to last for at least one year or to result in death.

Social Security pays only for total disability. No benefits are payable for partial disability or short-term disability, although a limited earning capacity may still be considered as total disability  For adults, a five-step evaluation process is used to determine whether you are disabled under Social Security. The process considers any current work activity you are doing or recently performed, as well as your medical condition and how it affects your ability to work.
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What is the Veterans Aid & Attendance Program?
The Aid and Attendance pension provides benefits for veterans and surviving spouses who meet certain qualifying requirements.  If eligible, individuals may receive financial benefits to help pay for assistance with their activities of daily living, such as dressing, bathing, and eating.  Such assistance includes individuals who, because of mental or physical incapacity, require care either in their homes, in assisted living facilities, or in nursing homes.  This is a federal program available in every state.
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