Caution...MassHealth Is Now Carefully Reviewing the Spouse’s Assets after Medicaid approval

If your spouse is in a Massachusetts nursing home and you completed MassHealth planning, especially if an immediate annuity was part of your strategy, this article is very important for you to read. At Senior Solutions, we are seeing a shift in how MassHealth (Massachusetts Medicaid) is handling annual eligibility redeterminations for married couples. For many years, once MassHealth approved nursing home benefits, the annual review focused primarily on the spouse receiving care. The spouse living at home,  often called the “community spouse”, was not routinely required to submit detailed updated asset information each year.

Recently, that appears to be changing.

What We Are Seeing in Massachusetts

In a recent Massachusetts case, during the annual MassHealth redetermination process, the agency requested updated asset information for the spouse living at home, not just income documentation.

In that case, the community spouse’s assets had increased above the allowable limit, which is currently approximately $162,000. MassHealth flagged the case. 

Why This Matters.

If the spouse at home exceeds the permitted asset level during redetermination, MassHealth may require that the excess funds be used to pay for nursing home or medical expenses.  That could mean unexpected payments that might have been avoided with advance review.

What Is the Current MassHealth Asset Limit for the Spouse at Home?

Under current federal guidelines adopted by Massachusetts, the spouse living at home may retain approximately $162,000 in countable assets (this amount is adjusted annually).

If assets exceed that amount, even unintentionally, it can raise eligibility concerns during the annual review, and MassHealth may stop paying for your spouse’s care.

And in our experience, assets often increase gradually over time because:

• Interest accumulates• Accounts grow• Investment markets rise• Income is not fully spent• Funds shift between accounts

Even when planning was structured properly at the time of application, eligibility during redetermination depends on where asset levels stand today.

Why This Is Especially Important If You Purchased an Immediate Annuity

Immediate annuities are frequently used in Massachusetts Medicaid planning for married couples. When properly structured, they can be an effective tool to protect assets while qualifying one spouse for MassHealth nursing home benefits.

However, over time:

• Liquid savings may increase• Unspent income may accumulate• Market gains may push accounts higher

If MassHealth is now reviewing the community spouse’s assets more carefully at annual redetermination, couples who implemented annuity strategies should not assume everything remains fine without a review.

Why We Recommend Being Proactive

Once MassHealth sends a redetermination letter requesting updated documentation:

• Deadlines can be short• Planning options may be more limited• Excess assets may need to be addressed quickly• Nursing home payments could increase temporarily

A proactive review is far easier, and often less expensive, than reacting after a notice is issued.

We Recommend a MassHealth “Checkup” Appointment

If:

✔ Your spouse is currently in a Massachusetts nursing home

✔ You completed MassHealth planning with our office

✔ An immediate annuity was part of your strategy

✔ It has been more than one year since we reviewed your asset levels

We strongly recommend scheduling a review.

MassHealth Planning Is Not “Set It and Forget It”

The Division of Medical Assistance is scrutinizing finances more carefully than ever.  It is no longer the case that once approved for MassHealth, you can forget it.  Our goal is to help you stay ahead of those changes so that both spouses remain protected.

If you would like to schedule a MassHealth Checkup, please contact our office and let us know this is regarding a MassHealth annuity redetermination review.

We are here to protect both the spouse receiving care and the spouse living at home.

Senior Solutions, Attorneys at Law, is an Estate Planning and Elder Law firm serving the Greater Boston, Massachusetts area since 2001. We are ready to help you with Medicaid Planning, Estate Planning, Probate, Guardianship & Conservatorships, Special Needs Trusts, and Fiduciary Services. We are here to help. Please call our office at 617-489-5900 or schedule a brief consultation (offered to new clients) by clicking the button below:

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