What Do You Need to Do to Get MassHealth?

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For Massachusetts residents 65 and older, and those residents who need long-term care, MassHealth coverage can be a literal lifesaver. MassHealth (the Massachusetts version of Medicaid) will pay for necessary medical services, including in-home care and nursing-home residency. These benefits may be worth thousands of dollars per month, so MassHealth has stringent eligibility requirements. Your financial reality and how carefully you complete the application will determine whether you get MassHealth coverage.

First: Become Eligible

For many Massachusetts residents, probably the biggest obstacle to getting MassHealth coverage is becoming eligible. There are different eligibility requirements for different programs, and they’re especially strict for people who are 65+ or who need long-term care services.

Applicants must be residents of Massachusetts and be U.S. citizens or be able to prove eligible immigration status. They must also qualify financially for services. To get MassHealth to provide you with benefits requires you to show that you can’t afford necessary care on your own. Financial requirements vary somewhat depending on what type of benefits you need, whether you have a spouse and whether that spouse lives at home or needs long-term care. In 2020, someone 65 or older who wants to get MassHealth coverage may have no more than $2,000 in countable assets, or $3,000 for a couple.

To keep people from giving away all their assets right before applying, MassHealth looks back at 60 months of an applicant’s financial data. An application may be denied if the person made disqualifying transfers of assets during that 60-month period. It’s advisable to consult an attorney about qualifying for MassHealth before making any financial moves on your own.

Next: Gather Key Documents

The MassHealth application for seniors and people who need long-term care is extensive. Because of the strict financial eligibility requirements, applicants have to provide a lot of specific information. The process is easiest if you collect the documents you’re likely to need in advance.

• Proof of identity and citizenship. Every person applying to get MassHealth must provide a Social Security number, and you’ll also need to provide proof of identity and citizenship/national status with your application. A copy of a U.S. passport satisfies both requirements; as an alternative you may provide a copy of your birth certificate and a copy of a government-issued ID card. Non-citizens should provide copies of both sides of their immigration cards.
•   Recent tax returns. You’ll need information from your most recent tax return to complete parts of the application. If you’re applying for long-term care, and either you or your spouse has submitted income tax returns in the last two years, you’ll be asked to send copies of those returns with the application.
•   Health insurance paperwork. You’ll need documents that show policy numbers for any policies that currently cover the MassHealth applicant(s), plus copies of health insurance premium bills.
•   Proof of any current income. This could be copies of pay stubs, or any other documentation that verifies the income you receive. If you earn income from rental properties, you’ll need to supply proof of that income and proof of expenses related to that income.
•   Proof of current assets. This is the part of the application that requires lots of documentation. To get MassHealth you’ll need to send proof of all major assets, including copies of bank account statements, life insurance policies, vehicle registrations, pre-paid burial plans, investment accounts and trusts.

Then: Complete the Application

Now that you’ve compiled your essential documents, it’s time to tackle the application. It’s extensive and includes several supplemental forms pertaining to different circumstances, so some people will only have to complete a fraction of the pages. Someone who is unable to complete their own application, or who wants help with the process, can choose an Authorized Representative Designation to help fill out their forms. This can be a friend or family member or a professional third party.

MassHealth applications for seniors and people who need long-term care can be submitted in one of several ways. The application can be printed, completed and submitted by mail or fax. Applicants also have the option to submit an application in person at one of five MassHealth enrollment centers.

Finally: Wait For Feedback

The reason it’s so important to complete your application completely and correctly the first time is that any error can add weeks or months to your response time. If anything is left out, you’ll receive a notification from MassHealth asking for additional information. Then you’ll have to wait for them to receive your response before the application is reviewed and a decision is made.

There’s an appeal process if your application is denied, but you may be in dire need of MassHealth benefits by the time the process is complete. Avoiding delays is one of the reasons that many people want expert help with the application process. Can you afford to wait several months before your MassHealth coverage kicks in? Considering that you can’t predict how your health will change over those months, probably not.

The attorneys at Ladimer Law have extensive experience helping clients get MassHealth coverage. We understand the complexities of this process, so we can help our clients avoid the pitfalls that lead to application denials. Contact Ladimer Law today for help with MassHealth.