Nursing Home Care & MassHealth – Eligibility Rules for the Single Person

As you well know, privately paying a nursing home bill is a very costly undertaking.  Should you need nursing home care someday, typically Medicare and your supplemental insurance cover up to 100 days.  After that, you either privately pay or look to Medicaid (MassHealth) to pay.  This post explains the basic MassHealth rules for a single person needing nursing home care.  See this post for the rules where one member of a couple needs nursing home care.

For a single person to receive MassHealth assistance with paying for nursing home care, generally speaking she can have no more than $2,000 to her name in liquid assets and minimal life insurance.  She can own a home and be accepted into MassHealth, but the agency will require her to sell the home and use the proceeds towards her care.  If the home does not sell during her lifetime, the agency will place a lien on the home and be paid back out of the member’s estate (“estate recovery”).

MassHealth uses a five-year look-back period.  From the date of application, MassHealth looks back five years to see if you have made any gifts (typically anything over $100 must be explained).  MassHealth disqualifies applicants who have made gifts in the last five years.  Read here about what to do if you have over $2000 in assets.