Massachusetts Long-Term Care

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The Commonwealth of Massachusetts does not participate in the federal long-term care partnership program; however, it offers special benefits if you own a qualified Long-Term Care Insurance policy. If you own a long-term care insurance policy that meets coverage requirements, you can be exempt from some MassHealth eligibility and recovery rules. These rules determine whether your home will need to be sold in order for you to become eligible for MassHealth benefits, and/or whether you or your estate may need to repay MassHealth for any of the long-term care expenses it paid on your behalf.

The policy must have a certain level of benefits available to pay for nursing home care in order for you to qualify for the MassHealth eligibility and recovery exemptions. When you enter a nursing home, your policy must cover at least $125 per day for at least 730 days, except where the actual cost is less, regardless of whether the policy counts days or dollars toward the benefit level, and not require an elimination period (days that services must be provided before your policy will begin to pay) of more than 365 days, or in lieu of a waiting period, a deductible of more than $54,750.

It should be noted that, although a long-term care insurance policy may satisfy the MassHealth minimum coverage requirements at the time it is purchased, if an insured uses the policy to pay for non-nursing home benefits (e.g., home health care, personal care or assisted living benefits), the amount of benefits remaining available to pay for nursing home care may be less than what is necessary to meet the MassHealth minimum coverage requirements. Depending upon the original maximum benefit and the benefits that may have been used, the policy may not meet the MassHealth minimum coverage requirements on the day you enter a nursing home.

Example: you purchased a policy with 730 days of nursing home and home health care

Coverage. Prior to entering the nursing home, you used 100 days of coverage to pay for home health care services. On the day you enter the nursing home, you would have 630 days of coverage left to pay for nursing home care. This is less than the minimum 730 days of nursing home coverage required for certain MassHealth exemptions.

Therefore, when buying a policy, you should keep in mind that use of non-nursing home benefits may reduce available nursing home benefits below what is required to meet the MassHealth minimum coverage requirements.

If you have a qualifying long-term care insurance policy, are institutionalized, and you notify MassHealth that you do not intend to return home, you may be exempt from the general recovery rules protecting your home.

There are no current state tax incentives for long-term care insurance, federal tax incentives still apply.

Long-Term Care Medicaid spend down is $2500. A spouse’s minimum asset allowance is $24,720.

A variety of products are approved in Massachusetts for Long-Term Care planning.

Massachusetts Long-Term Care Costs

Home Health Aide Average Monthly Rate $5,167
Homemaker Services Average Monthly Rate $4,910
Adult Day Care Average Monthly Rate $1,444
Assisted Living Average Monthly Cost $5,495
Skilled Nursing Home Semi-Private Monthly $12,015
Skilled Nursing Home Private Average Monthly $12,775