FAQs—Massachusetts Programs Enabling Elders To Stay In Their Homes & Avoid Nursing Home Care

ASAP stands for Aging Services Access Point. There is a network of twenty-seven or so ASAPs in Massachusetts. The goal of each ASAP is to provide services that will enable elders to live with dignity and independence in their home and to prevent premature institutionalization. Each ASAP has a different service area.

The three local ASAPs are as follows:

Old Colony Elder Services (located in Brockton, MA) services the following communities: Abington, Avon, Bridgewater, Brockton, Carver, Duxbury, East Bridgewater, Easton, Halifax, Hanson, Kingston, Lakeville, Marshfield, Middleboro, Pembroke, Plymouth, Plympton, Rockland, Stoughton, Wareham, West Bridgewater, and Whitman.

Bristol Elder Services (located in Fall River, MA) services the following communities:  Attleboro, Berkley, Dighton, Fall River, Freetown, Mansfield, North Attleboro, Norton, Raynham, Rehoboth, Seekonk, Somerset, Swansea, Taunton, and Westport.

Hessco Elder Services (located in Sharon, MA) services the following communities: Canton, Dedham, Foxboro, Medfield, Millis, Norfolk, Norwood, Plainville, Sharon, Walpole, Westwood, and Wrentham.

The Home Care Program is for elders with limited income and with low-to-moderate needs in terms of in-home services. The program also includes respite care for caregivers.

Elders are eligible for the Home Care Program if they meet the income criteria detailed below; are not residing in a rest home, nursing facility, convalescent home, or assisted living residence; are not receiving services from an all-inclusive program such as Adult Foster Care (also known as Adult Family Care), Group Adult Foster Care (GAFC), or Program for All-Inclusive Care (PACE); and have been assessed and determined to be in need of in-home services by a local Aging Services Access Point (ASAP) case worker.

The amount of services an elder receives through the Home Care Program depends on his or her needs and the availability of funding. There may be a waiting list for services. Those elders with critical unmet needs such as personal care, meal preparation, food shopping, and transportation to medical appointments receive higher priority.

Services through the Home Care Program are either partially subsidized through the Executive Office of Elder Affairs (EOEA) or fully by MassHealth.

Services through the Home Care Program include assistance with personal care (bathing, dressing, etc.), adult day health services, homemaker services, laundry, transportation, companion services, food shopping and delivery services, laundry, chore services to maintain the home or yard, and other services.

What are the income and asset rules for the Home Care Program?

There is no asset test; however, the income generated by the assets will count toward the income limit.

As of 2014, the maximum gross annual income for the Home Care Program is $24,838 for family size of one and $35,145 for family size of two. The family consists of the elder and his or her spouse, if living together. The fees for Home Care Program in-home services are on a sliding scale, based on the elder’s gross family income. As of 2014, for individuals with incomes of $10,924 to $24,837, the monthly co-payments are $9 to $130. As of 2014, for couples with income of $14,646 to $35,144, the monthly co-payments are $17 to $140.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

The Enhanced Community Options Program (ECOP) is a program within the Home Care Program that provides a higher level of service (at least twice the services of the Home Care Program) to elders who are clinically in need of nursing home care.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

Elders who are clinically in need of nursing home care and meet the asset limits detailed below qualify for the Home and Community Based Frail Elder Waiver (Waiver) Program.

The Waiver program is funded by MassHealth and provides the following services: skilled nursing, home health aide, housekeeping, laundry, transportation, grocery shopping, meal delivery, and the wander response system.

What are the income and asset rules for Waiver Program?

Under the Waiver program, there is no income limit. However, if the elder’s gross monthly income exceeds the threshold of 300% of the federal Supplemental Security Income (SSI) benefit ($2,205 as of 2017), he or she will be eligible for in-home services after meeting a deductible every six months. In other words, if an elder has gross monthly income of $2,205 or less in 2017, he or she gets to keep all of his or her income. In contrast, if the elder’s gross monthly income is over $2,205 in 2017, some of his or her income must be used to pay for in-home services.

An unmarried elder can qualify for the Waiver program if he or she has $2,000 or less of countable assets. There is a long list of noncountable assets. Most notable, the home is noncountable as long as the equity value does not exceed $840,000 (2017). The asset limit for a couple is $3,000. However, an advantage of the Waiver program is that the assets belonging to the healthy spouse will not count toward the asset limit. Under MassHealth regulations, transfers between spouses do not affect eligibility. As a result, a commonly-used strategy for an unhealthy married elder is to transfer assets to his or her healthy spouse and thereby qualify for the Waiver program.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

For the Community Choices (Choices) Program, the elder must not only be clinically in need of nursing home care, but also must be at imminent risk of entering a facility if he or she does not receive these services at home. The Choices program will provide more hours of service to an elder than the Home and Community Based Frail Elder Waiver (Waiver) Program described above.

In order to receive services under the Choices program, an elder must be enrolled in or eligible for the Waiver program.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

Adult Foster Care (also called Adult Family Care) is a program that enables elders who cannot live alone safely to have a live-in caregiver.  The services to the elder also include meal preparation, assistance with personal care and medication, shopping, laundry, housekeeping, transportation to medical appointment and social visits, and maintaining a clean and safe living space.

The live-in caregiver receives a non-taxable stipend of up to $18,000 per year. The amount of the stipend depends on the number of activities of daily living with which the elder requires assistance, i.e., bathing, dressing, eating, etc.

An elder’s spouse, parent and legally responsible relatives are ineligible to be paid as a live-in caregiver.

The Adult Foster Care agency provides periodic visits by social workers and registered nurses to supervise and evaluate and provide support and training to the live-in caregiver. The live-in caregiver is entitled to a maximum of 14 days off per year during which the Adult Foster Care agency provides respite.

What are the eligibility requirements for the Adult Foster Care Program?

The elder must be approved for Adult Foster Care by a physician and the local Aging Services Access Point (ASAP).

The elder must be enrolled in MassHealth (or pay privately). An unmarried elder can qualify for MassHealth if he or she has $2,000 or less of countable assets. There is a long list of noncountable assets. Most notable, the home is noncountable as long as the equity value does not exceed $840,000 (2017). Depending on the amount of the elder’s income, the elder also may have to meet a deductible every six months.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

The Personal Care Attendant (PCA) program is a MassHealth program that enables elders to stay at home by providing funds to hire a personal care attendant to assist with activities of daily living (ADLs) such as bathing, dressing, eating, toileting, exercising, taking medications, and moving about inside the home.

Once an elder is approved for the PCA program, MassHealth will provide funds to him or her with which to hire a personal care attendant. The personal care attendant will be paid to provide services for the number of daytime and nighttime hours per week approved by MassHealth.

What is unique about the PCA program is that the elder is in charge. He or she can hire the personal care attendant he or she wants except that the elder’s parent, spouse and legal guardian cannot be hired as a personal care attendant.

The elder also manages his or her personal care attendant’s training and scheduling. If the elder needs help with the management of his or her personal care attendant, he or she can delegate this role to a family member or other responsible adult.

What are the eligibility requirements for the PCA Program?

To be eligible for the PCA program, an elder must be enrolled in MassHealth and must need assistance with two or more of the following activities of daily living (ADLs): mobility/transfers, bathing/grooming, dressing/undressing, range-of-motion exercises, taking medications, eating, and toileting. An unmarried elder can qualify for MassHealth if he or she has $2,000 or less of countable assets. There is a long list of noncountable assets. Most notable, the home is noncountable as long as the equity value does not exceed $840,000 (2017). Depending on the amount of the elder’s income, the elder also may have to meet a deductible every six months.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

Program for All-Inclusive Care for the Elderly (PACE) is a nationwide model of care designed to help elders stay living in the community (instead of in nursing homes) as long as possible.

A team of health professionals assesses each elder’s needs and develops a plan of total care. Services are in the elder’s home, adult day health center or an assisted living facility.

The PACE program is for elders who are 55 or older (individuals under 65 must meet the Social Security disability definition), live in a PACE service area, are able to live safely in the community (with assistance through PACE), are certified by the state as eligible for nursing home care, and agree to receive health services exclusively through the PACE.

What is the difference between PACE and Elder Service Plan?

Elder Service Plans are part of the PACE program.

What are the income and asset rules for PACE?

If an elder has gross monthly income of $2,205 or less in 2017, there is no monthly spenddown and he or she gets to keep all of their income.  In contrast, if the elder’s gross monthly income in 2017 is over $2,205, there is a monthly spenddown to $542. In other words, if the elder’s income exceeds the threshold of 300% of the federal Supplemental Security Income (SSI)  benefit ($2,205 in 2017), he or she gets to keep only $542.

For PACE, the asset limit for an unmarried elder is $2,000 or less of countable assets. There is a long list of noncountable assets. Most notable, the home is noncountable as long as the equity value does not exceed $840,000 (2017). However, an advantage of the PACE program is that the assets belonging to the healthy spouse will not count toward the asset limit. Under MassHealth regulations, transfers between spouses do not affect eligibility. As a result, a commonly-used strategy for an unhealthy married elder is to transfer assets to his or her healthy spouse and thereby qualify for the PACE program.

What is the private pay rate for PACE?

The 2014 monthly private pay rate for the PACE program is $3,933.

Does PACE help pay for Assisted Living?

Some Elder Service Plans contract with assisted living facilities. For example, Harbor Health Elder Service Plan contracts with the Arbors in Stoughton, MA.  Typically, a large portion of the expense of assisted living care is the home-care component. PACE pays for the home-care component at some of the assisted living facilities with which the Elder Service Plans have contracts.

Can you keep your doctor and specialist when enrolled in PACE?

No, a PACE physician will coordinate your care. With regard to Harbor Health Elder Service Plan, they contract with specialists and specialists who do not contract with PACE are considered on a case-by-case basis.

Where is the closest PACE program?

Harbor Health Elder Service Plan (Brockton location) services the following communities: Abington, Bridgewater, Brockton, East Bridgewater, Easton, Halifax, Hanover, Hanson, Mansfield, Norton, Pembroke, Plympton, Raynham, Rockland, Taunton, West Bridgewater, and Whitman.

Harbor Health Elder Service Plan (Mattapan location) services the following communities:  Avon, Boston, Braintree, Brookline, Canton, Dedham, Foxboro, Holbrook, Milton, Norwood, Newton, Quincy, Randolph, Sharon, Stoughton, and Weymouth.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

There are a number of programs to help seniors afford assisted living. One such program is the Group Adult Foster Care (GAFC) Program.

An elder is eligible for GAFC if he or she has assets under the limit of $2,000, lives in an assisted living facility or other GAFC-approved housing, needs daily assistance with one or more personal care tasks such as bathing or dressing, has a statement from a physician confirming that GAFC is appropriate, and has been assessed and determined by a local Aging Services Access Point (ASAP) case worker to be in need of GAFC services.

GAFC pays a per diem care rate for personal care services; however, it does not pay for housing.

What is SSI-G?

Some elders eligible for GAFC also qualify for Supplemental Security Income in the “group living” category called SSI-G. To obtain SSI-G, the elder must live in a certified assisted living facility, be eligible for or participate in GAFC, and have countable unearned (fixed) income less than $1,175 per month (in 2014) if single. Although an individual or couple must be eligible for GAFC in order to be eligible for SSI-G, SSI-G is not required for GAFC eligibility.

Do all Assisted Living Facilities participate in GAFC?

Not all assisted living facilities participate in GAFC. Even those facilities that participate in GAFC usually limit the GAFC units to a small number and offer those units to residents who have spent down their money privately paying for assisted living care.

One common problem for elders attempting to qualify for the GAFC program is that they have more than $2,000. This means that they are not eligible for SSI-G or GAFC. A solution is to pay the assisted living facility the full amount each month and hope that when they run out of money a GAFC unit will be available.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

There is nothing more important than avoiding nursing home care (not always possible, but if possible). Often the key to avoiding nursing home placement is in-home care. Elder law attorneys are an important resource as they know the ins and outs of the various programs available to assist elders in covering the cost of in-home care.

Elder law attorneys often assist elders in applying for in-home care programs. Notwithstanding asset limits of the various in-home care programs, there typically are methods for attaining eligibility even if the elder exceeds the limit.

Elders also need to be mindful of "estate recovery" as the Division of Medical Assistance is entitled to recover against the probate estate of any individual for whom MassHealth benefits were paid when he or she was age 55 or over. In order to do so, the agency must file a timely claim against the estate. Typically, there is no probate estate when an elder is on MassHealth as the asset limit is $2,000. However, many elders on MassHealth own a home as the home is noncountable as long as the equity value does not exceed $750,000.

There are steps that can be taken to protect the home from an estate recovery claim.  An elder law attorney can assist by providing legal guidance regarding the home and MassHealth estate recovery.

Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.

 

 

 

 

 

 

 

 


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