MassHealth/ Medicaid Eligibility
To be eligible for MassHealth, applicants must live in Massachusetts and be a member of a household with low to medium income, which considers family size, living situation, and the type of coverage to be attained. In addition, the individual must fall into an eligible category, determined by age, family situation, work history, immigration status, and health care needs.
Certain health care needs may grant medical eligibility for nursing-facility care and services. To qualify, the applicant must require one skilled service daily or have a medical or mental condition that requires a combination of at least three services, including assistance with activities of daily living or nursing services. At least one of the three required services must be a nursing service.
Skilled services are health care services performed by or under the supervision of a registered nurse or therapist. This may include the administration or application of an IV, feeding tube, oxygen, sterile dressings, catheters, or physical, speech, or occupational therapy. It also covers any professional evaluations or observations that may be necessary under the patient’s care or treatment plan or in an institutional setting.
Assistance with daily activities encompasses all services that are required for the patient to live his daily life. These activities range from bathing, toileting, and eating to dressing, transferring from different locations or positions, and general mobility.
Nursing services are performed at least three times per week and can incorporate any of the above-mentioned skilled services, as well as any assistance associated with positioning while in bed or a chair as part of a treatment plan, measurement of intake or output based on medical necessity, administration of medications, and intervention for certain types of behavior that are considered medically to be disruptive, abusive, or hazardous to one’s one health or to the safety of others.
Like MassHealth, eligibility for Medicaid is based largely on income. To be eligible, an individual cannot have assets that are worth more than $2,999 and cannot have a home worth more than $750,000. For married couples, the family cannot collectively have assets worth more than $101,640 and a home (no limit on value). With proper planning, however, some of these assets can be protected in order to make an individual eligible.