Eligibility Exemption

If a person is seeking MassHealth coverage of nursing-home care, MassHealth may, in some cases, require the applicant's home to be sold in order to be eligible for benefits. But, if you have a qualifying long-term-care insurance policy, MassHealth will not require you to sell your home.

MassHealth does not require all persons without a qualifying long-term-care insurance policy to sell their homes. Regardless of whether you have a qualifying policy, MassHealth will not require you to sell your home in any of the following situations.

  • You notify MassHealth that you intend to return home.
  • Certain relatives are living there.
  • You own the home jointly with someone else and the other owner is living there.

Recovery Exemption

In some cases, MassHealth will take steps to recover some or all of the costs of MassHealth benefits that members use. But, if you have a qualifying long-term care insurance policy, are institutionalized and you notify MassHealth that you do not intend on returning home, you may be exempt from the general recovery rules.

MassHealth generally recovers its costs in two situations.

  • First, if MassHealth places a lien against your home, and you sell it during your lifetime, MassHealth will generally recover from the share of the proceeds the cost of all benefits provided.
  • Second, if you die and leave a probate estate, MassHealth will generally file a claim against your estate for the following costs:
    • all MassHealth benefits provided after age 55; and
    • any services in a nursing facility or other institution regardless of your age, if you remain in the nursing home or other institution permanently.

If you qualify for the recovery exemption, you will not have to repay the costs of your nursing home stay or other long-term care. You will still be required to repay the costs of other MassHealth services such as hospital care, physician visits, and prescriptions.

You should be aware that there are several situations in which MassHealth does not place liens or collect from estates regardless of whether you have long-term care insurance.

  • MassHealth does not place liens on the homes of all persons whose nursing home care is paid by MassHealth. MassHealth does not place a lien if certain relatives are living in the house, and it does not place a lien until it determines that you are unlikely to return home.
  • MassHealth does not collect from the probate estates of all MassHealth members who die. MassHealth will waive recovery if (1) real property must be sold to pay its claim and (2) the property was left to someone who meets certain financial standards and has continually lived there for a year before you started receiving benefits.
  • If certain relatives survive you, your estate may delay paying MassHealth. No payment will be required while your spouse or any blind or permanently and totally disabled child is still living, or while any of your children is under age 21.