MassHealth (Medicaid in Massachusetts) is a joint federal and state program that helps seniors pay for long-term care. However, this is not all that the program does. Often the goal of planning for long-term care is to help keep the senior involved as independent as possible for as long as possible. For many people, this means staying put in their own home. MassHealth has created several programs that can help facilitate this with proper planning, ensuring that Massachusetts seniors do not have to leave their homes just because they require chronic care.
In Massachusetts, MassHealth is the only resource which will pay for ongoing, daily, home care services for the chronically ill. MassHealth also pays for Medicare D prescription drug insurance plans, adult day programs, lifelines, medical equipment and short term respite stays in nursing homes for seniors who qualify.
Personal Care Attendant Program
The Personal Care Attendant Program (PCA) is a MassHealth funded program that pays for home care services for seniors who need daily assistance with at least two activities of daily living (ADLs). ADLs basically consist of dressing, eating, ambulating, toileting and hygiene.
In addition, participant must have MassHealth Standard or ComrnonHealth, have a permanent/chronic disability or medical condition that required personal care and be living in the community. A participant must also have a physician issue a referral for services based on their medical condition. After approval, an assessment of the senior’s particular needs will help determine a care plan. Care plans can increase or decrease, depending on the senior’s need or changing medical conditions. The senior will then be able to self direct (hire, fire, etc.) the care provided by the PCA worker.
Of particular benefit to many Massachusetts families is that the PCA program allows a senior to hire a son, daughter or any family member except their spouse to act as the care provider. In essence, this often results in a family member getting paid for providing necessary services that they would otherwise have to provide for free.
Adult Foster Care
When a senior cannot safely live alone but does not wish to enter a nursing facility, the Adult Foster Care (AFC) program may be appropriate. Like foster care for children, the elder is matched with a “host” family. A nursing assessment determines the level of care needed and social workers support the host and participant.
Like the PCA program, any family member of the senior (except spouse) can serve as the host provider. The senior can move in with the host provider, or a host can move in with the senior. The AFC host/provider must be 18 or older, maintain a private home in good repair and of sufficient size to accommodate both the AFC participant(s) and other residents of the home, pass certain health and background checks and be physically able to supervise and/or provide hands on care to AFC participant(s).
Caregivers receive a stipend of up to $18,000 per year from MassHealth to provide care to seniors who otherwise would need institutional care. Service providers, including a social worker and registered nurse, train the caregiver and provide ongoing support.
There are various rules pertaining to income and assets limits and asset transfers for participants of these programs, just like there are for MassHealth’s long-term care programs. Arranging assets to help a senior qualify can result in maximizing the value of their estate while also protecting their independence and maintaining a high quality of life. If you or a loved one are interested in MassHealth qualification, contact the Heritage Law Center today.