Medicaid
Approximately one in ten people over the age of 65 and one in four people over the age of 80 will be cared for in a nursing home at some time in their lives. For most elders, the prospect of long-term care in a nursing home is, to say the least, unpleasant. Elders are also often concerned that the cost of long-term care will deplete their estates. The cost of nursing home care in Massachusetts, now between $90,000 and $115,000 per year (the daily rate is often over $290), only serves to compound these fears. Full time at home professional services and care can be twice as expensive as nursing home care.
There are few elders who have sufficient income to meet such high monthly expenses. This results in lifetime savings of the typical middle class family being rapidly depleted. In some cases, the family home, for which the elders have worked their entire lives to pay for, may be in danger of being partially or wholly lost to pay for their late in life care. Long-term care is one of the few costs that individuals in this group frequently encounter that cannot be covered out of ordinary savings or means without impoverishing the elder or eliminating the ability of the elder to pass property to the next generation.
Many elders receive assistance from the federal Medicare program to help pay medical expenses and the cost of prescription drugs. Medicare, however, does not pay for extended nursing home care. Medicaid, called MassHealth in Massachusetts, on the other hand, is a joint federal-state program, which will pay for nursing home care for individuals that meet their medical and financial eligibility rules.
Understanding the complex Medicaid rules is the key to informed and legal long-term care planning and asset protection. It is important for families to seek guidance before they are in a crisis situation. With proper planning an elder or disabled individual may be able to receive assistance in paying for their long-term care, or even plan in keeping the elder at home by providing caretakers in a community setting.
MassHealth is a combination of several programs paying the costs of health care and related services for eligible individuals and their families. Covered services range from prenatal instruction to burial. Financial eligibility criteria differ widely depending on the program. MassHealth is administered by an agency called the Office of Medicaid of the Massachusetts Department of Health and Human Services.
The Deficit Reduction Act of 2005 was signed on February 8, 2006 and drastically changed the traditional rules for planning. It is important that elders begin planning as early as possible for the most positive results. There are numerous strategies that may be available to both couples and single individuals to preserve their assets for their loved ones and to ensure assets are preserved for their own long-term needs and supplemental care. Careful long-term care planning with an experienced elder law attorney prior to a hospitalization or medical crisis ensures that families understand their rights. This planning allows families to evaluate their options and often permits families to protect the family home and other substantial assets. The new law change has only added to what was already a complex planning process.
Good planning involves protecting the independence, integrity, and wishes of the elder individual or couple, as well as protecting assets. Our attorneys will be able to conduct a complete review of your personal and financial situation and make appropriate recommendations to address your health care needs and provide you with a framework of recommendations to protect your assets according to your own personal wishes.
CURRENT MASSACHUSETTS MEDICAID FIGURES
| Daily Divisor Rate for Penalty: | $256. per day or $7,680. per month |
| Individual Resource Allowance: | $2,000. |
| Allowance for Personal Needs (PNA) in Nursing Home: |
$72.80 |
| Community Spouse Resource Allowance (CSRA): |
Maximum - $101,640. |
| Monthly Maintenance Needs Allowance for Community Spouse: |
Minimum - $1,711.25 Maximum - $2,541. |
| Shelter Standard for Community Spouse: |
$495. |
| Standard Utility Allowance for Community Spouse: |
Heat included - $320. Heat not included - $528. |
