By Carol F. Barton:

Concerns about the state Medicaid (MassHealth) budget are nothing new, and the need for reform has been widely acknowledged.  Consequently, the biggest change to the MassHealth/Medicaid program in over ten years is now on the horizon.

Federal approval was received in November 2016 for the Baker-Polito Medicaid (MassHealth) 1115 waiver, allowing a major restructuring of the MassHealth program to provide care for 1.9 million state residents. The changes are both extensive and complex and will take time to resolve.

The many proposed changes for elders and some individuals over 65 and who rely on benefits from the Medicaid/MassHealth program include:

  • Single individuals aged 65 and older will not be able to place funds into a so-called pooled trust to quality for community care or nursing home benefits. Pooled trusts, also known as “(d)(4)(C) trusts”, are a type of special needs trust that allow disabled individuals to retain access to their funds for expenses not covered by the MassHealth program.
  • Married individuals seeking eligibility for community MassHealth programs (and possibly including couples where one member has already been approved from January, 2014 and on)  will be subject to the $120,900 spousal asset limit
  • Married individuals with income of $2,205 or less, who are just applying for community benefits, will also have their spouse’s income considered and a deductible imposed for income in excess of program limits
  • Applicants for community MassHealth benefits will be subject to the 5-year look back, with transfer penalties imposed for any disqualifying transfer/gift made within five years of applying

The impact of these regulations will be significant.  For example, the ability to transfer one’s funds above the $2,000 asset limit to a pooled trust has historically allowed a person in the community to reduce their assets while retaining the use of those excess assets for their own needs; this could result in earlier nursing home admission for someone who cannot otherwise financially sustain themselves at home.   We are monitoring these changes carefully as well as others that may impact your long-term care estate plan. As specialists in this area, we can help seniors and their families navigate these rules and identify the steps should be taken in planning for eligibility. In the meantime, if you have questions about your long-term care estate plan, please do not hesitate to contact us at 508 751-5010 or at

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