Should You Prepare and File a MassHealth Application on Your Own?

by: Brian E. Barreira, Esq.

Many people can file a MassHealth application on their own, but sometimes it makes sense to get help. The more complicated the applicant’s financial situation, the more it makes sense to get help from an independent professional.

For a person who is under age 65 and not in need of nursing home care, MassHealth eligibility is mostly based on the person’s income, so that type of MassHealth application process is usually fairly easy. If the MassHealth applicant is not under age 65, or if long-term care is needed, getting help is often necessary. In many cases, getting the assistance of an elder law attorney can be important.

A MassHealth applicant is limited to $2,000 in countable assets for some programs, and while it may be possible to transfer assets above that amount in order to become eligible, the transfer could make the applicant ineligible for nursing home coverage for 5 years. Thus, elder law advice can be important due to the mishmash of MassHealth programs that have different rules.

Elder law advice can also be important due to confusion about MassHealth rules among facilities and home care agencies. For example, the GAFC program that can help pay for assisted living can be accessed with a 6-month income deductible period, yet many assisted living facilities seem not to know about that possibility.

Submitting a MassHealth application to help cover nursing home costs without elder law advice can often be a bad idea. I often describe the MassHealth application process for nursing home care as “guilty until proven innocent.” MassHealth applications are closely scrutinized, with a lookback period of 5 years on all financial records. Gifts, below-market sales and unexplained financial transactions can cause problems; any unexplained or poorly-explained expenditure can be treated as a disqualifying transfer of assets, delaying MassHealth eligibility at a time when there are no remaining funds to pay for nursing home care. Trusts are often rejected without explanation. The application process can take several weeks or even months, while the MassHealth eligibility worker keeps asking questions and demanding further verifications.

Many elder law attorneys offer assistance with MassHealth applications as part of their services. Going this route can help you deal with difficult eligibility problems that can come up along the way and allow you to get advice on how to obtain MassHealth as quickly as possible. Payment for the elder law advice is often made with funds that would otherwise have been paid to the nursing home, so there is often no net loss to the family, and, in some cases, the elder law attorney can point out exceptions in the MassHealth law that allows assets to be preserved for the MassHealth applicant and the family.

Some nursing homes offer free help with the MassHealth application, or refer families to non-lawyers or companies that offer help for a fee. In those cases, you should not expect that the matter will be handled appropriately in all situations. One of my clients used a company that was referred by the nursing home, and learned that the company saw a problem with the application and overreacted; the company called the nursing home administrator, who then immediately sent out a discharge (i.e., eviction) notice to the nursing home resident who was not in debt and had enough funds to pay for a few months.

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Comments

  • Attorney John L. Roberts  On September 24, 2013 at 1:34 pm

    Good perspective on the need for professional planning. Elder care is a continuum. Companies that only prepare Medicaid applications don’t see this continuum of care.

    A client may begin with MassHealth – Medicaid eligibility for home care coverage. These homecare services, combined with unpaid family care services and Veteran’s Aid & Attendance (if available) make it possible to keep caring for the client at home.

    But if medical needs become more than what can be provided at home, we can provide the documentation and explanations needed to transition the client to Medicaid nursing home coverage. Companies that only prepare Medicaid applications don’t lead the family along this continuum of care.

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