Getting Help in the Bay State – Waivers in Massachusetts
By Regina Woodard for Assisted Living Directory
Welcome to the Bay State of Massachusetts. Much of the history of the US has happened here – the first colony at Plymouth, the Boston Tea Party, the Salem witch trials, and the Industrial Revolution. The state has a huge amount of history, being of the first US colonies and states, and the folks of Massachusetts enjoy their beautiful state.
As residents, Massachusetts has over 6 million people, with 14.8% of them over the age of 65. The last few years, the state has been overhauling its Medicaid waiver program, getting a five year, $41.4 billion waiver agreement with the federal government. This new agreement addresses some alternate payment systems, as well as helping to improve care for patients through continued health transformations of the health care delivery system.
With the changes happening, let’s look at the current waiver programs in the Bay State.
Frail Elderly Waiver
This waiver is to specifically help resident that are in need of nursing home levels of care to stay in their home. Individuals can receive health care and support services in their homes or community living residences.
To be eligible for this waiver, residents must be at least 60 years or older and require nursing home levels
of care. They must be willing to receive this level of care within their homes and the cost should not exceed to the cost that would be spent if in a nursing facility.
Home and Community Based Services Waivers
As with many other states, Massachusetts offers community based waivers that make long term community services available to individuals who would be at risk of needing a nursing facility. Eligibility is usually based on the determination that the individual is at risk for being placed within a nursing facility and would like to stay within their homes or community living residence.
There are several different waivers that are under this umbrella of services.
Home and Community Based Services Waivers
Money Follows the Person
Money Follows the Person or MFP is a program to help individuals move from a nursing facility or long stay hospital to a qualified residence within the community. There are two types of waivers for this program –
- Residential Supports: this is for individuals who need 24/7 supervision and staffing requirements.
- Community Living: this is for individuals who are able to move into their own residence or the residence of someone else and receive services within the community.
Some of the services that participants include residential habilitation, shared living, day services, occupational therapy, physical therapy, skilled nursing, supported employment, transportation, home health aides, respite, vehicle modification, and more.
To eligible for one of the above waivers, residents must be currently in a nursing facility or a long stay hospital for at least 90 days, be 65 years old or older, meet the requirements for the MFP waiver services.
Acquired Brain Injury
This waiver (Acquired Brain Injury) is for individuals who have suffered an acquired brain injury and are living in either a nursing facility or a rehabilitation hospital and want to move to their own residence or a community living facility.
As with MFP, there are two different options for this waiver –
- Residential Habilitation: this is for individuals who need 24/7 supervision and staffing requirements.
- No Residential Habilitation: this is for individuals who are able to move to their own residences or the residence of someone else.
Some of the services that this waiver offers includes assisted living services, residential habilitation, supported employment, transportation, transitional assistance, occupational therapy, specialized medical equipment, adult companion, and more.
To be eligible for these waivers, individuals must be currently living in a nursing facility or rehabilitation hospital for at least 90 days, have experienced an acquired brain injury at 22 years of age or older as a result of a stroke, brain trauma, infection, or anoxia, and meet the clinical and financial requirements to qualify for MassHealth.
These are just some of the different waivers Massachusetts senior residents can discover and apply for.
Other waivers include the Intensive Supports waiver, the Adult Supports waiver, and the TBI waiver;these waivers have no maximum age limit for eligibility, though the minimum age starts at age 18.
To be eligible for all waivers, individuals need to sign up for Massachusetts Medicaid program, known as MassHealth. Seniors can apply for the program when they reach the age of 65 and must meet the financial requirements for the program, usually having an income that is less than 100% of the federal poverty level and have assets that total no more than $2,000.
A second type of Medicaid program is called MassHealth LTC, which is provided to individuals who will be living in a nursing facility for greater than 6 months’ time and are 65 and older.
To learn more about MassHealth and its waiver programs, please contact their offices at 800.841.2900
Photo by T. Sackton Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)
Resources
Massachusetts gains federal Medicaid Waiver worth $41.4 billion
