Financial Eligibility Requirements

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What are the asset limits?

What assets are counted?

What are the income limits?

What income is counted?

What is my family size?

Are there special rules for seniors and people needing long-term care?

Are there special rules for noncitizens?

What changes can affect my eligibility?

What are the asset limits?

Your assets are the cash and savings you have and certain things you own that have value.

• For most applicants under age 65, there are no asset limits.

• For most people age 65 years or over, and people who are institutionalized or who would be institutionalized without community-based services, there is an asset limit.

For people with an asset limit:

• countable assets cannot be greater than $2000 for an individual and $3000 for a couple for MassHealth Standard, Essential, or Limited

• countable assets cannot be greater than $4000 for an individual and $6000 for a couple for MassHealth Buy-In

What assets are counted?

For many people, there is no asset limit. For people with an asset limit, some assets are counted, and some are not. MassHealth will give you a complete list of countable and noncountable assets.

• Assets that are not counted include:
   
  
  • one car per household, if certain conditions are met
  • your house
  • assets of anyone receiving SSI
  • funeral or burial arrangements
  • certain other noncountable assets
     

• Assets that are counted include:

  • other vehicles
  • other real estate
  • cash, bank accounts, securities
  • pensions, annuities, retirement accounts
    • most retirement accounts are counted fully, minus the penalty for early withdrawal, as long as the money is accessible
    • pension funds set aside by a current employer are not counted
    • pension funds from a previous employer, if accessible, are counted fully, minus the penalty for early withdrawal
  • cash surrender value of life insurance policies
  • certain other countable assets
     

There are special asset rules for people who are institutionalized or would be institutionalized without community-based care.

What are the income limits?

MassHealth is for Massachusetts residents with low to medium income. The income limits depend on your family size, your category of eligibility, and the type of MassHealth coverage you will get.

Your family's combined gross monthly income (before taxes and other deductions) is compared to the Federal Poverty Guidelines (FPG). Different MassHealth categories use different percentages of the FPG. Your family's monthly income must be no greater than the amount shown in the table for your category and family size.

'+' = amount to add for each additional family member

For other categories, see Coverage Types for the percentage of the FPG that applies. There are special income rules for people needing long-term care. For annual amounts, see 2009 MassHealth Income Standards on the MassLegalServices web site.

What income is counted?

The following income is counted:

• Wages, salary, tips, commissions (before deductions)
• Self-employment income (minus expenses)
• Social Security benefits
• Railroad Retirement benefits
• Pensions and annuities
• Federal veterans' benefits (minus allowed exclusions)
• Interest and dividends
• Rental income (minus expenses)

The following income is not counted:

• Income received by a TAFDC, EAEDC, or SSI recipient
• Income in-kind (non-cash payments)
• Sheltered workshop earnings
• The part of veterans' benefits identified as aid and attendance benefits, unreimbursed medical expenses, housebound benefits, or enhanced benefits
• Any other income that is excluded by federal laws other than the Social Security Act

In addition, for people age 65 or older, or for people of any age who would be institutionalized without community-based services, the following income is also not counted:

• $20 per month income disregard
• $65 per month of earned income
• one-half of any remaining earned income

People of any age who are institutionalized get a standard deduction of $11 and may also deduct certain work-related expenses.

What is my family size?

When counting family size, MassHealth includes members of your immediate family who live together, including children under 19, any of their children, and their parents. Children who are away at school are included in the family group. If you are pregnant, your fetus is counted in your family size.

If children are being cared for by a relative instead of their parents, the caretaker relative can decide to be part of the family or not.

If you are married with no children, your family includes you and your spouse if living together. If you are a single adult without children, your family includes just you.

Are there special rules for seniors and people needing long-term care?

Seniors age 65 or older and individuals needing long-term care who would qualify for MassHealth Standard except that their income or assets are too high, can become eligible by meeting a deductible and/or spending down their assets. Seniors who are in need of personal care attendant (PCA) services can take a special PCA deduction from unearned income.

Meeting a deductible:

Seniors age 65 or older who are eligible for MassHealth Standard except that their incomes are too high, can qualify by meeting a deductible. You must show proof that your medical expenses in a six-month period are greater than your deductible amount. Your deductible is a dollar amount based on your income, your family size, and the MassHealth Deductible Income Standard. The higher your income, the higher your deductible.

You must meet a deductible every six months. Once you meet the deductible, MassHealth provides coverage for any new covered medical expenses for the rest of the six-month period. MassHealth does not pay for the medical expenses you used to meet the deductible. You must pay these yourself.

To calculate your 6-month deductible:

• take your monthly gross family income
• subtract the Deductible Income Standard for your family size
• multiply the excess income times 6 (for six months)

In 2009, the monthly Deductible Income Standard is $542 for an individual, $670 for a couple, and $72.80 for residents of long-term care facilities.

There are many special rules about meeting a deductible. For more information, call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648).

Spending down your assets:

Individuals needing long-term care who do not qualify for MassHealth Standard because their assets are too high, can qualify by spending down their assets. To become eligible, you must follow MassHealth rules regarding transfer of assets:

• You must report all asset transfers for the five years before you enter a long-term care facility. This is referred to as the "look-back" period. For trust transfers, the look-back period is also five years.

• Any asset transfers during the look-back period that do not follow MassHealth rules can result in a period of ineligibility for MassHealth. The length of time that you will be ineligible depends on the value of the assets you transferred and the date of the transfer.

• You may spend down your assets within the look-back period without penalty, if you spend your money on noncountable assets or nursing home expenses. For example, you can spend your assets to fix up your home, pay down your mortgage, repair your car, or prepay your funeral expenses. You must receive fair market value for your money.

• Giving away your assets or selling them for less than fair market value during the look-back period will result in a period of ineligibility.

The asset rules for people needing long-term care are very complicated. If you have excess assets, you should get advice from Legal Services or another qualified legal advisor to make sure you spend down your assets without penalty.

Taking the personal care attendant (PCA) deduction:

Seniors age 65 or older who qualify for personal care attendant services through MassHealth can take a special PCA deduction from unearned income. For 2009, the PCA deduction equals $659 for one person, or $945 for a couple. The PCA deduction is calculated by subtracting the Deductible Income Standard from 133% of the Federal Poverty Guidelines.

The PCA deduction reduces countable income and allows some over-income seniors to qualify for MassHealth Standard. Note: Seniors taking the PCA deduction cannot take the standard $20 income disregard.

Are there special rules for noncitizens?

There are no special financial eligibility rules for noncitizens.

Sponsor deeming is not used by MassHealth. If you are a sponsored noncitizen, you do not have to count your sponsor's income or assets.

What changes can affect my eligibility?

Once you are enrolled in MassHealth, you need to report any changes that may affect your eligibility. Some examples are changes in income, assets (if you have an asset limit), disability status, health insurance, immigration status, family size, and address.