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When Is The Right Time To Apply For MassHealth?

Many patients, families and caregivers often ask, "When do you apply for Mass Health?" "How do you know when it is the right time?" The answer to this question is as individualized as is the patient. Before the question can be answered accurately, Mass Health needs to be defined and understood.

Mass Health is administered by the Division of Medical Assistance and funded by both the federal government and the state of Massachusetts. The first requirement of Mass Health is the recipient must be a Massachusetts resident. The program is designed to assist individuals and families to pay for medical costs, who otherwise could not afford health care.

The process by which an individual receives Mass Health is to file an application. The application is the tool used to determine the eligibility status of the individual. The application is overwhelming, complicated and burdensome for most to complete. It is advised that the applicant seek the assistance of a professionally trained person. The Social Worker or Admissions Coordinator should be able to supply the name of who completes their applications.

There are many requirements that need to be met to become eligible to receive Mass Health benefits. The financial and medical needs of the individual are crucial to the application process. As stated previously, residency in Massachusetts must be 65 or over or disabled. They must be a residency of a long-term care facility, rehabilitation hospital or awaiting placement in one of these facilities. There is a clinical evaluation or screening that must be completed to determine the need for skilled nursing care. If the clinical criteria is met, and the above mentioned requirements are met, then the application process can continue.

At this time, assets must be revealed and documentation provided. An individual applying for long-term care benefits may have $2000.00 in combined total assets, to be approved. If they are over the asset limit, monies must be spent on the applicant for long-term placement. If there is a spouse in the community, the spouse is entitled to keep up $82,000 of the couplešs assets. The community spouse is entitled to keep the marital home and motor vehicle. The applicant is allowed to have one accournt, not to exceed $1500.00, reserved for the sale purpose of a burial expense account. A life insurance policy for this same amount may be designated for this same purpose. In addition, the applicant is allowed to purchase a prepaid funeral, which needs to be irrevocable. Documentation of these accounts must accompnay the application. The appication must be complete, thorough, signed and dated to be accepted and reviewed.

Now, to return to the initial question of when to apply. It is suggested that when combined total assets are $15,000.00 or below. This is the time that the facility should be notified and the assistance of a trained professional be contacted. For further questions and/orinformation, the number for Mass Health customer service is 1-800-841-2900.

MassHealth/Medicaid
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