Medicaid Long Term Care Eligibility in Massachusetts

Navigating Medicaid nursing home coverage in Massachusetts can be a daunting task. The lengthy application process for MassHealth for seniors over 65 in Massachusetts has many intricate details that often leave seniors and their families or caregivers feeling overwhelmed by the journey ahead. 

That is where our leading comprehensive Medicaid application company, Senior Planning, steps in. We provide expert guidance to help you navigate Medicaid long-term care eligibility and simplify the Medicaid application process, streamlining everything from beginning to end.

MassHealth Coverage Requirements for Seniors

Medicaid long-term care eligibility requires you to be a legal U.S. citizen and a resident of Massachusetts. MassHealth also assesses an individual's financial situation by looking at both their income and assets to determine eligibility for long-term care services.

Asset Limits

Massachusetts Medicaid long-term care programs for seniors have different financial and functional eligibility requirements and may vary according to marital status.

As of 2025, whether you are looking at Institutional/Nursing Home Medicaid or Home and Community-Based Services Waiver, there is an asset limit of $2,000 per person with a $72.80 monthly personal needs allowance (PNA). If only one spouse applies, the non-applicant also has an asset limit of $157,920. This differs from regular Medicaid, which has an asset limit of $2,000 for single seniors and $3,000 for married seniors, whether one or both are applying.

This asset limit in Massachusetts is calculated by adding the value of countable assets together. Countable assets include:

• Bank accounts
• Savings
• Stocks
• Bonds
• Investments
• Real estate

If you are wondering, “can nursing homes take your house in Massachusetts?”, the short answer is no. The asset limit generally does not consider the senior’s primary home or personal belongings, although Medicaid may claim certain assets depending on the circumstances.

MassHealth long-term care also has a 5-year Look-Back Rule, which allows them to recall any transfers made 5 years prior to applying. Any assets gifted or sold under fair market value during this period are assumed to have been transferred to meet the Medicaid asset limit and are considered ineligible.

Income Limits

In addition to the asset limit that Medicaid sets, there are income limits for senior housing in Massachusetts. These vary by program:

• Institutional/Nursing Home Medicaid: There is no hard limit; however, nearly all of the applicant's monthly income must go towards their medical costs.
• Home and Community-Based Services (HCBS): Income limits are set to $2,901 per applicant. This applies only to the applicant; the income of a non-applicant spouse is disregarded.
• Regular Medicaid: The income limit for a single applicant is $1,305, and for married applicants, it is $1,763 per month, whether one or both spouses are applying.

The income limit includes nearly any income, including:

• Employment wages
• Pension
• Social Security income
• Alimony payments
• IRA withdrawals

Please note that these are the income limits as of 2025 but are subject to change.

Over the Income or Asset Limit?

If you are over the income or asset limit, you may still be able to meet the Massachusetts Medicaid nursing home eligibility. Here are several strategies to help you:

• Medically Needy Pathway: This is for someone with a higher income than the set limit. They can use their extra income to cover medical expenses until they meet the income limit. 

• Asset Spend Down: For someone whose assets are valued more than the set limit and needs to protect assets from nursing homes in Massachusetts, a possible solution is to convert them to approved, non-countable expenses. These include medical bills, home modifications, pre-paid funeral costs and Medicaid planners such as Senior Planning Services. Any transfers should be carefully documented to avoid violating Medicaid rules.

 

How to Apply for Massachusetts Long Term Care

Applying for MassHealth can be complex, but Senior Planning simplifies the process. Here is how to get started:

1. Identify the type of Medicaid you want to apply for: The first step is to determine which type of Medicaid coverage you need.

2. Gather the required documents: There are a lot of important documents required to apply. These documents show identification, income, assets, and medical needs. See the checklist below for more information.

3. Complete the application: Fill out the application thoroughly and accurately, either online or on a printed version.

4. Submit the application: Submit your completed application and supporting documents to a MassHealth Enrollment Center. Note that incomplete applications or missing documents can delay or deny your application.

Checklist for MassHealth Senior Long Term Care Application

Ensure you have the following documents to apply for Medicaid:

• Recent financial account statements. This includes all bank statements, investments, IRAs, 401Ks, and/or annuities from 5 years prior to applying
• Social Security Administration letter
• Income verification letters or tax forms
• Proof of health insurance coverage and costs
• Family trust documents
• Medical records

Choosing Nursing Homes Covered by MassHealth

The cost of nursing home care in Massachusetts is high. This makes MassHealth long-term care so important. After being approved for Medicaid nursing homes, seniors can choose one of the many nursing homes across Massachusetts that best suits them and their needs. 

There are many nursing homes in Massachusetts that accept Medicaid nursing home coverage, so after confirming this, here are some considerations when looking at nursing homes: 

• Medical Team: Are the medical staff properly equipped to support your medical conditions?

• Social Activities: Do they provide their residents with social activities and entertainment?

• Quality: Does the facility meet your standards? This includes looking at the staff, cleanliness, and overall environment.

• Location: Is the home located near family or friends?

 

Assisted Living Facilities Coverage in Massachusetts 

MassHealth provides support for seniors over 65 in Massachusetts in assisted living facilities. This is designed for those who do not need the intensive care that nursing homes offer but still require help with daily activities. Medicaid’s nursing home coverage includes:

• 24/7 staff response

• Personal care assistance

• Housekeeping

• Medication management

However, Medicaid does not cover the expenses of room and board.

To meet the eligibility requirements for Home and Community-Based Services (HCBS) or Aged Blind and Disabled Medicaid, applicants must fit the financial and functional criteria. This may vary depending on the program. However, the need for personal assistance with daily living activities is considered while also looking at behavioral and cognitive aspects. 

Get Help Completing Your Long Term Medicaid Application

Navigating Medicaid long-term care eligibility for seniors in Massachusetts can be a complex process. At Senior Planning, we are here to guide you every step of the way to completing your medicaid application. We help you understand the eligibility requirements and complete the detailed application forms to ensure you get long-term care in both nursing homes and assisted living situations.

Whether you're just beginning to explore your options or are feeling weighed down by the intricate details of Medicaid rules, Senior Planning offers expert advice and personalized assistance. 

Contact Senior Planning today for a free consultation. No strings attached. Take the first step toward ensuring your loved ones receive the care they deserve.