Important MassHealth Changes in the Protection of Spouses of Nursing Home Residents
[August 14, 2006]
Donald N. Freedman
Susan H. Levin
Ellen M. McVay
Kristin Wildman Shirahama

On July 30, 2006, the Massachusetts legislature passed a law favorably changing the amount of assets the spouse of a nursing home resident is entitled to keep when applying for MassHealth (Medicaid) coverage of nursing home care.

Under the new rules, the spouse living at home ("the community spouse”) may keep up to $99,540 as her share of the couple’s assets. (Formerly, the community spouse could keep all of the couple’s assets only if total assets were $19,998 or less; if more than that, the community spouse could keep only half the total assets, but not more than $99,540. The change returns the MassHealth law to the way it was before January 2003, when the state chose to make dramatic Medicaid cuts to deal with its budgetary crisis.)

For example, let’s say a couple has $120,000 in countable assets. Under the new rules, the community spouse would be permitted to retain $99,540. In contrast, under the former rules, the protected amount would be only $60,000.

This change benefits only couples with countable assets of roughly $200,000 or less. If a couple has more than $200,000, the protected amount would be the same -- $99,540 – under both the former and new rules.

The change was approved on July 30, 2006, but made retroactive to July 1, 2006. Does it apply to your situation?

• It DOES apply if you have not yet applied for MassHealth. You may have delayed filing because you thought your assets were too high. If so, you need to evaluate whether, under the new rules, your total assets may be within the allowable maximum of $99,540.

• It DOES apply to you if you (1) applied for MassHealth for nursing home care in July 2006 (or more recently) and (2) received a denial for excess assets.

• It DOES apply to you if you (1) applied for MassHealth for nursing home care in June 2006 (or earlier), (2) have been denied based on excess assets and (3) are still waiting for a hearing.

• It DOES apply to you if you (1) applied for MassHealth for nursing home care in June 2006 (or earlier), (2) filed an appeal seeking an increased spousal income allowance and (3) are still waiting for a hearing.

• It does NOT apply to you if you are not married.

• It does NOT apply to you if you are a married couple and BOTH spouses are applying for MassHealth for nursing home care.

• It does NOT apply if the institutionalized spouse is already receiving MassHealth for nursing home care.

If you think the new rules may apply to you, contact us, or another elder law attorney, at once. If you cannot afford a private attorney, you can locate the legal services office nearest you through the website, www.masslegalservices.org, and click on “Directory”.

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