The cost of long-term care in the United States is high across the country – and is expected to continue to increase for the foreseeable future. If you find yourself (or a spouse) in need of nursing home care in the Commonwealth of Massachusetts, you may be wondering how you are going to afford that care. Over half of all seniors rely on Medicaid to cover the high cost of nursing home care, which may lead you to ask “Will Massachusetts Medicaid pay my nursing home expenses?” The answer to that question depends on whether or not you qualify for Medicaid benefits.
The High Cost of Nursing Home Care
In the United States, the average cost of a year stay in a long-term care facility in 2015 was around $80,000. If you are a Massachusetts resident, however, you can expect to pay considerably more. In Massachusetts, the average cost of a year in a semi-private room was $135,000 in 2015, with the private room running, on average, almost $145,000 a year. Given that the average length of stay is 2.5 years it is easy to see how the cost of nursing home care is a concern for most seniors.
Why Medicaid May Be the Only Solution
Like most people, you probably relied on employer sponsored or private health insurance to cover your medical expenses during your working years. Unfortunately, most health insurance policies do not cover long-term care unless you purchased a separate long-term care rider at an additional expense. Don’t look to Medicare to cover the cost either as the Medicare program only covers long-term care under very narrow circumstances, and even then for only a very short period of time. Medicaid, however, will cover the cost of nursing home care – if you qualify for benefits.
Qualifying for Medicaid Benefits in Massachusetts
Although Medicaid (called MassHealth in Massachusetts) will cover the costs of nursing home care, you will first need to meet the program eligibility guidelines. Those guidelines include both income and asset limits that you cannot exceed. The income and asset limits change each year; however, if your income is at, or below, the federal poverty rate, or you already qualify for SSI, you will meet the income limit test. You may still qualify if your income exceeds the federal poverty rate under certain circumstances, such as if you have significant medical expenses or are already paying for nursing home care. For most seniors, the real problem is found in the asset, or resources, limit.
In order to qualify for benefits that will cover nursing home care you cannot have countable resources that are valued at over $2000 for an individual or $3000 for a married couple. Fortunately, some assets are exempt, meaning their value is not counted when determining eligibility. For example, in Massachusetts, one car of any value may be exempt, as long as a household member is using it. Personal belongings are also exempt. Your home is exempt up to an equity value of a specific amount that changes each year. You may also be able to exempt more equity if you have a spouse or a minor or adult disabled child living in the home. In addition to the exemptions, if you are married and your spouse plans to remain in the community, the spousal maintenance allowance may also allow you to keep more income and assets and still qualify for Medicaid benefits.
If the value of your countable assets exceeds the program limits you will have to wait through a penalty period before the program will start helping with your nursing home expenses. In essence, you will be expected to rely on those assets to cover your costs during the penalty period.
One more thing – the Medicaid five year “look-back” period also prevents you from transferring assets in an effort to qualify for the five-year period prior to applying for benefits. Any asset transfers made during that time period will likely be ignored and the value of the asset added back into your estate. Including Medicaid planning in your estate plan early on in your life will ensure that you do not find yourself in this situation.
If you have additional questions or concerns regarding Massachusetts Medicaid, contact the experienced New Hampshire estate planing attorneys at Debruyckere Law Offices by calling (603) 894-4141 or (978) 969-0331 to schedule an appointment.