In some cases, MassHealth can pay you back for medical bills that you paid before you got approved for MassHealth. We may do this if your eligibility was denied and later found to be incorrect. In this case, your health-care provider must pay you back for a MassHealth-covered service and bill MassHealth for the service.
Can MassHealth recover money paid for my medical care?
In some circumstances, MassHealth is entitled to recover the amount of benefits paid for a recipient’s medical care. This right applies only to the extent that MassHealth has provided medical services after the recipient reached the age of 55 or for services provided in a nursing home, hospital or other medical institution at any age.
How much can I Keep On my MassHealth benefits?
Every MassHealth recipient can keep $72.80 per month for personal needs. There are additional deductions such as for payment of health insurance premiums and payments to support a spouse or dependent child.
Can MassHealth take money from a family?
For example, MassHealth cannot take money from a family as long as there is a surviving spouse, a child under 21 or a child who is disabled. Often, the only asset a MassHealth patient has is their home. In some cases, the state would put a lien on that property and recoup money once it is sold.
Do I have to sell my house to get MassHealth benefits?
The State will never force you to sell your primary residence as a condition for obtaining MassHealth benefits. There are two big caveats, however, that may result in a sale of the home. a) If your house has a value of more than $823,000 (after mortgages) then the house is a countable asset.
Can MassHealth take inheritance?
In general, MassHealth can only pursue payment from the assets of the deceased member's estate. In general, MassHealth will not pursue any unsatisfied claim amount from your family or loved ones if the assets in your estate were not enough to repay the MassHealth claim in full.
How do I avoid MassHealth estate recovery?
MassHealth will not pursue any estate recovery if the value of the member's estate is $25,000 or less. In other cases, MassHealth may decide that recovering assets would be unduly hard on the member's family or on the person who inherited the estate (the “heir”). In these cases, MassHealth may grant a hardship waiver.
Can MassHealth take my home?
The short answer is yes - although there are exceptions. This is not a new policy, and some of it is enshrined in federal law. Under U.S. law, states are required to try to recover the costs of nursing home care as well as some other hospital, home and community-based services for individuals over 55.
How much money can you have in the bank and still get MassHealth?
$2,000For MassHealth Standard you can only have up to $2,000 in savings, although there are certain types of assets that are not counted towards this limit.
Is MassHealth considered private insurance?
MassHealth members can have both MassHealth and private health insurance at the same time. If you have both types of insurance, the private health insurance is considered a liable third party or “TPL”. This means the private health insurance is billed as the primary insurer and MassHealth is the secondary coverage.
What is a MassHealth Lien?
In Massachusetts, TEFRA liens are referred to as “living liens” because they cannot be placed on the property of a MassHealth member once he or she has died. They give the State authority to recover Medicaid payments for a member's long-term care expenses if his or her property is sold while the member is alive.
Can you cancel MassHealth at any time?
You usually have 30 days to make good on unpaid premiums before policies can be cancelled. You should contact your insurance company to find out if there are ways to make arrangements to pay the overdue premium over a period of time.
What income is MassHealth?
Countable income includes: Wages, salary, tips, commissions (before deductions) Self-employment income (minus expenses) Social Security benefits.
Who qualifies for MassHealth?
To be eligible for this benefit program, you must be a resident of Massachusetts and meet all of the following: 18 years of age and under, and. A U.S. Citizen, National, or a Non-Citizen legally admitted into the U.S, and. Ineligible for Medicaid.
Do I have to pay for MassHealth?
MassHealth Premiums If you need to pay a premium, MassHealth will tell you the amount and send you a bill every month. Premiums are based on family size, monthly income, and whether you have other health insurance. Your premium will not be more than 3% of your monthly household income.
Is MassHealth free?
Quick Info. Medicaid provides free or low-cost health coverage to eligible needy persons.
Can I get MassHealth if I quit my job?
Losing job-based coverage, even if you quit or get fired, qualifies you for a Special Enrollment Period any time to enroll in coverage for the rest of the year. Your coverage can start the first day of the month after you lose your insurance.
How much does MassHealth cost?
MassHealth copays for pharmacy services covered under MassHealth are subject to member and service exclusions. The copays are as follows: 1 $1 for each prescription and refill for each generic drug and over-the-counter drug covered by MassHealth in the following drug classes: antihyperglycemics, antihypertensives, and antihyperlipidemics; and 2 $3.65 for each prescription and refill for all other generic and over-the-counter drugs, and all brand-name drugs covered by MassHealth.
When will MassHealth start paying copays?
Members will be subject to the new copay policy starting July 1, 2021.
What is a copay in MassHealth?
A copay is the dollar amount charged by a provider to a member for the use of a covered service or item. Drugs dispensed by a pharmacy are the only MassHealth covered service that may have copays. There are no copays for other MassHealth covered services.
What is the monthly copay cap for July?
For example, if a member’s monthly copay cap is $12.50 in July, the member is not charged more than $10 of copays in July. If the member’s household income or family size changes in August, their monthly copay cap may change for August. This copay policy does not apply to Children’s Medical Security Plan (CMSP) members.
What is MassHealth EAEDC?
Members who are eligible for MassHealth because they are receiving certain public assistance benefits such as Supplemental Security Income (SSI), Transitional Aid to Families with Dependent Children (TAFDC), or services through the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program.
How old do you have to be to be eligible for MassHealth?
Members receiving hospice services. Members who were a foster care child and are eligible for MassHealth Standard, until age 21 or 26.
Does MassHealth have copay rules?
If a member is enrolled in a health plan through MassHealth, the copay rules depend on the type of plan. MassHealth Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) use MassHealth’s copay rules. Copays are not applied for enrollees in One Care, Program of All-Inclusive Care for the Elderly (PACE), ...
Why is MassHealth a payer of last resort?
The point of the policy is to ensure that MassHealth remains a payer of last resort, used only by individuals who do not have money to buy their own health insurance. Recovering money from an estate helps ensure that people do not try to hide their assets or leave them to family members while benefiting from taxpayer-funded health insurance ...
Does MassHealth take money from a person?
What this means is MassHealth will take money from a person's assets after they die. If there are no assets, MassHealth will not get any money. The children, or inheritors, will not face any debt. There are some exceptions. For example, MassHealth cannot take money from a family as long as there is a surviving spouse, ...
Can you recover Medicaid from an estate in Massachusetts?
Under state law, MassHealth can recover money from the estate of any individual who is permanently institutionalized, such as in a nursing home, regardless of age.
Does MassHealth have a lien on your home?
Often, the only asset a MassHealth patient has is their home. In some cases, the state would put a lien on that property and recoup money once it is sold. They will not do so in certain circumstances - such as if the person's adult child who stands to inherit the property is living there and is low-income. The point of the policy is ...
How long does it take for MassHealth to mail a return form?
In this instance, if the recipient indicates on the MassHealth application that he or she intends to return home, MassHealth will mail a form to the recipient’s physician asking if there is a reasonable expectation that the recipient will return home within the following 6 months.
How long does MassHealth review a patient?
However, MassHealth will review the recipient’s status after 6 months and, if the recipient is still institutionalized, ask his or her physician to complete another form assessing whether there is a reasonable expectation that the recipient will return home at that time. If the physician’s assessment is that the recipient is not expected ...
How to avoid estate recovery MassHealth?
In order to avoid estate recovery, the recipient must have (1) been institutionalized; (2) notified MassHealth that he or she has no intent of returning home; and (3) had certain benefits available to pay for nursing home care at the time the policy was purchased.
How long does a lien on a property last in MassHealth?
The property will then be counted as an asset for purposes of MassHealth eligibility. However, its value is disregarded for up to 9 months, provided that the recipient signs an agreement to sell the property for fair market value. Presence of the lien will insure reimbursement for the medical services provided if the property is sold ...
When does MassHealth release a lien?
Masshealth must release the lien after they have received notification of the member’s death and a copy of the death certificate. When a MassHealth recipient dies, MassHealth’s right of recovery is limited to the recipient’s probate estate. A probate estate includes property that a person possesses at the time of death in his or her name alone.
Does MassHealth have a lien against a living person?
This right applies only to the extent that MassHealth has provided medical services after the recipient reached the age of 55 or for services provided in a nursing home, hospital or other medical institution at any age. MassHealth may secure a lien against a living MassHealth recipient’s principal residence and any other real estate located in ...
Can you recover a lifetime lien in Massachusetts?
Under current Massachusetts regulations, property in joint names, in trust or in a life estate generally passes outside the probate estate and would be exempt from MassHealth’s right to recover. The probate estate may include real property on which a lifetime lien was filed. However, the lifetime lien is no longer valid after ...
How much can a spouse have in MassHealth?
While the MassHealth asset limit for an applicant is $2,000, currently the spouse of an applicant cannot have assets in excess of $123,600. There are allowable options to spend-down assets to reach these limits, but this should be discussed with an elder law attorney to avoid a possible denial of benefits.
What is MassHealth for seniors?
MassHealth has several programs designed to help ill or disabled seniors remain in their homes and “age in place.” The Mass Home Care Program, the Frail Elder Waiver, the Choices program are just a few. All of these programs have income limits, however, some of which are very strict. The official position of the State is that seniors should be able to remain at home with care, so long as they can do so safely. The Department of Veterans Affairs also has a program for home care which is available to Veterans and their surviving spouses.
How much is a countable asset in MassHealth?
a) If your house has a value of more than $823,000 (after mortgages) then the house is a countable asset. Since a MassHealth applicant is only allowed to have $2,000 in countable assets, owning a property with more than $823,000 in equity makes the applicant ineligible for benefits.
How much equity do you need to reduce to be eligible for MassHealth?
In order to become eligible, the applicant must reduce the equity in the home to below $823,000. You may reduce the equity by taking out a loan or reverse mortgage and spending that money on your care. However MassHealth will put a lien on your home in order to recover the money they have paid for your care.
Can you keep your home in MassHealth?
This is a very common misconception and we hear it all the time even from nursing home administrators. Although it seems odd that a person without a spouse or dependent children can keep their home and still qualify for MassHealth, that is the rule. As discussed in #3 above, there is a lien on the house and the recipient is not usually permitted to pay the expenses of keeping the home.
Is MassHealth free?
MassHealth is free. MassHealth is rarely free to recipients. MassHealth recipients in a nursing home pay a potion of their regular monthly income to the nursing home. This is called the Patient Paid Amount (PPA). Every MassHealth recipient can keep $72.80 per month for personal needs.
Does MassHealth pay for assisted living?
MassHealth does not generally pay for assisted living. There are a few programs which pay for group living at a level of care lower than that of a nursing home. Unfortunately, all of these programs have strict income limits which make them unavailable to many seniors. However individual facilities may have their own affordable housing programs or programs through the city/town which may be more generous than the MassHealth programs.
How long does MassHealth look at bank statements?
MassHealth will look at every one of your bank statements, going back five years from the date of your application. (MassHealth isn’t allowed to look at bank statements that date back more than five years.) All your transactions will be studied to make sure you didn’t give away significant amounts or transfer money to other accounts.
What happens if you give away too much money to MassHealth?
If you have too much money, or had too much money but gave it away, MassHealth will deny your application. That might sound unfair or cruel – after all, it was your money to spend!
Is long term care expensive in Massachusetts?
Keep in mind that long-term care is extremely expensive, and MassHealth wants to make sure that only people who can’t shoulder the burden themselves receive coverage. These policies are in part intend-ed to keep applicants from giving away their assets right before they need coverage in order to force Massachusetts to pay the bill.
Does MassHealth have a look back period?
That’s the length of the look-back period that MassHealth uses when considering a resident’s eligibility for nursing home care. Let’s say your health is worsening and your doctor says that you’ll soon need long-term care in a nursing home.
How long does Medicaid look back?
Often, families try to sidestep a lien by selling or transferring the property. "But Medicaid actually has a look-back period of five years in which they can analyze all income and assets disposed of by the individual before applying for Medicaid," cautions Orestis.
How does Medicaid recover funds?
One way Medicaid can attempt to recover funds is to put a lien on property you own or are due to inherit. "Once a Medicaid recipient goes into a nursing home but still owns a home, Medicaid will typically put a lien on the house at that point.
Can you take cash from Medicaid?
Technically, Medicaid can’t take away any cash or assets you inherit. "But because of Medicaid's disqualification rules, you may lose your Medicaid benefits," says Neel Shah, an estate planning attorney and financial advisor/owner at Beacon Wealth Solutions. Additionally, "you can be billed for service values and costs between ...
Can you lose Medicaid if you inherit money?
You could lose Medicaid coverage if you're on Medicaid and inherit money or property. Craig said Medicaid has asset and income qualifications. An inheritance could lead to you exceeding those limits. "This is important to understand for people who want to leave assets to their parents, for example, or for those who want to leave assets ...
