MassHealth Home-Based Programs for Children and Elders

by Matthew Karr, Esq. on August 12, 2011

Massachusetts offers several programs, covered by MassHealth, that allow both disabled children and elderly adults who need more help than family members can provide to get certain long-term-care services while living at home. The goal of these programs is to allow elders and other who need intensive care services to maintain the greatest amount of independence possible. Although these special programs are available under MassHealth, each program has its own eligibility rules and application process. Generally, however, the asset limits imposed by MassHealth are enforced.

Kaileigh Mulligan Program (Home Care for Disabled Children)

The Kaileigh Mulligan Program allows certain severely disabled children (under age 18) to live at home with their parents and have MassHealth eligibility determined without counting the income and assets of their parents. The child’s medical needs must be severe enough to require a level of care equal to that provided in a hospital or pediatric nursing facility.

This program covers payments for a wide range of medical and nursing care, and certain medical equipment and supplies for the child. To qualify, the cost to MassHealth cannot be greater than what it would cost for the child to live in a hospital setting or nursing facility.

PACE (Program of All-Inclusive Care for the Elderly)

PACE allows certain frail people (aged 55 and older) who need help with daily personal care, and have a medical condition that needs regular attention, to remain as healthy and independent as possible and to live in their communities instead of in nursing homes. To qualify, the need for a level of care must be equal to that provided in a nursing facility.

Once eligibile for the program, a team of health professionals does an assessment of each elder’s needs, and develops a plan of total care. Services are usually provided in an adult day health center, but may be given in the elder’s home or other facility.

Home- and Community-Based Services Waiver

The Home- and Community-Based Services Waiver allows certain frail people (aged 60 and older) to live at home and still get MassHealth benefits.

This program allows the person needing the at-home services, if married and living with his or her spouse, to have MassHealth eligibility determined without counting the income and assets of the other spouse.
The Home and Community-Based Services Waiver (HCBS) is a program for low-income Massachusetts residents who qualify for nursing facility or other institutional care but want to live at home. The Waiver allows MassHealth members to get needed health care and support services at home rather than in an institution. MassHealth does not cover these home-based services without a waiver.

The program helps frail elders, people with intellectual disabilities, young children with autism spectrum disorders and adults with traumatic brain injuries to live safely in their communities, and to prevent or delay institutionalization.

For frail elders, waiver services may include personal care services, housekeeping and chore services, laundry, home health aide, skilled nursing, companion services, supportive day program, home delivered meals, grocery shopping, transportation, wander response system, respite care, environmental accessibility adaptation, and transitional assistance.

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