If you or a loved one is considering moving into an assisted living facility in Massachusetts, one of the most important questions is how to pay for it. With the cost of care rising yearly, even those with significant savings can quickly find themselves running out of funds. As an Elder Law Attorney in Boston with Senior Solutions, I often help families understand the options available, including whether Medicaid (MassHealth in Massachusetts) will cover the costs of assisted living, home care, or nursing home care.
The Cost of Assisted Living in Massachusetts
Assisted living facilities in the Boston area can be expensive. Depending on the location and level of care, monthly fees range from $5,000 to $14,000 or more. That means even with substantial savings, your funds could be depleted quickly. For example, if you're paying $8,000 monthly, a $300,000 nest egg would only last about three years. This doesn’t even consider rising care costs or other medical expenses you may face.
Even if you have enough to cover assisted living for a few years, it is important to plan for the possibility of running out of funds, especially if long-term care is required due to conditions like dementia. This is where Medicaid planning becomes essential.
Does Medicaid (MassHealth) Cover Assisted Living?
The short answer: It isn’t easy to find an assisted living facility in Massachusetts that will accept Medicaid (MassHealth) programs that help you pay for it. If you do find one of these facilities, it is even more difficult to find one that will accept you from the very beginning and MassHealth payments when you move in; most will require that you pay privately for some time before considering MassHealth programs as an option.
Here are some key things to consider:
Income and Asset Limits: To qualify for MassHealth, your income must be below a certain threshold. In 2024, this limit is $2,829 gross per month for individuals needing care. (Note: If you have income that is just slightly over this limit, in some cases, you may qualify by meeting a deductible every six months, but this is very complicated.)
Additionally, your countable assets must be under $2,000. However, with careful planning, there are legal strategies we can use to ensure that any excess funds are either spent wisely or preserved for your heirs.
Married Couples: If you are married and your spouse continues to live at home, only the spouse's income needing care is considered for MassHealth eligibility. This provides more flexibility, as the healthy spouse’s income and certain assets may not affect the eligibility process. However, the spouse living at home will still be subject to an asset limit.Â
Limited Facilities Accept Medicaid: Even if you qualify for MassHealth, only a limited number of assisted living facilities in Massachusetts accept Medicaid programs. Typically, these facilities require that you pay privately for some time, often a year or longer, before Medicaid coverage kicks in. Finding an assisted living facility that will accept Medicaid from the beginning is extremely rare.
Contribution of Income: If you qualify for Medicaid, most of your income will need to be contributed toward the cost of your care, with MassHealth covering the difference.
Tips for Planning
If you are considering moving to an assisted living facility but have limited funds, ask the facility about their policies regarding Medicaid. Ask if they offer any programs for residents who run out of private funds or if they accept Medicaid after you have paid privately and run out of money. Â
Whatever assets you disclose to the assisted living facility on their application, the facility is likely to expect you to spend this money on your care before any Medicaid programs are considered. So, consider carefully what you disclose.
Some facilities are more flexible than others, so it's important to know their policies before making a long-term financial commitment.
The Importance of Medicaid (MassHealth) Planning
Planning ahead is essential. Starting with a Medicaid Plan (MassHealth Plan) can help you prepare, giving you the best chance to protect your assets and meet your needs.
At Senior Solutions, we are Elder Law Attorneys specializing in Medicaid planning and helping individuals navigate the complexities of long-term care. If you are concerned about the cost of home care, assisted living, or nursing home care and want to explore your options, we can guide you through the process and create a road map. It is always best to start before care is needed. We will work with you to ensure you have the right plan to protect your future. We are here to help. Please call our office at 617-489-5900 or schedule a brief free consultation (offered to new clients) by clicking: https://seniorsolutions.as.me/FreeConsultÂ
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